{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T11:51:03Z","timestamp":1775649063387,"version":"3.50.1"},"reference-count":29,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Yorkshire Cancer Research","award":["H423"],"award-info":[{"award-number":["H423"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,27]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Needs Assessment Tool-Cancer (NAT-C) is a consultation guide to identify, triage and reduce unmet patient needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      We aimed to assess NAT-C fidelity, mechanisms of action and implementation issues in UK primary care as part of a clinical and cost-effectiveness cluster randomised controlled trial of the NAT-C for people with cancer compared with usual care (registration:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"15497400\">ISRCTN15497400<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Design: a mixed-methods process evaluation informed by normalisation process theory (NPT). Setting: 21 participating general practices in England were randomised to be trained to conduct an NAT-C guided consultation with people with cancer (excluding those in remission). General practitioner fidelity of intervention and clinical action resulting from the NAT-C consultation was noted. Two Normalisation MeAsure Development Questionnaire surveys were distributed to trained clinicians before (Survey 1) and after delivery of \u22652 NAT-C consultations (Survey 2). Semi-structured interviews were conducted with clinicians (post delivery \u22652 NAT-C consultations) and key stakeholders in primary and cancer care. Fidelity, action and paired before\/after survey data were analysed using descriptive statistics. Interview data were analysed using a deductive thematic framework approach (NPT-informed). Data were narratively synthesised with cross-tabulated key findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 360\/376 (96%) NAT-C consultations delivered, 258\/360 (72%) resulted in clinical action, including 50 (13%) external referrals. 14 paired before (Survey 1, n=53) and after (Survey 2, n=29) responses. Survey 1 showed positive responses across all NPT domains, but while continuing to see relevance, usefulness and legitimacy, Survey 2 highlighted concerns about insufficient resources and management support. 16 clinician participants (eight GPs, eight key stakeholders; 50% male) completed interviews. Following synthesis, we identified five themes: (1) the perceived value of the NAT-C; (2) \u2018champions\u2019 are important at all levels (practice, regionally and nationally); (3) research evidence is seen as important, but influences implementation indirectly through policy, clinical guidelines and resourced initiatives; (4) adequate resources are fundamental for implementation beyond practice level and (5) NAT-C practicalities; training is adequate, but robust functional information technology systems are needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Implementation requires champions and clinicians \u2018buy-in\u2019 to the patient value to legitimise use. In the context of current primary care pressures, resources were seen as essential to embed the NAT-C, but financial incentives were viewed with mixed feelings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN15497400\">ISRCTN15497400<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-113686","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:55:24Z","timestamp":1775645724000},"page":"e113686","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Mixed methods process theory evaluation to explore the implementation issues of the Needs Assessment Tool-Cancer (NAT-C) in primary care for people with cancer"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"isrctn15497400","registry":"10.18810\/isrctn"},{"clinical-trial-number":"isrctn15497400","registry":"10.18810\/isrctn"},{"clinical-trial-number":"isrctn15497400","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7723-5244","authenticated-orcid":false,"given":"Flavia","family":"Swan","sequence":"first","affiliation":[{"name":"Wolfson Palliative Care Research Centre, University of Hull, Hull, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1410-0996","authenticated-orcid":false,"given":"Joseph","family":"Clark","sequence":"additional","affiliation":[{"name":"Wolfson Palliative Care Research Centre, University of Hull, Hull, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Blenkinsopp","sequence":"additional","affiliation":[{"name":"Oslo New University College, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda J","family":"Farrin","sequence":"additional","affiliation":[{"name":"Edinburgh Clinical Trials Unit, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8839-6756","authenticated-orcid":false,"given":"Alexandra","family":"Wright-Hughes","sequence":"additional","affiliation":[{"name":"Clinical Trials Research Unit, University of Leeds, Leeds, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"McNaught","sequence":"additional","affiliation":[{"name":"Clinical Trials Research Unit, University of Leeds, Leeds, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terry","family":"McCormack","sequence":"additional","affiliation":[{"name":"Hull York Medical School, University of Hull, Hull, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6204-9158","authenticated-orcid":false,"given":"Miriam J","family":"Johnson","sequence":"additional","affiliation":[{"name":"Hull York Medical School, University of Hull, Hull, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"2026040803551502000_16.4.e113686.1","article-title":"Prevalence and factors associated with unmet needs in post-treatment cancer survivors: A systematic review","volume":"28","author":"Miro\u0161evi\u010d","year":"2019","journal-title":"Eur J Cancer Care 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