‘WICKED’ (Wales Interventions and Cancer Knowledge about Early Diagnosis): The development and evaluation of primary care interventions to expedite the diagnosis of symptomatic cancer in Wales. 

Chief Investigators
  • Ruth Lewis (NWCPCR, Bangor University)
  • Julia Hiscock (NWCPCR, Bangor University)
  • Maggie Hendry (NWCPCR, Bangor University)
  • Nefyn Williams (NWCPCR, Bangor University)
  • Paul Brocklehurst (NWORTH, Bangor University)
  • Zoe Hoare (NWORTH, Bangor University)
  • Rhiannon Tudor Edwards (CHEME, Bangor University)
  • Joanne Rycroft Malone (SHS, Bangor University)
  • Kate Brain (Cardiff University)
  • Andy Carson Stevens (Cardiff University)
  • Sunil Dolwani (Cardiff University)
  • Willie Hamilton (University of Exeter)
  • Fiona Walter (University of Cambridge)
  • Greg Rubin (Durham University)
  • Georgios Lyratzopoulos (University College London)
Research team
Type of study 
  • Systematic review of reviews and realist review Survey, DCE, interviews with GPs and practice-based focus groups.
  • Development of intervention, external pilot trial with pilot cost effectiveness analysis & Phase III planning. 

Wales, like other UK countries, has relatively poor cancer outcomes and late diagnosis is a major contributor. This research programme concentrates on the primary care interval: the time between presentation of symptoms by patients and referral.

Referral is informed by NICE guidance, but GPs in Wales are less likely to refer or investigate, and cancer guideline adherence is lower. There is an evidence gap relating to effective ways of reducing primary care intervals.

WICKED aims to synthesise current evidence, gather new empirical evidence, and use this to develop and evaluate a complex intervention to change primary health care professionals' knowledge, attitudes and clinical behaviour, with the intention of reducing primary care intervals and improving cancer outcomes.

Please describe how the public / patients were involved in the development of the study design, and how they will be involved in the funded study?

Two members of the public were engaged in the study as collaborators during the design stage.  They were recruited through the North Wales Cancer Forum and the NCRI Consumer Forum.  Both have directly relevant experience, and were able to draw on this to comment on drafts of the proposal and make a valuable contribution to the study design.  Unfortunately, due to ill-health, one of them has been unable to make any further contribution, but the other is a very active member of the study management group.  Her ongoing input is invaluable and she is a respected member of the team. 

How could this research potentially benefit patients?

The main outcome of the research will be a complex intervention to promote prompt referral and/or diagnosis of patients presenting in primary care with suspected cancer symptoms.  Earlier diagnosis may lead to faster and potentially less invasive treatment, better survival, and improved quality of life.

Who is the study sponsor?

Bangor University

UKCRN portfolio number

To follow


Cancer Research Wales Programme Grant

Total grant value


Start date


End date


Further information
Outputs generated

Published papers


  1. Cancer: Doctors urged by charity to identify symptoms sooner
  2. GPs to be trained by charities to ‘think cancer’