# Randomised trials of how to spread proven cancer treatments, not just what works

Source: https://onco.cc/ideas/idea-data-implementation-trials-programme/  
OnCo record `idea-data-implementation-trials-programme` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Fund proper trials of the methods used to get new evidence into practice (training, reminders, feedback, incentives), measured by whether patients actually receive the better treatment.

## Summary

Implementation science in oncology is small and mostly observational. The proposal is a dedicated programme of cluster-randomised implementation trials, each testing strategies (audit and feedback, EHR defaults, champions, payment nudges) to accelerate uptake of a specific practice change, with structured-data outcomes and a common design so results generalise. NCI's Implementation Science programme is a base; the scale and randomisation are new.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A portfolio of implementation trials will identify strategies that halve the time to majority uptake for specific practice changes, and those strategies will transfer across at least some other practice changes.
- Rationale: Cardiology's Get With The Guidelines and similar programmes showed that structured implementation measurably improves guideline adherence; oncology lacks equivalent evidence about what works.
- Proposed test: Fund five cluster-randomised implementation trials on current practice changes; report effect sizes and cost per additional patient receiving guideline-concordant care.
- Maturity: early-clinical
- Actor: research

## Sources

- Bottleneck evidence (Knowledge reaches practice too slowly): Morris, Wooding & Grant, The answer is 17 years, what is the question (JRSM 2011): https://doi.org/10.1258/jrsm.2011.110180

## Connected records

- fronts: [AI & Computation](https://onco.cc/fronts/ai-computation/)
- institutions: [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/)
- bottlenecks: [Funding follows fashion, not burden](https://onco.cc/bottlenecks/b-funding-allocation/), [Knowledge reaches practice too slowly](https://onco.cc/bottlenecks/b-knowledge-diffusion/)
- key papers: [The answer is 17 years, what is the question: understanding time lags in translational research](https://onco.cc/key-papers/paper-morris-j-r-soc-med/)

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