FACILITATING LIFESTYLE CHANGE
BARRIERS ‘I haven’t had enough training in how to raise the issue of cancer prevention ‘How can I talk to someone about and lifestyle risk.’ weight management/healthy eating or smoking when I’m overweight or smoke?’ ‘We have far too much to do in an appointment, I couldn’t possibly open it up to a discussion on living a healthy lifestyle as this would take far too much time.’ ‘It’s not my job to talk about these things – my job is to cure people.’
MAKING EVERY CONTACT COUNT (MECC) NHS England Health Education Online MECC course http://www.makingeverycontactco unt.co.uk/training/e- learning/health-education- england-e-learning/
CRUK RCGP - BEHAVIOUR CHANGE AND CANCER PREVENTION (Free to access for all health professionals e-learning module)
BEHAVIOUR CHANGE AND CANCER PREVENTION How does VBA differ from MECC? Making every contact count is an approach which embraces a number of ways health workers can promote health and wellbeing as part of their roles. As such VBA can be seen as a distinct but very important evidence based example of making every contact count. • On-line CRUK RCGP Behaviour Change and Cancer Prevention for health professionals - free training module available through RCGP link (registration is required) http://elearning.rcgp.org.uk/course/info.php?id=211
TALKING ABOUT CANCER ONLINE COURSE: Reducing Risk, Early Detection & Myth-Busting • Summarise simple, reliable facts about cancer, prevention, early diagnosis and screening • Engage those around you in effective conversations about cancer • Reflect on how your own feelings about cancer may affect your conversations • Identify appropriate sources of support and information, and signpost people to them • Assess the barriers that can prevent people from changing their lifestyle or visiting the doctor, and engage them in a way that encourages them to take action • Develop a plan of action for talking about cancer http://www.cancerresearchuk.org/health-professional/awareness-and-prevention/talk- cancer/talking-about-cancer-online-course
CRUK RESOURCES TO SUPPORT YOU cruk.org/health o publications.cancerresearchuk.org o scienceblog.cancerresearchuk.org
SUMMARY • Having a brief conversation with patients about reducing cancer risk can make a difference • Acknowledge making lifestyle changes can be difficult • Health professionals are highly trusted by the public, and brief opportunistic discussions are considered helpful by patients.
Improving cancer recognition and referral in primary care
Introduction Cancer Referral Guidelines: Theory and Practice
Warm up question Raise your hand for the correct answer According to the National Cancer Diagnosis Audit, what percentage of patients first reported their symptoms to a GP? Was it: 1. 48% 2. 58% 3. 68% 4. 72%
Why do we deliver this workshop? • About 1 in 5 GPs in England and 1 in 4 GPs in Wales are not aware of NG12 • In Scotland and Northern Ireland, GPs' awareness of their national guidelines is higher than of NG12 (which doesn’t currently apply in these countries) (Scotland: SCRG 71% vs NG12 65%) (Northern Ireland: NICAN 78% vs NG12 56%) Reference: CRUK HCP T Tracker 2 2018
Why do we deliver this workshop? • NICE suspected cancer referral guidelines 2015 (NG12) were developed using a risk threshold ~ the risk of symptoms being caused by cancer is above a certain than action (referral or investigation) is warranted. A positive predictive value (PPV) was used to determine the threshold. • Only 1 in 5 GPs is aware of the lower risk referral threshold/PPV for referral and 37% would refer more often if they knew it was lower • Recent training improves familiarity: GP trainees better informed about the low risk referral threshold (31%) than GPs with 10+ years of experience (12%) References: 2018 GP audience survey (by Health Focus), NICE NG12 guidance
Why focus on cancer earlier diagnosis?
The scale of the challenge • One in two people in the UK born after 1960 will be diagnosed with some form of cancer during their lifetime • Cancer cases are rising as our population ages • In the UK, 1 in 4 deaths among adults are due to cancer
The scale of the challenge If NHS England is successful in implementing the initiatives and ambitions outlined in the recently published 10 year plan, they expect that the most significant benefits will be: by 2028, the proportion of cancers diagnosed at stages 1 and 2 will rise from around half now to three-quarters of cancer patient The role for GP practice? .. we want to ensure that all GPs are using the latest evidence based guidance from NICE to identify children, young people and adults at risk of cancer…
The case for early diagnosis
Most cancer patients present to a GP first (GP surgery and GP home visit)
Where are the avoidable delays in diagnosis in England?
Exploring Barriers Only half of GPs and GPs do not feel that practice nurses report they have the time to they have safety carry out necessary netting systems in examinations to spot place in their practice, Some GPs feel they do potential signs and however, when given not have the symptoms of cancer a list of systems only knowledge/confidenc 20% selected ‘none’. e to implement NG12 guidelines. Most GPs feel there is not enough training on NG12. Reference: CRUK HCP T Tracker 2 2018
How can cancer referral guidelines improve earlier diagnosis?
Suspected Cancer: Recognition and Referral Evidence: • Move to a lower risk NICE Guidelines (NG12) threshold for referral • More emphasis on investigation in primary care and encouraging use of clinical acumen Practicality: • Collaboration: Presented in two ways: by cancer • Specific safety netting site and by symptoms • recommendations Recommendations also presented Allows for • Guidance on what following investigations done in adaptations to information to give to primary care local pathways • patients with Allow for adaptations to local suspected cancer pathways • Not intended to override clinical judgement
What are cancer referral guidelines useful for? Evidence-based framework Can support the transformation of healthcare services to drive improved outcome s Provide evidence based clinical guidance for recognition and referral practice Can be used to develop quality standards to assess the clinical referral practice of health professionals. Can be used in the education and training of health professionals . Can assist patients to make informed decisions, and improve communication between the patient and health professional.
A GP Practice’s role in early cancer diagnosis
Common challenges (HCP Tracker, 2018) “When patients have vague but non red flag symptoms, it is difficult to refer them quickly.” “sometimes the suspected cancers do not entirely fit the No cancer pathway for unknown cancer – pathway's criteria so there should be some little leeway England allowing for clinician's discretion” Difficult to meet criteria – England “patients not always seen in secondary care in the timeline” Delays in waiting times – Scotland “Patients may not entirely fulfil the referral criteria but I strongly believe they have cancer, so their referral may be delayed or even declined” “what’s the point of guidelines where the reality Referrals declined – Wales is severe lack of diagnostics and third world services?” Access to scans – England “I do not feel that there are barriers. If someone qualifies for a 2 week wait referral, that is what they get” Works well – England
Pathway Challenges Doctor interval System interval Patient interval Treatment interval Diagnostic interval Secondary care interval Primary care interval Potential screening interval First First pre- First Investigation Referral to First Diagnosis/ First presentation/ Start of cancerous development of related secondary specialist referral to symptom clinical treatment indicator of cancer symptoms care visit treatment appearance
First First pre- First Investigation Referral to First Diagnosis/ First presentation/ Start of cancerous development of related secondary specialist referral to symptom clinical treatment indicator of cancer symptoms care visit treatment appearance • Understanding the Cancer Referral Guidelines • Give constructive patient First presentation/ communication • Use of clinical decision support clinical appearance tools • Ensure effective safety netting
First First pre- First Investigation Referral to First Diagnosis/ First presentation/ Start of cancerous development of related secondary specialist referral to symptom clinical treatment indicator of cancer symptoms care visit treatment appearance • Knowledge of tests available in your area. • Identifying the most appropriate Investigation of related pathway for the patient based on symptoms the presenting symptom using the most up to date cancer referral guidelines • Use of decision support tools
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