Early diagnosis and primary care UK perspec4ve David Weller University of Edinburgh

Transcription

1 Early diagnosis and primary care UK perspec4ve David Weller University of Edinburgh

2 Early diagnosis

3 Cancer policy and primary care - UK 3

4 CBP: 5 year relaave survival. Coleman et al, Lancet AUS CAN SWE NOR DEN UK AUS CAN SWE DEN UK CAN AUS SWE NOR DEN UK Colorectal Cancer 5yr RS Lung Cancer 5yr RS 90 SWE AUS CAN NOR DEN UK CAN NOR AUS UK DEN Breast Cancer 5yr RS AUS CAN SWE NOR DEN UK Ovarian Cancer 5yr RS AUS CAN NOR DEN UK

5 Significant varia4ons in stage at diagnosis across England Propor4on of new cancers where the stage is known, diagnosed as early stage (stages 1&2) Source: PHE. Accessed May Source: hkp:// health- outcomes- framework#gid/ /pat/10002/a4/102/page/6/par/cat- 2-5/are/E

6 Early Diagnosis is a complex, mul4faceted challenge The NAEDI hypothesis Achieving early presenta4on Op4mising clinical prac4ce Improving GP access to diagnos4cs Research, evalua4on and monitoring Richards MA. The NaAonal Awareness and Early Diagnosis IniAaAve in England: assembling the evidence. BriAsh Journal of Cancer 2009, 101: S1 - S4

7 Na4onal Awareness and Early Diagnosis Ini4a4ve key elements Achieving early diagnosis by public and paaents Raising awareness of cancer, symptoms, importance of early presentaaon Reducing barriers to early presentaaon (fear, difficulty accessing GP) Reducing barriers to screening OpAmising clinical pracace and systems Raising awareness of cancer symptoms amongst GPs and other health workers PromoAng opamal referral by GPs OpAmal screening services Improving GP access to diagnosacs eg ultrasound, MRI, colonoscopy Research, evaluaaon and monitoring

8 RAISING AWARENESS OF SYMPTOMS

9 Barriers to symptoma4c presenta4on % Worried about wasting the doctor's time Worried about what the doctor might find Too busy Too embarrassed ICBP Module 2: Data for England only 9

10 Public communica4on: CR- UK campaign PRIMARY OBJECTIVE: To tackle people s fear of cancer and encourage them to confront it by reinforcing the benefits of early diagnosis SECONDARY OBJECTIVES: To tackle people s reluctance to visit their GP To raise awareness of signs and symptoms of cancer To build brand leadership in early diagnosis To strengthen public engagement with CR- UK

11 Approach Raising awareness of cancer symptoms

12 Lung cancer cough campaign

13 Be Clear on Cancer

14 Awareness raising impact on primary care Bowel (Jan March 2011) Lung (Oct Nov 2011) Dura4on 7 wks; longer lead Ame 5 wks; shorter lead Ame Weight (OTS= OpportuniAes to see) Reach; 88% EofE and 90% SW OTS;13.1 EofE and 14 SW Awareness RecogniAon 75% Support 96% public, 89% GPs Significant increase in recall of symptoms AKendance at Primary Care Based on 74 pracaces: 3 most relevant read codes 51.6% increase VariaAon from 58 addiaonal visits to 13 fewer visits; 1 extra visit per pracace per week Overall yrs highest increase (55%), the target group saw a 46% increase. Varied across areas Reach; 94.5% OTS; 9.1 RecogniAon 70% Support 94% public, 87% GPs Significant increase in recall of symptoms Based on 35 pracaces: Most relevant read codes 23% increase VariaAon as an example, 92 more visits in one pracace and 51 fewer in another; 2.4 extra visits per pracace per week Aeendances increased from 30 yrs and tailed off at 85 highest impact yrs

15

16 SCREENING

17 Bowel screening campaign London (2014) INTERVENTIONS CRUK endorsement leeer Kit enhancement pack Outdoor adverasing EVALUATION CombinaAon of all intervenaons most effecave (significantly increased uptake by 2.1-6% among year olds and % among year olds) 17 Thursday 18 December 14

18 ENDORSEMENT IMPROVES UPTAKE BY 5 TO 6% VARYING LEVELS/TYPES OF ENDORSEMENT CAN COMPLEMENT OTHER SIMPLE INTERVENTIONS SUCH AS PATIENT LEAFLETS

19 Often not so much active decision not to participate but, rather, issues such as deferment, low prioritisation etc Anonymity of invitation process Content of information materials limits to how much it makes a difference

20 IMPROVING DIAGNOSIS IN PRIMARY CARE

21 We will need to engage with primary care to really improve diagnosis Source: NaAonal Cancer PaAent Experience Survey 2010

22 Cancer Risk Assessment Tools

23 RATS 2593 RATS (1160 LUNG, 1433 COLORECTAL) COMPLETED, IN 165 PRACTICES COMPARED WITH THE PRECEDING 6 MONTHS, THERE WERE: 292 more chest X- rays, 104 extra 2- week chest clinic appointments, 47 addiaonal diagnoses of lung cancer FOR SUSPECTED COLORECTAL CANCER, THERE WERE 304 more 2- week referrals 270 more colonoscopies, 10 more cancers idenafied RATS APPEARED HELP GPS IN: their selecaon of paaents for cancer invesagaaon providing reassurance when invesagaaon was not needed Br J Gen Pract. Jan 2013; 63(606): e30 e36.

24 Strategies to support GPs EDUCATION CLINICAL DECISION SUPPORT (CDS) TOOLS CRUK FACILITATORS URGENT REFERRAL GUIDELINES

25 ACCESS TO INVESTIGATIONS

26 Access to inves4ga4ons

27 Interna4onal comparisons - crude colonoscopy rates per 1,000 in 2010/11 Wales England Worst (West Midlands) England Average England Best (N East) Scotland Poland Australia Canada (Nova Scotia)

28 CANCER REFERRAL GUIDELINES

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31 Revision of NICE referral guidelines WE REALLY WANT MUCH MORE GP INVOLVEMENT IN THE WAY GUIDELINES ARE WRITTEN AT THE MOMENT GUIDELINES ARE WRITTEN BY SPECIALISTS FOR PATIENTS WITH ONE DISEASE, THEY RE NOT WRITTEN FOR REAL LIFE. DR. MARGARET MCCARNEY, RCGP

32 IN CONCLUSION

33 Strategies which may bring about earlier diagnosis: Awareness raising in the community Practice profiling/ benchmarking Significant event analyses Risk assessment tools

34 Poli4cians don t always come up with the best ideas for general prac4ce

35 Summary SIGNIFICANT CHANGES OVER LAST DECADE MANY OF CURRENT UK INITIATIVES ARE GP- FOCUSED AND/ OR GP- LED EMERGING STRONG EVIDENCE BASE HELPS SHAPE NEW POLICY INITIATIVES AND MAKES US RESILIENT TO BAD IDEAS

36 THANKS FOR YOUR ATTENTION

37 Acknowledgements: COLLEAGUES AT: CRUK & NAEDI NATIONAL CANCER RESEARCH INSTITUTE PRIMARY CARE CSG CANCER & PRIMARY CARE RESEARCH INTERNATIONAL NETWORK (CA- PRI) DEPARTMENT OF HEALTH, ENGLAND PC4 AUSTRALIA 37 Thursday 18 December 14 View <Headers and Footers> to alter this text