LIFESTYLE CHANGE BARRIERS I havent had enough training in how to - - PowerPoint PPT Presentation

FACILITATING LIFESTYLE CHANGE

‘It’s not my job to talk about these things – my job is to cure people.’ ‘I haven’t had enough training in how to raise the issue of cancer prevention and lifestyle risk.’ ‘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.’ ‘How can I talk to someone about weight management/healthy eating

• r smoking when I’m overweight or

smoke?’

BARRIERS

NHS England Health Education Online MECC course

http://www.makingeverycontactco unt.co.uk/training/e- learning/health-education- england-e-learning/

MAKING EVERY CONTACT COUNT (MECC)

CRUK RCGP - BEHAVIOUR CHANGE AND CANCER PREVENTION

(Free to access for all health professionals e-learning module)

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

BEHAVIOUR CHANGE AND CANCER PREVENTION

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

TALKING ABOUT CANCER ONLINE COURSE:

CRUK RESOURCES TO SUPPORT YOU

cruk.org/health o publications.cancerresearchuk.org o scienceblog.cancerresearchuk.org

• 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

• pportunistic discussions are

considered helpful by patients.

SUMMARY

Improving cancer recognition and referral in primary care

Introduction Cancer Referral Guidelines: Theory and Practice

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%

Warm up question

• About 1 in 5 GPs in England and 1 in 4 GPs in Wales are not aware
• f 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 do we deliver this workshop?

Why focus on cancer earlier diagnosis?

• 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
• ur 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

• utlined 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

• f cancer…

The scale of the challenge

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?

GPs do not feel that they have the time to carry out necessary examinations to spot potential signs and symptoms of cancer

Exploring Barriers

Only half of GPs and practice nurses report they have safety netting systems in place in their practice, however, when given a list of systems only 20% selected ‘none’. Some GPs feel they do not have the knowledge/confidenc 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 NICE Guidelines (NG12)

Allows for adaptations to local pathways

Evidence:

• Move to a lower risk

threshold for referral

• More emphasis on

investigation in primary care and encouraging use

• f clinical acumen

Practicality:

• Presented in two ways: by cancer

site and by symptoms

• Recommendations also presented

following investigations done in primary care

• Allow for adaptations to local

pathways

• Not intended to override clinical

judgement Collaboration:

• Specific safety netting

recommendations

• Guidance on what

information to give to patients with suspected cancer

What are cancer referral guidelines useful for? Evidence-based framework

Can support the transformation of healthcare services to drive improved

• utcomes

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

“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 “sometimes the suspected cancers do not entirely fit the pathway's criteria so there should be some little leeway allowing for clinician's discretion” Difficult to meet criteria – England “what’s the point of guidelines where the reality is severe lack of diagnostics and third world services?” Access to scans – England “When patients have vague but non red flag symptoms, it is difficult to refer them quickly.” No cancer pathway for unknown cancer – 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” Referrals declined – Wales

Common challenges (HCP Tracker, 2018)

First pre- cancerous indicator First development

• f cancer

First symptom First presentation/ clinical appearance Investigation

• f related

symptoms Referral to secondary care First specialist visit Diagnosis/ referral to treatment Start of treatment

Potential screening interval Primary care interval Secondary care interval Diagnostic interval Treatment interval Patient interval Doctor interval System interval

Pathway Challenges

First presentation/ clinical appearance

• Understanding the Cancer Referral

Guidelines

• Give constructive patient

communication

• Use of clinical decision support

tools

• Ensure effective safety netting

First pre- cancerous indicator First development

• f cancer

First symptom First presentation/ clinical appearance Investigation

• f related

symptoms Referral to secondary care First specialist visit Diagnosis/ referral to treatment Start of treatment

Investigation of related symptoms

• Knowledge of tests available in

your area.

• Identifying the most appropriate

pathway for the patient based on the presenting symptom using the most up to date cancer referral guidelines

• Use of decision support tools

First pre- cancerous indicator First development

• f cancer

First symptom First presentation/ clinical appearance Investigation

• f related

symptoms Referral to secondary care First specialist visit Diagnosis/ referral to treatment Start of treatment

Referral to secondary care

• Complete and accurate

referral form to avoid delay

• Appropriate referral for those

with non-specific symptoms

• Undertaking learning events

(previously referred to as SEAs) if case can be learned from

First pre- cancerous indicator First development

• f cancer

First symptom First presentation/ clinical appearance Investigation

• f related

symptoms Referral to secondary care First specialist visit Diagnosis/ referral to treatment Start of treatment

Resources & Tools

• Cancer Chat
• Prevention leaflets
• Cancer Screening leaflets
• Urgent Referral Explained leaflet

Patient Resources

• Patient support

Informed decision

• Discuss potential risks and benefits
• Explain they are being referred to a

cancer service (most people referred do not have cancer)

• Information on possible diagnosis

(benign & malignant)

• Where, when, what, who (Direct

booking if available)

Patient Communication: Symptomatic Presentation

Online and education resources

• RCGP/CRUK

cancer pages inc. e-learning module

• n Early Diagnosis
• CRUK CPD pages
• CRUK Referral

Guidelines webpages

• Cancer Insight

Centre

• Summary SCRG

poster/infographic

• NICE interactive

symptom desk easel

National Cancer Diagnosis Audit 2019

The 2019 NCDA will:

• Allow practices that took part last time to

understand what’s changed

• Support ongoing cycles of quality

improvement to drive cancer early diagnosis

• Provide vital local and regional cancer

intelligence (at CCG, Health Board, Cancer Alliance and STP levels)

• Measure the impact of national

programmes and initiatives, such as new cancer referral guidelines

• Offer a UK-wide NCDA dataset (England,

Scotland and Wales) for the very first time

Facilitate practice level discussions on emergency presentations and promote learning events.

Facilitator Programme – How can we support?

Enable safety netting principles to be embedded in practice Open up the conversations about the route to diagnosis through review of practice level cancer data. Support practices to undertake a cancer diagnosis audit.

Lisa-Lyna Abangma and Sarah Barker Lisa-Lyna.Abangma@ cancer.org.uk/ Sarah.Barker@ cancer.org.uk CRUK Facilitators

THANK YOU!