Early Detection of Cancer A Needs Assessment of GPs

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Early Detection of Cancer A Needs Assessment
of GPs

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• Introduction
• Dr. Michael Boland

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Study Aim

• to identify the barriers experienced by GPs to
  the early diagnosis of cancer

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Definition Early Detection

• prompt and effective referral of early
  symptomatic patients and identification and
  screening of high risk asymptomatic
  individuals.
• total population screening was excluded.

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Early Detection of Cancer A Needs Assessment
of GPs

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• Research Methodology and Findings
• Dr. Helena Daly

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Methodology

• Literature review
• Focus group interviews
• Postal questionnaire survey

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Focus Groups

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Questionnaire

• based focus groups/literature review findings
• 25 Qs practice details, presentation,
  investigation, referral, communication,
  screening, barriers, educational needs,
• role of ICS/ICGP
• piloted - 5 GPs within ICGP
• 1st mailing 2080 GPs May 2nd 1300
  GPs June
• collated and analysed using SPSS v 14

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Findings Literature Review

• lack of studies conducted in primary care
• no systematic reviews, good quality RCT, research
  conducted in Ireland (baseline audit GP cancer
  referral practices)
• 1 similar study Scotland
• clinical practice guidelines - referral suspected
  cancer, opportunistic screening average/high
  risk individuals

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Findings Focus groups Main
barriers (1)

• not confined to early detection
• delay in patient presentation
• inequity of access/long waiting lists for
  investigation/referral of patients who cannot pay
  privately
• lack of direct access to hospital based
  diagnostics
• communication difficulty with referral to
  hospital services for investigation/assessment
• cited examples of serious delay in diagnosis of
  cancer particularly those with non-specific
  symptoms

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Findings Focus Groups Main
Barriers (2)

• lack of clear recommendations
• inadequate (access to) investigative facilities
• lack of GMS re-imbursement
• for cancer screening
• GPs frustrated, angry, feel expertise ignored,
  not recognised
• members of healthcare team

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Findings Focus Groups GPs
Solution

• direct/equal access to hospital services
• ring fenced community diagnostics
• agreed referral criteria/rapid access clinics
• clear communication links/information
• clinical guidelines
• I think the two things that would be a big help
  would be more rapid access clinics and more
  access to investigative radiology for GPs

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Findings Focus Groups How
ICS/ICGP Could Assist?

• coordinated public awareness early cancer/value
  early detection
• cancers common to MF
  colo-rectal, lung
• coordinated response to media misinformation/mispl
  aced emphasis
• patient information videos (GP waiting rooms)
• promotion of primary care/advocacy
• additional resources
• improved access to hospital services
• GMS re-imbursement cancer screening
• guidelines - investigation/referral
  criteria/screening
• cancer study days/workshops at local hospital

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Findings Quantitative Questionnaire

• 957 questionnaires received (929 analysed)
• 47 response rate
• representative of ICGP membership/other ICGP
  surveys

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Availability of Direct Access to Investigations
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Waiting Times at Public Hospitals

• Investigations
• significant discrepancy between public and
  private patients
• Results
• still a public/private differential but not as
  great as for investigations

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Referrals

• Less than half have access to a fast-track system
  at local hospital for urgent referrals (only)
• 41 of GPs say ability to pay always affects
  access to referral services 42.4 say it does so
  usually

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Does a patient's ability to pay affect access to
referral services?

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Communication re patients with suspected cancer
at local hospital
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Services which GPs need to improve early
detection, but do not have, at local hospital
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Screening of high-risk individuals

• Only two in five GPs have access to clear
  guidelines
• how to identify
• how to screen
• how to respond to an abnormal screening test
• GPs reported no difference in the screening they
  offer GMS and private patients

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Barriers to Screening high-risk individuals
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Factors to improve early detection
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Areas in which GPs wish to receive further
education/clinical practice guidelines
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ROLE OF ICGP/ICS
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Early Detection of Cancer A Needs Assessment
of GPs

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• Conclusions and Recommendations
• Dr. Claire Collins

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The ICS and ICGP are committed to collaborative
action on the recommendations of this report and
have outlined the activities they intend to
pursue.