Trish Green

Evaluation of risk assessment tools for suspected cancer in general practice: a cohort study

BACKGROUND Diagnostic delay is deemed to account for an estimated 5000 to 10 000 extra cancer deaths each year in the UK. Many cancer patients do not have symptoms meeting national referral criteria for rapid investigation. Risk assessment tools (RATs) have been developed to assist GPs in selecting patient for cancer investigation. AIM To assess the usability and acceptability of lung and colorectal RATs, as well as subsequent resource use and cancer diagnoses. DESIGN AND SETTING Cohort study with nested qualitative study with 614 GPs from 165 practices in seven English cancer networks were provided with RATs applicable to patients aged ≥40 years with bowel or respiratory symptoms. In-depth interviews were conducted with 34 individuals (11 project managers and 23 GPs). METHOD The study measured the number of RATs used, and subsequent cancer investigations and diagnoses, over a 6-month period and compared these with the previous 6 months. RESULTS A total of 2593 RATs (1160 lung, 1433 colorectal) were completed. Compared with the preceding 6 months, there were 292 more chest X-rays, 104 extra 2-week chest clinic appointments, and 47 additional diagnoses of lung cancer. For suspected colorectal cancer, there were 304 more 2-week referrals, 270 more colonoscopies, and 10 more cancers identified. RATs appeared to help GPs in their selection of patients for cancer investigation. Users reported that RATs helped to confirm a need for investigation as well as allowing reassurance when investigation was not needed. CONCLUSION Use of RATs in primary care was accompanied by increased diagnostic activity and additional cancer diagnoses.

Landscapes of the dead? Natural burial and the materialization of absence

This article questions the emphasis on presence within material culture studies, using the example of a new burial landscape where the UK’s now conventional mortuary culture is often missing. The authors ask how the absences initiated by a death are articulated or materialized when body disposal and memorialization occur outwith a delineated boundary and identifiable buildings, a grave marked with head and kerb stones, and an embalmed body in a hardwood casket. Exploring data generated through an ESRC-funded project, the article examines tensions between the Natural Burial Movement’s goals and the practices of particular natural burial ground owners, managers and bereaved users. These practices, the authors argue, reflect the layers of competing orientations towards the landscape and nature that those involved in natural burial are heir to. In this way, the article draws out the ambiguities and contradictions implicit within the social practices that constitute natural burial and the landscapes within which it occurs.

Living with the dead

The visual survey has provided a valuable insight for the research team into the many different ways in which bereaved people interact with graves. In a burial context intended to promote nature and the creation of a collective memorial landscape into which the identity of the individual is ultimately subsumed, we have observed many different strategies that try to preserve the location of the grave and identity of the deceased. These include mowing the grave space, marking its boundary with small stones or temporarily with cut hay gathered on site. The regular photographic diary made it possible to trace these stories as they were played out over time.

GPs’ perceptions and experiences of public awareness campaigns for cancer: a qualitative enquiry

Public awareness campaigns for cancer are used to alert the UK population to symptoms which, if experienced, should be discussed with their general practitioner (GP). More timely diagnosis of cancer is assumed possible if patients with the appropriate symptoms present to GPs and GPs recognise the need to act on these symptoms.

Using primary care-based paper and telephone interventions to increase uptake of bowel scope screening in Yorkshire: a protocol of a randomised controlled trial

Introduction Evidence suggests bowel scope screening (BSS) can significantly reduce an individual’s risk of developing colorectal cancer (CRC). BSS for 55 year olds was therefore introduced to the English Bowel Cancer Screening Programme (BCSP) in 2013. However, the benefits are only gained from test completion and uptake is low (43%). Primary care involvement has consistently shown benefits to cancer screening uptake and so this study aims to build on this knowledge and evaluate general practitioner (GP) practice led interventions designed to increase BSS attendance. Methods and analysis A three-arm randomised controlled trial will be conducted to evaluate three interventions: one intervention for prospective BSS invitees (primer letter with locally tailored leaflet sent by an individual’s GP practice) and two interventions for those who do not attend their BSS appointment (a self-referral letter sent by an individual’s GP practice and a patient navigation call made on behalf of an individual’s GP practice). The trial will be set in Yorkshire. Individuals soon to receive their invitation to attend BSS at one of the Hull and East Yorkshire Bowel Cancer Screening centre sites, will be randomly assigned to one of three groups: control (usual care; no input from GP practice), Intervention group A (primer letter/leaflet and a self-referral letter), Intervention group B (primer letter/leaflet and a patient navigation call). Attendance data will be obtained from the BCSP database (via National Health Service (NHS) Digital) 3 months after the last intervention. Regression analysis will compare uptake, and additional clinical outcomes, across the three groups. The analysis will be multivariate and adjust for several covariates including gender and area-level deprivation. Ethics and dissemination NHS ethical approval has been obtained from London-Harrow Research Ethics Committee. The results will be submitted for publication in a peer-reviewed journal and presented at conferences. Trial registration number ISRCTN16252122; Pre-results.

P75 Exploring public awareness and understandings of cancer through qualitative Methods

Background In terms of morbidity and mortality, cancer remains one of the UK’s biggest health problems. Because of this, there has been considerable focus from policymakers and charitable bodies alike on raising awareness of cancer symptoms among the lay-public. Whilst awareness of symptoms for different cancers does seem to have filtered through to some areas of the public domain, the perception of cancer as a ‘death sentence’ has not been fully dispelled. The problem is to understand why, despite the continued efforts of campaign organisers to promote the advantages of early symptom detection on survival rates for some cancers, the term ‘cancer’ itself retains a powerfully negative status within the public consciousness. Methods We are conducting a series of focus groups and semi-structured interviews in a northern city of the UK with higher than average cancer mortality rates. Participants are members of the public who have not been diagnosed with cancer. The study sample is a mixed cohort with regard to gender, age and socio-economic status. Our inquiry focuses on participants’ awareness of cancer symptoms, their understandings of cancer risk and cause, their perceptions of awareness campaigns, and their experiences of help-seeking and consequent behaviour. Results Although data collection and analysis are ongoing, early findings from five focus groups and 12 interviews conducted so far demonstrate a distinction with regard to cancer and mortality between participants who perceive cancer as an ‘umbrella-term’ for a multiplicity of cancers with a range of symptoms and outcomes, and participants who perceive cancer as a singular, random disease that can strike anyone at any time, with death the inevitable outcome. These latter perceptions have emerged across the study sample, despite participants’ experiences of family members/friends who have survived different cancers. Conclusion Campaigns to raise awareness of different cancers among the general public that continue to emphasise the positive impact earlier detection can have on treatment and survival should continue. However, there is also a need to employ strategies that might dispel notions of cancer as an inevitable ‘death sentence’. As GPs are promoted through campaigns as the first port of call for people with worrying symptoms, it would seem sensible to explore how practitioners within primary care could foster more nuanced understandings of different cancers.