Call for a Kit Clinic Evaluation October 2016

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1 1 Project summary Call for a Kit Clinic Evaluation October 2016 The Lancashire Bowel Cancer Screening Programme (BCSP) our excited to share the great results from their newly developed BCSP Health Promotion Initiative - Lancashire BCSP- Call for kit clinics. The BCSP kits are sent automatically to all individuals aged years of age who are registered with a GP. Individuals are requested to complete the kit and send it back to the HUB within two weeks of receiving it. Early detection of bowel cancer saves lives and the BCSP started in Lancashire in Since it has started the BCSP in Lancashire has picked up over 700 bowel cancers in individuals who completed the BCSP kit. Unfortunately though the uptake of the BCSP kit is varied across Lancashire with some areas it being as low as 19% in some GP practices. The national aspirational requirement is 60% uptake within GP practices. Various barriers to uptake have been highlighted over the past few years in community/professional research undertaken by the Lancashire BCSP health promotion team. Key areas of issues highlighted by communities have been: Not understanding the BCSP or how to complete the kit Cultural/language reasons Gender issues in completing the kit Not receiving the kit or realising the importance of the screening programme. Key issues highlighted by professionals include: Lack of time in GP consultations to fully discuss the BCSP and ordering the kit for patients Primary Care staff lacking of awareness/knowledge about the BCSP Overwhelming chronic disease/health priority targets in GP practices Taking all these points into consideration and using local and national evidence that shows talking to individuals who have not completed the BCSP kit face to face helps increase understanding, awareness and helps increase the uptake of the BCSP kit. The Lancashire BCSP health promotion team developed the Call for a Kit model of intervention to help increase the uptake of the BCSP. What is the Call for A Kit Clinic? (CFAKC) It is a specific clinic where patients who have not completed the BCSP kit are invited to the surgery by the practice to meet members of the BCSP health promotion team. At this 15 minute clinic appointment the non-responder patient is shown the kit, multi-lingual leaflets are given and a DVD is shown on how to complete the kit. All patient questions, anxieties and worries are addressed within the short clinic appointment. If the patient is in agreement after informed consent is given the health promotion team will then ring the HUB and order a kit on behalf of

2 2 the patient. Special needs, languages, cultural issues and specific requests are all addressed within the clinic to help encourage the patient to understand, obtain and complete the kit. Project Evaluation This paper gives updated evaluation of the clinics held from September 2015 August 2016, which has formed the majority of the team s health promotion work over this time period. In partnership with NHS England North forty low uptake GP practices were selected from across 8 CCGs. Number of nonresponders invited Number of people seen Number of kits ordered Number of kits completed The above information shows: 84% of people invited to CFAK clinic attend 91% of people attending CFAK clinic have a kit ordered 58% of people attending CFAK clinic subsequently complete the kit Number people DNA, cancelled or unsuitable 58% of people complete a kit after attending CFAKC appointment compares to other initiatives done including 35% in GP practice face to face, 20% following telephone advice and 11% where practices send a letter. To date 27 clinics have been held in 24 GP practices within Lancashire, with priority being given to the practices with the lowest bowel screening uptake.

3 3 Gender of those invited to CFAKC MALE FEMALE Gender specific clinics were offered to all patients attending the CFAKCs. The health promotion team noted that this worked very well and helped patients overcome issues around cultural dignity, discussing sensitive body parts and it aided discussions on how to collect the poo and complete the kit in a sensitive manner. Ethnic group of those invited to CFAKC WHITE BRITISH PAKISTANI INDIAN BANGLADESHI EUROPEAN AFRICAN SRI LANKAN COLOMBIAN The CFAKC offered 5 languages to engage with patients who attended. The languages offered were English, Urdu, Gujarati, Punjabi and Hindi. The majority communities in Lancashire are from White British, Pakistani and Indian heritage.

4 4 It has previously been identified that the decision whether or not take part in the first screening invite has a significant bearing on whether that individual will take part in the screening programme in future rounds. As part of CFAKC, GP practices are recommended to prioritise year olds when identifying individuals to invite. By targeting the younger age group the intervention is likely to have a more sustainable effect on future uptake as those individuals will be eligible to take part in screening for longer. Outcomes Those who completed a BCSP kit following CFAKC attendance were at various rounds within the programme: Round 1 Round 2 Round 3 Round 4 Round This shows how many times the patients who received the kit did not complete it in each round. For example 108 patients did not complete the kit after it was sent to them 3 times over 6 years. Outcome of kit ordered following CFAKC Negative Positive Spoilt kit Weak Positive Positivity rate of 1.76% in individuals who completed the kit following CFAKC compared to 1.64% in the Lancashire programme. Positive results Of the 6 people with positive bowel screening results one person was subsequently diagnosed with bowel cancer and 5 people had polyps removed. All had not responded to previous multiple rounds (3 had not responded to previous 2 rounds and 3 had not responded to previous 3 rounds). In addition to these 6 positive outcomes, 10 people had a weak positive result and required further test kits to be completed.

5 5 As part of the work the reasons people gave for not completing the kit were captured and are summarised below: Number of Reasons people gave for not having completed the kit respondents "just not done the kit" 267 "never received the kit" 86 "didn t know how to complete the kit" 67 kit not due" 59 "completely overlooked it" 37 "didn t know about the kit" 37 refused to complete the kit" 37 "too many things going on in my life" 26 other health problems 14 never heard about the BSCP 9 fatalistic attitude" 8 "fear of the unknown" 5 currently in the BCSP system" 2 lost the kit /17 priorities for Lancashire Bowel Screening Health Promotion Specialists Further run the Call for a kit clinics in next cohort of lowest uptake GP practices in each CCG Formal evaluation of the CFAKC in partnership with Edgehill University Present findings at national, regional and local conferences Explore models of expanding the CFACK model across Lancashire Support organisations who were commissioned to carry out bowel screening activity following community bids Project to raise awareness of BCSP in care/residential homes Authors: Shahida Hanif BCSP Health Promotion Specialist Kathryn Jones NHS England Screening & Immunisation Coordinator Sadiq Patel BCSP CVS Community Engagement Officer