Dr Graham Wardman Consultant in Public Health (S&I) 29 Nov 2016

Screening: doing more good than harm Arpana Verma Screening: doing more good than harm This is about identifying and inviting HEALTHY PEOPLE – not ill people looking for help – Screening can do harm so have to explain benefits and risks and have quality systems to minimise harm and maximise benefit. ( many people are screened to be told all is well, need support when they are told things are not well ) 24th October 2012 MSC

It’s NOT just a Screening test Screening Pathways- key steps It is a sieve – it is not diagnostic but groups of may have and may not have condition identifying the individuals eligible for screening/immunisation inviting the eligible individuals giving information and facilitating uptake undertaking the test acting on results: referral, diagnosis, intervention and treatment providing support and follow up optimising health outcomes

Limitations: Effectiveness of predicting behaviour change Intention-behaviour gap Not addressing automatic motivation, habits and impulsive behaviour

Identified Barriers (people) Don’t understand own body and the disease Fear of the disease Fear bad news Low confidence in care Don’t understand screening, test, benefits, harm Fear of test –embarrassment of test Fear of wasting doctor’s time perceptions of barriers to access screening consideration of the consequences of not attending for screening Don’t think test relevant to me ( not sex active)

Identified Barriers (organisational) Inconvenient test times, location, Remembering appointments No female screeners Difficult physical access to test for people with physical disability Negative staff attitudes to some patient groups Difficulty consenting to test ( LD) Communication methods and materials inappropriate and poor quality (LD, visually impaired, English not first language, sexuality) Information given not appropriate Don’t understand information provided Poor experience of communication Reliance on relatives to help (eg translation ) Not registered with a GP

Overview of Breast Screening System (women 50-70) The norm : 2 thirds of women attend

The Randomised Controlled Trial GM served by 4 Breast screening units, (UHSM, Wigan, Bolton, E.Cheshire) Women aged 50-70 are screened every 3 years Currently about 67% uptake in GM and over 75000 screens per year. 6 months trial ( started this month ) Outcome is uptake Ethical approval Women randomised to the standard letter (control) , or one of 2 behaviour change letters Every missed appointment costs the NHS approximately £75.  We are only offering women from your GP practice appointments at XXXXX for the next few weeks. Plus tear off reminder slips for woman.