1. Welcome Ian Carpenter Assistant Director, Communications & Engagement NHS Doncaster

2. Doncaster early detection of lung cancer project

3. Project Rationale National   Most common cancer in the world   Associated with deprivation   Early presentation is essential   Five year survival rates for early diagnosis and surgery are over 60% - much higher than the national survival rate of 7% Local   Doncaster’s incidence of lung cancer and mortality rate is higher than the national average   The impact of lung cancer in Doncaster is a key driver of health inequalities in the area   Concerns that mortality rate was due to late presentation due to lack of awareness of symptoms and fatalistic attitudes

4. Aims & Objectives Project Aim   To improve life expectancy and reduce health inequalities in the Doncaster area by focussing on the early identification of lung cancer within the most disadvantaged areas. Objectives   To raise awareness of the early symptoms of lung cancer – specifically a cough that lasts more than three weeks.   To significantly increase the number of people with potential symptoms presenting at the prioritised GP surgeries within the most disadvantaged and high-risk areas of Doncaster   To increase the number of chest X rays undertaken in Doncaster by 20% by the end of 2008.

5. Target   Campaign target areas based on high incidence of Lung Cancer   hospital admissions, coinciding with high levels of deprivation   C2 (skilled manual) D (semi/unskilled) and E (casual) social grades grades   Over 50s   Predominantly men   Fatalistic attitudes and fear around lung cancer.   Lung cancer can often be either subsumed in a Stop Smoking message, or can be misconstrued as being Stop Smoking messages. Smokers are highly adept at ‘screening out’ stop smoking advertising.   Social and educational differential between target and healthcare professionals means that they do not feel able to challenge professionals where they are not getting chest X-rays   Tend to be more stoical about their health (particularly men) and reticent about presenting at GPs

6. Campaign Key Message

7. The social marketing approach Audience segmentation Where do they live? Who are they? ‘Weathered communities’ Target audience – primary audience and secondary audience Target areas – 11 practices covering deprived communities in Clay Lane, Denaby, Highfields, Hyde Park, Stainforth and Toll Bar

8. The campaign   Creative and media buying agencies commissioned   Insight used to develop messages and creative design   Key message: Cough not better after 3 weeks? Better go to your doctors now. We’re waiting. You shouldn’t.

9. Creative concept

10. Media and PR campaign   Local press and radio   Bus advertising   ‘Coughing’ bus shelters   Beer mats   Pharmacy bags   Media launch covered by regional TV   Local football and rugby team endorsement   ‘Cough Patrols’

11. An integrated approach Essential that healthcare professionals were aware of and prepared for the initiative:  Additional training for practice staff  Awareness raising for practice staff  Extra demand anticipated – x rays

12. Evaluation   An in-depth, independent evaluation has been undertaken.   The outcomes to date are very positive, with the headlines being:  Good campaign recall  A significant change in attitude has been seen amongst the target group  An increase in the number of chest X-ray referrals by the target GP practices  A clear correlation between campaign message recall, changes in attitudes and increase in chest X- ray referrals

13. Evaluation Objectives Key to the evaluation was to be able to demonstrate measurable behaviour outcomes in the target market. Therefore the methodology needed to be robust enough to produce a framework of indicators against which the campaign could be assessed. The focus of the evaluation was very much centred on the key message:   If you have a persistent cough that lasts for over 3 weeks ask your GP about a chest x-ray. Acting quickly is critical   A number of different evaluation methods were used. These were: a pre and post campaign survey of the target population a set of depth interviews with patients in the pilot practices analysis of hard data coming out of the target areas’ GP practices

14. Quantitative Survey Reach   How well did the campaign cover the target areas?   Did the target audience notice the campaign? Changing attitudes How effective was the campaign at increasing the likelihood of: The target group presenting at GP if they have had cough for 3 weeks or more  The target group presenting at GP and asking for an X-ray, if they have had cough for 3 weeks or more

15. Likelihood of visiting GP with Bad Cough Statistically significant increases in our targets likelihood to visit their GP (and ask for an x-ray) if they have a ‘really bad’ cough. Key messages effectively communicated across both men and women.

16. Campaign Recall 23% of our target recall something to do with the campaign (male: 22%; female 25%) LOCATION% Recall Clay Lane31 Denaby Main20 Highfields17 Hyde Park18 Stainforth32 Toll Bar & Almholme17 Control (DN8 4)14 A quarter of our target recall seeing/hearing our key message. Some variation seen across the different target locations. Analysis of the cost of the different media used does not highlight well targeted, effective and reached 1 in 4. Base: Target who recall campaign n=138

17. Key measures by smoking status % Change: Pre Campaign to Post Campaign Smokers (n=115;107) Ex Smokers (n=280;305) Never Smoked (n=207;188) Would visit GP if had a ‘really bad’ cough +9+3 Would visit GP if had a ‘really bad’ cough and ask for an X-ray +20+9+12 Very concerned if had a cough for more than 3 weeks +5+60 Would leave cough no more than 3 weeks before visiting GP +4+9-4 Statistically Significant positive change at 95% level. CAMPAIGN HAS RESONATED SLIGHTLY MORE WITH SMOKERS/EX SMOKERS THAN NON SMOKERS ALLAYS FEARS THAT SMOKERS OR EX SMOKERS MAY NOT TAKE NOTICE

18. Response: Converting Intent into Action How effective was the campaign at getting the target patients showing symptoms of lung cancer to:  Visit their GP  Visit their GP and ask for an X-ray Has there been a rise in the numbers being diagnosed with lung cancer from our target practices?

19. Chest X-Ray referrals Comparing the six weeks from the start of the campaign with the same period the previous year Overall increase in target practices Overall increase in all other PCT practices 80% 31% 40% Overall increase for whole PCT During and after the campaign there was an increasing number of chest x-rays across the PCT compared to the same period last year. Increase was generally larger from the supported practices

20. Chest X-Ray referrals Comparing the six weeks from the start of the campaign with the six weeks leading up to the campaign Overall increase in target practices Overall increase in all other PCT practices 27% 9% Overall increase for whole PCT 13% During and after the campaign there was an increasing number of chest x- rays across the PCT compared to the same period last year. Increase was generally larger from the supported practices

21. Summary   The campaign has had a positive impact on our target audience’s attitudes towards having a long term or ‘bad’ cough i.e. our target are now more likely to present at their GP if they have symptoms of lung cancer   Around eight lives saved through early detection   Our target are now more likely to ask their GP for a chest X-ray   Chest X-rays have risen by twice the proposed target for the Doncaster area   There is a strong positive relationship between our target's intent to visit their GP (with a ‘bad’ cough) and the number chest X-rays taking place   Double the increase in chest X-rays from our target practices compared to the rest of Doncaster   There are signs that the campaign has had a positive impact on those with a more ‘fatalistic’ attitude to health (avoid visiting GP in case they hear bad news)   There are signs that the campaign has resonated slightly more with smokers and ex smokers than those who have never smoked   Some variation in effectiveness across individual target areas

22. Thank you Any questions?