1. Camden & Islington Practice Nurse/HCA Event Gali Siegal Health Professional Engagement Facilitator Haringey and Enfield March 2016

2. The continuum line

3. The Prevention Game

5. Motivational Interviewing Ask patient what he/she already knows about topic Ask permission to provide information, advice or express concerns Provide information Ask what it means

6. Cancer Screening: Quick Quiz How many cancer screening programmes are there in the UK? What are the screening programmes? Who is eligible? (age group) What do you think the national targets are for each cancer screening programme? (% of people eligible for screening who should be screened?)

7. Screening Programme Who is invitedHow it’s conducted ImpactNational Target Cervical Women Age 25 to 64 Smear test – can be done at GP practice Estimated to save 5,000 lives a year 80% Breast Women Age 50 – 70 women over 70 can request expanding to age 47 to 73 A mammogram is done at a screening centre 15,500 breast cancers diagnosed and 1,300 lives saved 70% Bowel Men and women Age 60 - 74 Over 74 can ask for kit Testing kit received in the post. This is done at home and posted back Only fully running since 2010 but estimated to save 2,000 lives by 2025 60%

8. Cervical Screening Benefits 5000 lives estimated to be saved each year by screening Screening women aged 25-34 reduces their risk of developing cervical cancer by 45% Screening women aged 35-64 reduces their risk of developing cervical cancer by 60-80% Since the start of screening in the 80’s cervical cancer rates have almost halved

9. Screening 45 – 74 year olds can lower their risk of dying from bowel cancer by 16% Estimated to save more than 2000 lives each year by 2025 16 out of every 20 people with an abnormal result will have a colonoscopy: - 8 will have nothing abnormal found 6 will have polyps 2 will have cancer Bowel Screening Benefits

10. FIT kit Pilot in London for 6 months FIT - Faecal Immunochemical Test one sample only FIT measures the human -specific ‘globin’ part of Hb, not ‘haem’ which is detected using the current FOB test FIT uses an automated laboratory instrument to detect blood

11. 15500 breast cancers diagnosed through screening each year 1300 lives are saved a year But, for every life saved from breast cancer screening around 3 women are over diagnosed Breast Screening Pros and Cons

12. Why do we screen for cancer? All three programmes can help detect abnormal cells or tissue changes before: They develop into full-blown cancer (cervical and bowel- prevention is possible) They develops into an advanced stage Early detection means that there is a higher chance of treatment being successful Prevention means we can stop cancers before they develop We can save more lives and improve cancer outcomes in the UK

13. Detecting bowel cancer at an early stage vs late stage : Early diagnosis of bowel cancer – 93% of those diagnosed survive 5 years or longer Late diagnosis of bowel cancer - less than 7% of those diagnosed will survive five years or longer Detecting breast cancer at an early stage vs late stage: Breast cancer early diagnosis results in 99% survival rate of five years or longer Late stage diagnosis of breast cancer - 15% survive five years or longer The importance of catching cancer early Detecting cervical cancer at an early stage vs late stage: Early diagnosis of cervical cancer - 96% survive their disease for five years or longer. Latest stage diagnosis of cervical cancer - 5%: survive their disease for five years or longer.

14. Who do you think is less likely to take up screening? Why? BME Groups Some socio economic groups Men People with existing health problems People with learning disabilities

15. Patients are unsure about who to call to rearrange appointment Embarrassment Cultural issues Inconvenient appointment time Fear of pain Low perceived risk of getting cancer Patients are worried about finding cancer Patients don’t understand the test No time/busy Barriers to Screening (The Public) Didn’t get an invitation letter Patients with learning disabilities Patients with physical disabilities

16. Role plays Time for you to practice

17. Feedback

18. Demonstrate how to use the kit to patients if you can Provide easy to read leaflets for patients to read Be breast aware yourselves Introduce symptom recognition and screening info into conversations Familiarise yourself with common risk factors so you are more ‘alert’ when supporting certain patients Ask about common symptoms – changes in body and behaviours Ask about receipt/completion of bowel screening kits Flag cervical screening non attenders Identify other ways to discuss screening and symptoms – awareness weeks, soap operas, news items Know where you can obtain patient info and useful resources to help you Share resources with your colleagues Convey optimism about the effectiveness of treatment and survival Address the barriers promote the positives – ‘do it for the family’ ‘early presentation saves lives’ ‘modern treatments are much better’ Visit the resources for health professionals section at CRUK website – topics for dealing with mixed messages and understanding research

19. Time to plot yourselves on the continuum line again…