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

2. 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

3. 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

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

5. 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)

6. 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

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

8. The Randomised Controlled Trial
GM served by 4 Breast screening units, (UHSM, Wigan, Bolton, E.Cheshire)
Women aged are screened every 3 years
Currently about 67% uptake in GM and over 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.