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Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Referral guidelines for.

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Presentation on theme: "Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Referral guidelines for."— Presentation transcript:

1 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Referral guidelines for suspected cancer NICE Clinical Guideline Issue date: June 2005 Review date: June 2009 1

2 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 NICE clinical guidelines Recommendations for good practice based on best available evidence DH document Standards for better health includes expectation that organisations work towards implementing clinical guidelines Healthcare Commission will monitor compliance with NICE guidance 2

3 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Top 10 cancer killers Lung Colorectal Breast Prostate Oesophageal Pancreatic Stomach Non-Hodgkins lymphoma Ovarian Leukaemia 3

4 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Rationale for this guideline Recent improvements seen in diagnosis and treatment of cancer patients Still some patients not being referred urgently, leading to a delay in treatment This guideline helps practitioners distinguish between common symptoms associated with common illnesses, and those that might indicate cancer 4

5 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 What this guideline covers Referral processes for the following cancers - Lung- Upper and lower GI - Breast- Gynaecological - Urological- Haematological - Skin- Head and neck including thyroid - Brain and CNS- Bone cancer and sarcoma Cancers seen in children and young people Support and information needs Key priorities for implementation 5

6 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 What this guideline does not cover Screening programmes for cancer Tests undertaken after referral Referral for suspected recurrence in previously diagnosed cancer patients Referral for palliative care 6

7 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Cancer referral timelines Immediate referral Urgent referral Non-urgent referral Acute admission or referral within a few hours Patient seen within 2 weeks (national target) All other referrals 7

8 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 New in the NICE guideline… This NICE guideline updates previously published Department of Health guideline 2000, as indicated in the National Cancer Plan The NICE quick reference guide provides signs and symptoms indicating urgency of referral 8

9 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Lung cancer 9

10 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Upper GI cancer 10

11 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Lower GI cancer 11

12 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Breast cancer 12

13 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Gynaecological cancer 13

14 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Urological cancer 14

15 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Haematological cancer 15

16 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Skin cancer 16

17 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Skin cancer – 7-point check list Major featuresMinor features Change in sizeLargest diameter 7mm+ Irregular shapeInflammation Irregular colourOozing Change in sensation 17

18 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Head and neck cancer 18

19 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Thyroid cancer 19

20 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Brain and CNS cancer 20

21 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Bone cancer and sarcoma 21

22 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Children and young people 22

23 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 So key priority is: education for healthcare professionals to ensure that all indications for referral are picked up timely and appropriate investigations are ordered patients and carers get appropriate support and information 23

24 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Assess patients needs Check if patient wants to consult practitioner of same sex? Check if patient wants to be involved in decision about referral ? Tell patient they are being referred to cancer service Give bad news following current advice Provide opportunity for second consultation For children, involve parents and carers Tell patient they can contact practitioner again Take account of social, cultural and gender issues Pass information on to specialist team Support and information for patients 24

25 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Breaking bad news Effects of inappropriate giving of bad news can be profound but good techniques can be learnt Recognise the changing expressions of grief: despair, denial, anger, bargaining, depression and acceptance (not always in that order!) 25

26 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Key factors for implementation (1) Training and education to ensure practitioners are: familiar with typical presenting features of cancers alert to unusual symptom patterns or unexpected failure to recover alert to parental concerns when dealing with children 26

27 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Key factors for implementation (2) Systems in place so that practitioners can: refer urgently and discuss referral with specialist start investigations without holding up referral provide appropriate support and information 27

28 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Implementation for clinicians Be familiar with new guideline Address changing roles of primary care health professionals Review current referral and investigation procedures Consider implications and consequences of support and information needs Find opportunities for collaboration and joint training between primary and secondary care Link with your cancer network 28

29 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Implementation for managers Disseminate guidance effectively Review current practice, protocols and referral processes Develop and implement an action plan Check capacity, schedules and waiting times for access to specialist teams and investigations Establish collaborative working across primary/ secondary care and links with the cancer network Consider workforce planning and training issues Monitor, audit and review progress 29

30 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Assessing cost locally NICE is developing a costing tool for this guideline A national costing report and local costing templates will be available on the NICE website from August 2005 30

31 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 What services are provided in your area? Create your own local services list! Consultant Specialist Oncology team Oncology Clinics Clinical Nurse Specialist Counsellor Radiology Voluntary organisations 31

32 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Audit criteria Immediate referral Urgent referral Non-urgent referral Acute admission or referral within a few hours Patient seen within 2 weeks (national target) All other referrals Audit against recommendations 32

33 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 Further information Quick reference guide: summary of the recommendations for health professionals –www.nice.org.uk/CG027quickrefguidewww.nice.org.uk/CG027quickrefguide NICE guideline: all of the recommendations –www.nice.org.uk/CG027niceguidelinewww.nice.org.uk/CG027niceguideline Full guideline: all of the evidence and rationale behind the recommendations –http://www.nice.org.uk/CG027fullguidelinehttp://www.nice.org.uk/CG027fullguideline Information for the public: plain English version for patients, carers and the public –http://www.nice.org.uk/CG027publicinfohttp://www.nice.org.uk/CG027publicinfo 33

34 Intro Context Cancer guidance – key differencesImplementation 123456789101112131415161718192021222324252627 Info 28293031323334 www.nice.org.uk 34


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