1. Delayed Cancer Diagnosis…and how to avoid it (possibly) Barnsley GP Training Scheme, 2013

2. To understand the concept of “delayed diagnosis” (with regards Cancer) To identify the causes of delayed cancer diagnoses To identify tools that can help you as a clinican improve your detection of cancer

3. 294,000 people will be diagnosed with cancer and around 155,000 will die from cancer every year http://info.cancerresearchuk.org/cancerstats/incidence/#mortality http://info.cancerresearchuk.org/cancerstats/incidence/#mortality Leading cause of mortality in people under age of 75 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/dh_ 081006 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/dh_ 081006 8-9 new cancer cases per 2000 patients (DoH, 2009) Examples of a delayed cancer diagnosis: –What is a delayed cancer diagnosis? –At what point in the “patient journey” was the delay? –Why did that occur? –What could be done/changed/instigated to avoid the delay?

4. Definition of a delayed diagnosis (NPSA, 2010) Delayed diagnosis in cancer is when someone who has cancer: is not investigated or referred for investigation;or having been investigated, is not diagnosed at the time of the investigation;or is diagnosed incorrectly;or where a positive test result or diagnosis is not communicated effectively to a clinician with The ability to act on the information;or where a positive test result or diagnosis is not acted upon and treatment commenced as appropriate.

5. i.e. US – GPs !! “mis-diagnosis and insufficient examination most common themes (Mitchell, 2008) Hansen’s model Appraisal: delay in symptom interpretation may account for up to 60 % of total cancer delay in Breast/Gynae cases (Anderson, 1995) Behavioural: delay in making an appt; Cancer was No 1 Fear ahead of MIs, Alzhemier’s and Terrorism (CRUK, 2007) Scheduling: delay between making appt and being seen Pathology 41% Radiology 12% C O M U N I C A T I O N S 26 % Cancellations 15%

7. Only 11% of patients referred with suspected Cancer = Cancer Audit PGP, all Cancer dx May 2010 – May 2011 = 58 cases 14% Routine (5/8 potentially 2WW) 30% 2WW 12% Emergency (only 2/7 potentially 2WW)

8. Always our fault… Types of Patient Safety Incidents: –Diagnostics Pathology 41% Radiology 12% –Communications 26% –Cancellations 15% –Clinical Assessments 5% –Waiting Lists <1% Key issues raised by “stakeholder meetings”: –Communication –Clinical assessment and management –Cultural issues (patients assuming a “passive” role)

9. MDU More than 50 % claims settled against GPs were for delayed diagnosis Major risk group was Cancers: –Breast 22% –Bowel 14% –Cervical 13% –Skin 8% Causes: –Failure to examine patient properly –Inadequate f/u arrangements –Lack of appropriate investigations –Dysfunctional communication

10. Tools that may help…

11. Audit and SEA audits –ENT malignancy audit,10 yrs, 5 malignancies, 39-320 days for diagnosis (average 130 days) Other risk tools –http://qcancer.org/http://qcancer.org/

12. Take home messages… What are yours? Mine: –Communicate effectively (with patients and with team members ie receptionists/secretaries) –Examine appropriately and thoroughly –Use the appropriate investigations and do not falsely reassure yourself with “normal” results –SEAs when necessary –Use the guidelines

13. SH T HA ENS