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Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
Referral for suspected cancer: presenter slides - Slide 1
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Referral for suspected cancer: presenter slides - Slide 1

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  • NOTES FOR PRESENTERS
    DISCLAIMER
    This slide set is an implementation tool and should be used alongside the published guidance. This information does not supersede or replace the guidance itself.
    HEADER SLIDE – ALL
    You can add your own organisation's logo alongside the NICE logo if you want.
  • NOTES FOR PRESENTERS
    SLIDE FOR COMMISSIONERS AND MANAGERS
    This slide sets the context on what NICE guidelines are, what the expectation is for compliance, and how this will be monitored.
  • NOTES FOR PRESENTERS
    SLIDE FOR ALL
    Rationale for this guideline (Refer to full guideline Section 1.2)
    Improving care for people with cancer is a key aim for NHS; includes reduction in mortality by 20% in people under 75 years by 2010 compared to 1995-97 baseline.
    National Audit Report on cancer services in England shows that patients tended to have more advanced cancer at time of diagnosis compared to other countries. Older people and those from more deprived areas more likely to be diagnosed with cancer at a more advanced stage.
    Therefore early referral important. For example, delays of 3 to 6 months between the onset of symptoms and diagnosis are associated with worse survival rates in breast cancer. In a study of time between presentation and treatment of six common cancers in general practice, the median number of days between presentation of the 1st symptom and initiation of referral was 0 days for breast, 28 days for large bowel, 31 days for lung, 84 days for oesophageal, 20 days for prostate and 66 days for stomach cancer.
  • NOTES FOR PRESENTERS
    SLIDE FOR ALL
    Refer to the National Audit Report: Tackling Cancer: Improving the Patient Journey March 2005
    http://www.nao.org.uk/publications/nao_reports/04-05/0405288es.pdf
    Four cancers looked at: breast, lung, bowel and prostate
  • NOTES FOR PRESENTERS
    SLIDE FOR ALL
    Refer to Scope: referral guideline for suspected cancer Section 4.1
  • NOTES FOR PRESENTERS
    SLIDE FOR ALL
    Refer to Scope: referral guideline for suspected cancer Section 4.1.2
  • NOTES FOR PRESENTERS Refer to QRG Page 4
    SLIDE FOR ALL
    NICE GUIDELINE SAYS:
    Referral timelines
    The referral timelines used in this guideline are as follows:
    immediate: an acute admission or referral occurring within a few hours[A1], or even more quickly if necessary
    urgent: the patient is seen within the national target for urgent referrals (currently 2 weeks)
    non-urgent: all other referrals.’
    Current DH target is 17 weeks (4 months). By December 2005 – 3 months.
    Some recommendations refer to the appropriateness of non-urgent referrals for e.g. breast cancer (QRG page 19), penile cancer (QRG page 23), basal cell carcinomas (QRG page 28), head and neck cancer (QRG page 31) and brain and CNS cancer (QRG page 34).
    NICE guideline recommendation 1.2.14 – investigations should not delay referrals.
  • NOTES FOR PRESENTERS
    SLIDE FOR ALL
    When viewing the following slides (10- 22) please ensure participants have a copy of the quick reference guide (QRG) and /or NICE guideline
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Ask participants to refer to Pg 9 in QRG
    NICE ADDITIONS TO DH 2000 GUIDELINE
    Asbestos exposure is included as a risk factor
    Refer to full guideline Table 1: In 2003 cancer of the trachea, bronchus and lung accounted for the highest number of deaths from cancer (17,141) Separately identified was mesothelioma which accounted for 1,373.
    For an explanation of ‘risk factors’ refer to full guideline 2.8.3
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Ask participants to refer to Pg 10 in QRG
    NICE ADDITIONS TO DH 2000 GUIDELINE
    Refer urgently adults with persistent vomiting and weight loss without dyspepsia to specialist
    Refer urgently for endoscopy patients over 55 years with unexplained and persistent recent-onset dyspepsia alone
    H. pylori status should not affect decision to refer
    Stop acid-suppressing medication for 2 weeks minimum if referring for endoscopy
    In obstructive jaundice consider urgent ultrasound
    Patients with new onset dyspepsia should have FBC to detect iron deficiency anaemia. Get FBC done before outpatient appointment
    FBC= full blood count
    Definition on dyspepsia is taken from the NICE guideline on Dyspepsia: ‘Management of dyspepsia in adults in primary care’ (www.nice.org.uk/CG017). Dyspepsia in unselected patients in primary care is defined broadly to include patients with recurrent epigastric pain, heartburn or acid regurgitation, with or without bloating, nausea or vomiting.
    In this guideline ‘unexplained’ is defined as ‘a symptom(s) and/or sign(s) that has not led to a diagnosis being made by the primary care professional after initial assessment of the history, examination and primary care investigations. In context of this recommendation the PCP should confirm that the dyspepsia is new rather than a recurrent episode and exclude common precipitants of dyspepsia such as ingestion of NSAIDS. ( taken from QRG Pg 10)
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Ask participants to refer to Pg 11 in QRG
    NICE ADDITIONS TO DH 2000 GUIDELINE
    Exclude positive family history as risk factor
    Ulcerative colitis is a risk factor
    Do DRE for unexplained lower GI symptoms
    Do FBC to check for iron deficiency anaemia
    Refer urgently patients over 40 years reporting rectal bleeding and change in bowel habits lasting over 6 weeks
    ‘Treat, watch and wait’ when equivocal symptoms but patient not anxious
    DRE = digital rectal examination
    FBC= full blood count
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Ask participants to refer to Pg 11 in QRG
    NICE ADDITIONS TO DH 2000 GUIDELINE
    Descriptions of the features of lumps
    Family history as a risk factor
    Urgent referral for lumps persisting after menstruation
    Breast cancer in men
    Not allowing investigations to hold up referral
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Ask participants to refer to Pg 13 in QRG
    NICE ADDITIONS TO DH 2000 GUIDELINE
    No lower age limit in cases of post-menopausal bleeding
    Tamoxifen as a risk factor in endometrial cancer
    Symptoms of ovarian cancer
    Indications for full pelvic examination
    Advice that smear is not needed if cancer is suspected
    Ultrasound for checking abdominal or pelvic mass not obviously uterine fibroids, or of GI or urological origin
    Urgent referral to specialist team if urgent ultrasound not available
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Ask participants to refer to Pg 14 in QRG
    NICE ADDITIONS TO DH 2000 GUIDELINE
    Indications for PSA and DRE
    But exclude UTI before PSA
    How to deal with haematuria with UTI
    Testing for proteinuria and creatinine in cases of microscopic haematuria
    Urgent ultrasound when scrotal masses do not transilluminate and/or when the body of the testis cannot be distinguished
    PSA = prostate-specific antigen
    DRE = digital rectal examination
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Ask participants to refer to Pg 16 in QRG
    NICE ADDITIONS TO DH 2000 GUIDELINE
    Investigating unexplained fatigue
    Lymphadenopathy and bruising
    Indications for FBC
    Investigating persistent bone pain
    FBC = full blood count
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Ask participants to refer to Pg 17 in QRG
    NICE ADDITIONS TO DH 2000 GUIDELINE
    7-point check list to assess pigmented lesions
    Photographs to monitor growth
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    For checklist refer to QRG Pg 17
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Ask participants to refer to Pg 19 in QRG
    NICE ADDITIONS TO DH 2000 GUIDELINE
    Hoarseness persisting more than 3 weeks as an indication for X-ray (DH says over 6 weeks)
    Urgent referral for persistent unexplained parotid or submandibular masses
    Section on thyroid cancer
    Advice on dental check-ups
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Ask participants to refer to Pg 20 in QRG
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Ask participants to refer to Pg 21 in QRG
    NICE ADDITIONS TO DH 2000 GUIDELINE
    Progressive cognitive impairment and personality change
    Past history of cancer as a risk factor
    Indications for examination
    Discussion with specialist if in doubt
    Need to reassess if progress unsatisfactory
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Ask participants to refer to Pg 23 in QRG
    NICE ADDITIONS TO DH 2000 GUIDELINE
    Investigate unexplained or persistent bone pain
    Consider metastases, myeloma, lymphoma and sarcoma in older people
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Ask participants to refer to Pg 24 in QRG
    NICE ADDITIONS TO DH 2000 GUIDELINE
    Repeated presentation with same problems, parental concerns and persisting symptoms as triggers for referral
    Down’s and other syndromes as risk factors
    History of injury does not exclude bone sarcoma
    Urgent referral for lymph nodes over 2cm
    Recommendations on retinoblastoma
    Indications for FBC
    Imaging should be performed by specialist paediatricians
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    Refer to QRG Pg 5 – Key priorities for implementation
  • NOTES FOR PRESENTERS
    SLIDE FOR ALL
    This slide is intended as a discussion tool
    Refer to NICE guideline section 1.1.7 – 1.1.15
    When referring a patient with suspected cancer to a specialist service, primary healthcare professionals should assess the patient’s need for continuing support while waiting for their referral appointment. The information given to patients, family and/or carers as considered appropriate by the primary healthcare professional should cover, among other issues:
    where patients are being referred to
    how long they will have to wait for the appointment
    how to obtain further information about the type of cancer suspected or help prior to the specialist appointment
    who they will be seen by
    what to expect from the service the patient will be attending
    what type of tests will be carried out, and what will happen during diagnostic procedures
    how long it will take to get a diagnosis or test results
    whether they can take someone with them to the appointment
    other sources of support, including those for minority groups.
    The primary healthcare professional should be aware that some patients find being referred for suspected cancer particularly difficult because of their personal circumstances, such as age, family or work responsibilities, isolation, or other health or social issues.
    Primary healthcare professionals should provide culturally appropriate care, recognising the potential for different cultural meanings associated with the possibility of cancer, the relative importance of family decision-making and possible unfamiliarity with the concept of support outside the family Discuss with patients (and carers as appropriate) their preferences for being involved in decision-making about referral options and further investigations (including risks and benefits).
    Take into account personal circumstances, such as age, family or work responsibilities, isolation, or other health or social issues.
    Provide culturally appropriate care.
    Be aware that men may have similar support needs to women, but may be more reticent about using support services.
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS
    The guideline refers to the document below. While a primary healthcare professional (PCP) may be imparting the news that the referral is to ascertain whether or not the patient does have cancer this is still bad news for the patient and the principles on how to handle this remain the same.
    Taken from ‘Improving communication between doctors and patients' A report of the working party of the Royal College of Physicians (1997)
    Changing Expressions of Grief: Kubler-Ross E. On death and dying. New York: Macmillan, 1970
  • NOTES FOR PRESENTERS
    SLIDE FOR PCPs (Primary healthcare professionals) OR COMMISSIONERS, PRACTICE MANAGERS
    Primary healthcare professionals must be alert to the possibility of cancer when confronted by unusual symptom patterns or when patients who are thought to not have cancer fail to recover as expected. In such circumstances, the primary healthcare professional should systematically review the patient’s history and examination, and refer urgently if cancer is a possibility.
    Discussion with a specialist should be considered if there is uncertainty about the interpretation of symptoms and signs, and whether a referral is needed. This may also enable the primary healthcare professional to communicate their concerns and a sense of urgency to secondary healthcare professionals when symptoms are not classical.
    Cancer is uncommon in children, and its detection can present particular difficulties. Primary healthcare professionals should recognise that parents are usually the best observers of their children, and should listen carefully to their concerns. Primary healthcare professionals should also be willing to reassess the initial diagnosis or to seek a second opinion from a colleague if a child fails to recover as expected.
  • SLIDE FOR PCPs (Primary healthcare professionals) OR COMMISSIONERS, PRACTICE MANAGERS
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICIANS, COMMISIONERS AND MANAGERS
    Guideline refers to ‘primary health care professional’ not specifically GP. Organisations need to interpret this in the light of their own local arrangements
    Refer to The NHS Cancer Plan: A progress report www.nao.org.uk/publications/nao_reports/04-05/0405343es.pdf
  • NOTES FOR PRESENTERS
    SLIDE FOR COMMISSIONERS AND MANAGERS
    This slide is intended as a discussion tool
    It starts with internal dissemination but moves on to undertaking a gap analysis
    Dissemination – Have the right people received the guidance?
    Consider what are the actions for those receiving the guideline?
    Monitoring and audit: Consider a baseline assessment and plan change against this. Plan for audit
    Action planning: Use local action planning templates, consider how progress is fed back into the organisation
  • SLIDE FOR COMMISSIONERS AND MANAGERS
    Costing templates will be available on the Implementation section of the website from August 2005 www.nice.org.uk
  • SLIDE FOR PRESENTER TO COMPLETE
    This slide allows you to add your own local information. It helps identify what services exist within your area. You can use this slide to update teams on individuals and teams providing cancer services, you can include contact details etc
  • NOTES FOR PRESENTERS
    SLIDE FOR CLINICAL EFFECTIVENESS, AUDIT LEADS
    Refer to NICE guideline Appendix D Technical detail on the criteria for audit
  • SLIDE FOR ALL
    The slides do not replace the full version of the guideline and should be used in conjunction with the Quick Reference Guide or Full Guideline – links displayed above
  • SLIDE FOR ALL
    You can find more information on NICE and our work by visiting the website at www.nice.org.uk
  • Transcript

    • 1. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Referral guidelines for suspected cancer NICE Clinical Guideline Issue date: June 2005 Review date: June 2009 1
    • 2. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Top 10 cancer killers • Lung • Colorectal • Breast • Prostate • Oesophageal • Pancreatic • Stomach • Non-Hodgkin’s lymphoma • Ovarian • Leukaemia 3
    • 4. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Lung cancer 9
    • 10. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Upper GI cancer 10
    • 11. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Lower GI cancer 11
    • 12. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Breast cancer 12
    • 13. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Gynaecological cancer 13
    • 14. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Urological cancer 14
    • 15. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Haematological cancer 15
    • 16. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Skin cancer 16
    • 17. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Skin cancer – 7-point check list Major features Minor features Change in size Largest diameter 7mm+ Irregular shape Inflammation Irregular colour Oozing Change in sensation 17
    • 18. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Head and neck cancer 18
    • 19. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Thyroid cancer 19
    • 20. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Brain and CNS cancer 20
    • 21. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Bone cancer and sarcoma 21
    • 22. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Children and young people 22
    • 23. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Pass information on to specialist team Take account of social, cultural and gender issues Tell patient they can contact practitioner again For children, involve parents and carers Provide opportunity for second consultation Give ‘bad news’ following current advice Tell patient they are being referred to cancer service Check if patient wants to be involved in decision about referral ? Check if patient wants to consult practitioner of same sex? Assess patient’s needs Support and information for patients 24
    • 25. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 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 differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 Further information • Quick reference guide: summary of the recommendations for health professionals – www.nice.org.uk/CG027quickrefguide • NICE guideline: all of the recommendations – www.nice.org.uk/CG027niceguideline • Full guideline: all of the evidence and rationale behind the recommendations – http://www.nice.org.uk/CG027fullguideline • Information for the public: plain English version for patients, carers and the public – http://www.nice.org.uk/CG027publicinfo 33
    • 34. Intro Context Cancer guidance – key differences Implementation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Info 28 29 30 31 32 33 34 www.nice.org.uk 34

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