Cancer screening: informed consent

Public Health England has updated the Cancer Screening: Informed consent guidelines.

These guidelines give commissioners, providers and healthcare professionals in cancer screening information on consent to screening and procedures.

The document covers information and advice on:

  • breast screening
  • cervical screening
  • bowel cancer screening
  • mental capacity and consent

It also provides several template letters for patients withdrawing from programmes.

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Interactive dashboard provides new insight into cervical screening coverage

GPs and health organisations will be able to improve cervical screening rates thanks to an innovative new online data tool | NHS Digital

It is hoped that the interactive dashboard will help identify areas where screening levels could be improved and encourage work to boost coverage.

The dashboard will provide more detailed and timely information about cervical screening and will help Clinical Commissioning Groups (CCGs), GP practices and local authorities to improve coverage rates for the potentially lifesaving test, which are currently falling.

NHS Digital, Public Health England (PHE) and Jo’s Cervical Cancer Trust have collaborated on the initiative, which aims to provide easier access to the latest data about cervical screening3. This is part of a PHE-led project to empower GP practices and CCGs to improve cervical screening attendance and coverage rates.

Commissioning ophthalmology services for children

The approaches to the prevention of vision/eye conditions and promotion of good visual health for children require very different approaches to those used in adult services | The Royal College of Ophthalmologists

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Image source: RCO

This briefing document will help inform commissioners of the key issues to consider when commissioning services for:

  • Children with conditions that cause (or may cause) visual impairment (VI), severe visual impairment (SVI) or blindness (BL) (WHO definition i.e. corrected acuity in better eye of LogMAR 0.5 or worse)
  • Children with common eye conditions that cause (or may cause) unilateral or milder reduction in vision
  • Children with isolated refractive error alone or those with mild/acute/self-limiting conditions (e.g. conjunctivitis)

This briefing document sets out the themes and issues relevant to commissioning of ophthalmic services for children, on behalf of the Paediatric Sub-committee of The Royal College of Ophthalmologists.

Read the full overview here

Read the full briefing here

Targeted screening offers same benefits as health check at lower cost

Millet, D. GP Online. Published online: 8 November 2016

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Offering health checks to just the 8% of patients most at-risk of developing cardiovascular disease offers similar health benefits to national screening at a far lower cost, researchers have concluded. Offering health checks to all patients aged 40-74 in the national NHS Health Check is a ‘poor use of resources’, a modelling study has suggested.

A targeted approach to assessing cardiovascular disease in patients provides similar benefits to national screening, but at a fraction of the cost.

A total of 10,000 patients aged 30-74 who did not have existing cardiovascular disease or diabetes were involved in the study. Researchers from the University of Birmingham ran several simulations to model the costs of different approaches to screening patients. It showed that performing no case finding and inviting all the patients involved in the study for a cardiovascular check would yield 30.32 QALYs (quality-adjusted life years) – years lived without disease – at a cost of £706,000. In another simulation, they ranked the patients by cardiovascular risk and invited only the top 8% to attend a check. This yielded 17.52 QALYs, but cost considerably less at £162,000.

Read the overview here

Read the original research article here

Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial

Aveyard, P. et al. The Lancet. Published online: 24 October 2016

Background: Obesity is a common cause of non-communicable disease. Guidelines recommend that physicians screen and offer brief advice to motivate weight loss through referral to behavioural weight loss programmes. However, physicians rarely intervene and no trials have been done on the subject. We did this trial to establish whether physician brief intervention is acceptable and effective for reducing bodyweight in patients with obesity.

Methods: In this parallel, two-arm, randomised trial, patients who consulted 137 primary care physicians in England were screened for obesity. Individuals could be enrolled if they were aged at least 18 years, had a body-mass index of at least 30 kg/m2 (or at least 25 kg/m2 if of Asian ethnicity), and had a raised body fat percentage. At the end of the consultation, the physician randomly assigned participants (1:1) to one of two 30 s interventions. Randomisation was done via preprepared randomisation cards labelled with a code representing the allocation, which were placed in opaque sealed envelopes and given to physicians to open at the time of treatment assignment. In the active intervention, the physician offered referral to a weight management group (12 sessions of 1 h each, once per week) and, if the referral was accepted, the physician ensured the patient made an appointment and offered follow-up. In the control intervention, the physician advised the patient that their health would benefit from weight loss. The primary outcome was weight change at 12 months in the intention-to-treat population, which was assessed blinded to treatment allocation. We also assessed asked patients’ about their feelings on discussing their weight when they have visited their general practitioner for other reasons. Given the nature of the intervention, we did not anticipate any adverse events in the usual sense, so safety outcomes were not assessed. This trial is registered with the ISRCTN Registry, number ISRCTN26563137.

Findings: Between June 4, 2013, and Dec 23, 2014, we screened 8403 patients, of whom 2728 (32%) were obese. Of these obese patients, 2256 (83%) agreed to participate and 1882 were eligible, enrolled, and included in the intention-to-treat analysis, with 940 individuals in the support group and 942 individuals in the advice group. 722 (77%) individuals assigned to the support intervention agreed to attend the weight management group and 379 (40%) of these individuals attended, compared with 82 (9%) participants who were allocated the advice intervention. In the entire study population, mean weight change at 12 months was 2·43 kg with the support intervention and 1·04 kg with the advice intervention, giving an adjusted difference of 1·43 kg (95% CI 0·89–1·97). The reactions of the patients to the general practitioners’ brief interventions did not differ significantly between the study groups in terms of appropriateness (adjusted odds ratio 0·89, 95% CI 0·75–1·07, p=0·21) or helpfulness (1·05, 0·89–1·26, p=0·54); overall, four (<1%) patients thought their intervention was inappropriate and unhelpful and 1530 (81%) patients thought it was appropriate and helpful.

Interpretation: A behaviourally-informed, very brief, physician-delivered opportunistic intervention is acceptable to patients and an effective way to reduce population mean weight.

Read the full article here

HPV cervical cancer test introduced in England

BBC Health News. Published online: 4 July 2016

Illustration showing an artists interpretation of a Cervical cancer cell

The NHS in England is introducing a “superior” test for cervical cancer, following a successful pilot programme. Experts say it is a switch that could pick up an extra 600 cancers a year.

Women invited for a routine smear test will now automatically be checked for an infection called HPV (Human Papilloma Virus), which has been strongly linked to cervical cancer. Until now, an HPV test has only been done if doctors noticed abnormal cells in the smear sample.

Public Health Minister for England Jane Ellison said: “These changes are a breakthrough in the way we test women for cervical disease. The new test is more accurate, more personal and will reduce anxiety among women.

Read the full news story here