intro context cancer guidance – key differencesimplementation...
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Intro Context Cancer guidance – key differences Implementation
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Referral guidelines for suspected cancer
NICE Clinical GuidelineIssue date: June 2005
Review date: June 2009
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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
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Top 10 cancer killers
• Lung
• Colorectal
• Breast
• Prostate
• Oesophageal
• Pancreatic
• Stomach
• Non-Hodgkin’s lymphoma
• Ovarian
• Leukaemia
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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
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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
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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
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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
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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
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Lung cancer
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Upper GI cancer
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Lower GI cancer
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Breast cancer
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Gynaecological cancer
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Urological cancer
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Haematological cancer
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Skin cancer
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Skin cancer – 7-point check list
Major features Minor featuresChange in size Largest diameter 7mm+Irregular shape InflammationIrregular colour Oozing
Change in sensation
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Head and neck cancer
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Thyroid cancer
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Brain and CNS cancer
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Bone cancer and sarcoma
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Children and young people
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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
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Pass informationon 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 toconsult
practitioner of same sex?
Assess patient’s needs
Support and information for patients
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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!)
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Key factors for implementation (1)
Training and education to ensure practitioners are:
familiar with typicalpresenting features
of cancers
alert to unusual symptom patterns orunexpected failure
to recover
alert to parental concerns when
dealing withchildren
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Key factors for implementation (2)
Systems in place so that practitioners can:
refer urgently and discuss referral
withspecialist
start investigations
without holding up
referral
provide appropriate support and information
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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
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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
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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
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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
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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 re
commendations
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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
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www.nice.org.uk
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