Project update November 2012

1. Project update November 2012

2. What are cancer decision support tools? • Cancer decision support tools (CDS) are an aid to clinical decision-making, to assist GPs in their decisions about whether or not to refer or request further diagnostic investigation, in patients where they believe there is a risk of cancer • The tools in this project display the risk of a patient having a specific type of cancer • This risk is founded on analysis of historic population cohorts and their risk of having cancer based on a range of factors including symptoms, medical history and demographic data. • In this project we are focusing on rollout of two existing high profile tools: • QCancer developed by Professor Julia Hippisley-Cox • The Risk Assessment Tool (RAT), developed by Professor Willie Hamilton

3. What are the project’s aims? • Phase one of this project will focus on ensuring that tools have sufficient clinical buy-in that they are embedded in everyday practice, and that they work across primary and secondary care as valid and defendable reasons for referral. We will also evaluate their impact on referral and diagnostic activity • The project will focus on development of an IT-based version of these tools, integrated into GPs’ IT systems, and able to use historic READ-coded information in order to calculate risk • Phase one of the project will focus on risk scores for the assessment of the following cancers: lung, colorectal, pancreatic, ovarian and oesophago-gastric • Following phase one, and taking into consideration the messages from evaluation, we will promote these tools and their widespread use in general practice

4. CDS project phase one timeline 2012 2013 July August November December January February March April May June Phase one end Assimilation of QCancer and RAT into IT platform Development of training materials Cancer network training sessions GP training rollout Phase one tool in use GP practices recruited Load software onto GP systems Define evaluation methodology Data gathering for evaluation Engagement with GP IT providers

5. Who is involved? • This project will focus on the QCancer and RAT tools • Macmillan Cancer Support will lead the project, with an evaluation overseen by Cancer Research UK, and with part-funding from the Department of Health. The project forms part of the National Awareness and Early Diagnosis Initiative (NAEDI) • In phase one of the project, a number of English cancer networks will lead the rollout at a local level, working with over 650 GP practices • Practices in Wales and Scotland are also planning to take part • In phase one, the tool used in practice will be developed by BMJ Informatica, though it will work across a wide range of native GP IT software • In parallel, the project will engage with GP software providers, to promote understanding and ensure widespread use and rollout after phase one

6. What will the tool look like? • Cancer decision support tools are designed to assess the risk of a patient having an existing, but as yet undiagnosed cancer, by calculating a risk based on factors such as symptoms, medical history and demographic profile • GPs will use in everyday practice an IT-based cancer decision support tool with a simple user interface which can display scores for either RAT or QCancer • The tool will work in three ways: • Reactive prompt • Symptom checker • Audit function

7. (i) Reactive prompt Working automatically in the background using READ-coded information, the tool will calculate a risk of having cancer for every patient seen in consultation. If the risk is above a certain level, a prompt will appear on screen letting the GP know that they might like to consider whether the patient might warrant a referral or investigation for a suspected cancer.

8. (ii) Symptom checker Used in consultation where READ codes are not already known, a symptom checker can be called up, which allows the GP to enter relevant symptoms, calculate a risk, and then re-enter observed symptoms into the patient’s record as a READ-coded entry.

9. (iii) Audit function An audit function will show calculated risk levels of all registered patients on a practice’s list. This can be sorted to show those calculated to have the highest risk, and used to consider whether any further action should be taken for these patients.