Early diagnosis amongst older audiences Creative development research

1. Prepared by: Research Works Ltd, Regency House, Quadrant Business Centre, 219a Hatfield Road, St Albans AL1 4TB October 2011 Early diagnosis amongst older audiences Creative development research Be Clear on Cancer: Breast Cancer in Women 70+

2. Research objectives • To contribute to the development of the Breast cancer pilot campaigns by:

3. Method and sample: summary • 13 extended mini-focus group sessions (2 hours, 5 respondents) • 10 with the core target audiences (including ethnic minorities) • 3 with influencers (including ethnic minorities) • 48 hall test depth interviews (20 minutes duration) • 32 with the core target audience (including ethnic minorities) • 16 with influencers/friends/family (including ethnic minorities) • 8 depth interviews with GPs (1 hour) • Fieldwork conducted in Durham, Hull, Wolverhampton, Manchester, Blackburn, Bristol, Nottingham, Brighton, Lambeth, Wandsworth, Harrow and Luton between 3rd and 6th October 2011

4. Overview of findings

5. Overview • The ingredients for the campaign’s continued success have been established: • Communicating ‘new news’ about potential cancer symptoms • Providing guidance about when to take action i.e. describing a specific, identifiable symptom • Offering reasons for taking action i.e. early diagnosis • Supporting the decision to go and see the GP • The campaign also maintains an informative, reassuring tone. Any deviations – e.g. humour or increasing alarm - were rejected

6. Core target audience: Women 70 and over • Older respondents were more likely to struggle with the practicalities of using health services, particularly in terms of understanding how to access services and the new types of services available • This group wanted to feel that their GP understood their needs – sometimes feeling that there was a lack of interest in their whole health (both minor ailments and major health problems) • Influencers described how it was often difficult to influence parents and friends determined to lead independent lives yet increasingly needing their support • Neither influencers nor the target audience were aware of the relevance of breast cancer for those aged 70+ years old prior to reviewing the campaign

7. Breast cancer: 1 in 3  The headline “1 in 3 women diagnosed with breast cancer are over 70” proved extremely impactful  This message provided some news – and in doing so, distinguished the campaign as saying something different about breast cancer ? Amongst older ethnic minority groups there was some uncertainty about the meaning of the phrase ‘past it’, although this did not affect overall comprehension of the headline  A small minority interpreted the copy text as saying that 1 in 3 women over 70 die of breast cancer. Consider how to communicate the idea of ‘diagnosed’ more clearly

8. Breast cancer: radio The radio execution successfully communicates the range of breast changes that need to be reported in a non-alarmist way  The voices were perceived to be relevant and credible  The delivery was perceived to be calm and informative. It was recognised that as one gets older skin texture changes, but the fact that these changes may not simply be the result of ageing was new news  The phrase ‘perhaps it is because I am getting old’ should be amended to read ‘perhaps it is because I am getting older’. Target audience respondents simply did not think of themselves as old!

9. Leaflet: overall • Overall, the breast cancer leaflet was very well received. As with the bowel cancer leaflet, the overall amount of information, tone and layout were commended • The key piece of information was that one can request breast screening even if aged over 70 years old. For many this was welcome news • There were other surprises: the incidence of breast cancer amongst those aged over 70, and the range of different symptoms that could indicate breast cancer (e.g. swelling around collarbone) • Influencers felt that they would be more likely to pick up and read the leaflet than their elderly relations/friends. They appreciated the support the leaflet would give them when raising this personal subject (e.g. ‘you’re not wasting anybody’s time’)

10. Imagery The target audience selected women they felt were ‘like them’, avoiding any women who looked elderly (and were therefore less likely to be perceived as at risk)

11. Breast cancer: overall Myths held by the target audience were challenged (e.g. that there is always a lump, that older women less likely to get breast cancer) and the call-to-action was understood and taken seriously Influencers were encouraged to think about the relevance of breast cancer for the older ladies (mothers and friends) they looked after  The research supports the development of: • the 1 in 3 press execution • the radio execution • and the leaflet

12. GPs

13. GPs – campaign overview There were signs that awareness of the campaign is beginning to filter through: some GPs reported that they recalled the BCOC logo The perceived informative, reassuring tone of the campaign was supported. GPs felt that the campaign struck a balance between: encouraging those who need to be motivated to see a GP; and those who are likely to over-react and may become alarmed

14. GPs – breast cancer ? There was surprise that the breast cancer campaign was targeting those aged over 70 years old – and some scepticism regarding the ‘1 in 3’ statistic ? A tension between a campaign reporting highlighting the risks of breast cancer for the over 70 audience and the fact that screening stops at 70 was identified ? Some GPs suggested that it would be useful to emphasise the survival rate  The campaign briefing will need to explain the reasons why a target audience of women over 70 years old has been selected and what the campaign is trying to achieve

15. GPs – toolkit “What do you mean by toolkit? Yes, we receive them, but the question is, do we use them anddo they help us?” “You need it in electronically so you can use the links easily that are in the information.” “We receive things electronically. If it comes on hard copy it will get filed away. We won’t actually see it unless it’s loaded onto our server. I will save the ones I think I will use. I prefer electronic as I can find it when I want it.”

16. GPs – toolkit: in general  As previous research has indicated, GPs preferred an electronic version of the toolkit, reporting that hard copy was likely to become filed or shelved  Toolkits providing this type of information will need to provided in an electronic format • There were complaints about being given too much information  Short resources (i.e. 1-2 pages) which make key points accessible by using bullet points were strongly favoured

17. GPs – Lung cancer toolkit The BCOC toolkit was described as short with a clear layout  GPs felt that the answers to their questions were clearly accessible and that the document was easy to read  Overall, GPs appreciated the ‘briefing’ and felt that it would make them feel more prepared

18. Conclusions

19. Conclusions: • BCOC typically provides a strong, symptom and duration-based message that can be easily understood and assessed by its target audience. Its tone is balanced, practical, reassuring and relatively unemotional • The campaign approach opens up a straightforward dialogue that normalises the issue of cancer and helps to educate and inform the target audience