Feasibility of interventions for early cancer diagnosis explored in latest psychological studies

CanTest senior faculty member, Prof Suzanne Scott, recently presented at the 50th Annual Scientific Meeting of the SAPC (Society for Academic Primary Care), on her work with colleagues around ‘Provider perceptions of interventions to encourage prevention and early diagnosis of cancer after a negative diagnosis’.

Prof Scott is a Professor of Health Psychology & Early Cancer Diagnosis at Queen Mary University of London and specialises in applying psychology to the early diagnosis of cancer. Her research investigates patients’ help-seeking behaviour and symptom perception with the aim of using this to create interventions that could encourage timely healthcare use and facilitate early detection of cancer.

In her address to the SAPC audience, Prof Scott explained that for the majority (over 90%) of patients referred on urgent cancer referral pathways, cancer is ruled out: they have a negative or benign diagnosis. There are over 2 million people in England each year who receive a negative diagnosis after referral on an urgent cancer pathway. However, there is some evidence that these patients may delay seeking help for the same or subsequent symptoms potentially due to over reassurance, or just because patients are not sure what to do next. Following a negative diagnosis, people may be more receptive to health advice, but it is not currently clear whether it is feasible to provide additional support to these patients surrounding prevention and early diagnosis of future cancer.

As a starting point, Prof Scott and colleagues studied healthcare professionals’ views about the feasibility of introducing new initiatives to offer advice and support to encourage early diagnosis and reduce future cancer risk, after an initial negative diagnosis.

Online, semi-structured interviews were conducted with practising NHS healthcare professionals involved in the referral or ongoing care of patients referred onto the two-week wait pathway for suspected cancer. 36 healthcare professionals were interviewed in total (14 from primary care, including practice nurses, GPs, dentist; and 22 from secondary care across referral pathways for 8 different types of cancer). Participants were supportive of the need to explore additional ways to encourage early diagnosis of cancer. There was variability in the extent of support currently offered to patients after the two-week wait pathway for suspected cancer. Whether patients should or could be offered additional support and the content of that support was influenced by perceptions of resource requirements (e.g., consultation time, skill level of staff involved), along with judgements about the effectiveness of the intervention for achieving health behaviour change, and the potential consequences including patient anxiety or confusion. Perceptions around the goals of the two-week wait pathway and role of primary care influenced ideas about where support should be offered, healthcare professional’s motivation to offer support, and how support might be perceived by patients.

Overall, healthcare providers’ views will be crucial in informing the design of possible future interventions. The content, format and delivery of initiatives directed towards patients who receive a negative diagnosis following urgent referral for suspected cancer needs to be resource-efficient, have proven impact and be both relevant and understandable to patients in the context of their recent health experience. The team will explore the views of patients in their next project, starting Autumn 2022.

The above study builds on Prof Scott’s work on finding opportunities in existing systems to raise cancer awareness, concentrating on one-to-one interventions (rather than mass-media campaigns). Her latest paper published this week in Community Dentistry and Oral Epidemiology, entitled, ‘Talking about cancer: Patient responses to raising awareness of oral cancer in primary dental care’ explores the feasibility and fidelity of interventions within the dental setting, with positive results – raising awareness of oral cancer during dental check-ups doesn’t appear to lead to patient anxiety. In this new study, patients’ anxiety was monitored before and after their consultation. Dentists used a communication guide to lead conversations with patients about signs and symptoms of oral cancer. The consultations were audio-recorded so that the content of the discussions and reactions of patients could be monitored. Dentists are often concerned that introducing the topic of cancer cause patients to be worried, but this new research indicates that such interventions are well received and do not appear to induce anxiety. Read more in-depth details here.