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BMJ and Macmillan help GPs spot cancer earlier

Interview by Ingrid Bray, BMJ

BMJ and Macmillan help GPs spot cancer earlier

BMJ and Macmillan's Cancer Decision Support tool picked up first prize for 'Cancer Care' at the Patient Safety Awards 2015.

It also won the HSJ Award 2014 for 'Value and Improvement in Information and Technology.'

Dr. Anthony Cunliffe is a London-based GP and Macmillan GP advisor. We caught up with him to hear how BMJ and Macmillan's double award-winning Cancer Decision Support Tool (eCDS) supports GPs' everyday decision-making.

Delivering excellent cancer care is a core priority for the NHS and the Patient Safety 'Cancer Care' award 2015 celebrates those who have worked hard to improve care within this field. Macmillian Cancer Support curried favour with the judges for its work on an electronic cancer decision support (eCDS) tool. In collaboration with BMJ, Macmillan created an electronic tool designed to support GPs with early diagnosis of cancer. The tool intends to aid diagnosis in a situation where a GP is unsure whether to refer a patient or wants confirmation of next steps.

Since its development the tool has been implemented in more than 550 GP practises and is now being regularly used by more than 2,000 GPs across the UK. The Patient Safety Awards 2015 judges described the tool as “very innovative” and were convinced that it will “contribute to improved outcomes for patients”. The tool is now installed at 1228 practices across the UK and rising. 

About the tool

The eCDS toolset is 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. The tool was developed by BMJ with insight from Macmillan’s primary care community. It is IT-based with a simple user interface which can display scores based on two risk calculators for cancer: the Risk Assessment Tool (RAT), developed by Professor Willie Hamilton and QCancer developed by Professor Julia Hippisley-Cox.

CDS

The tool works in three ways:

1. Reactive prompts. Working automatically in the background, 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, at the point of care, letting the GP know that they might like to consider whether the patient might warrant a referral or investigation for a suspected cancer.

2. 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.

3. Audit function. Out of consultation, an audit function can be used which 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 then used to consider whether any further action should be taken for these patients.The programme has been deemed successful by BMJ. Over 65% of practices that currently subscribe to BMJ products have installed and are using the eCDS tool.   

The success of the eCDS tool pilot scheme has lead to the investment for significant improvements to create better usability and support faster diagnosis: both eRAT and QCancer calculators will trigger as pop‐up notification from the patient record, where the patient meets a defined threshold of a 2% risk of a cancer.  Notifications for each ‘triggered cancer’ will provide the clinician with the risk of the cancer and the contributing symptoms.   

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