From attitude to action - measuring awareness of cancer

NHS Durham and Darlington commissioned a large survey, with 6,000 people interviewed face to face in the five communities in Durham and in Darlington. Consultant in public health Nick Springham says, ‘We knew lung cancer was one of the biggest killers. Only when we did the CAM did we realise we had a huge job to do with communities in terms of raising awareness.’

The PCT has commissioned a new cancer awareness service, with 12 staff working in four clusters, and will test how effective it has been in its first year by running the CAM again in the areas where it has been operating and in some other communities to provide a control.

The CAM helped to inform the work of the new service. As well as pinpointing which areas to work in, it identified the barriers that stopped people going to their GP if they were worried about a possible sign of cancer and prompted the idea of publicising some good news stories about cancer survivors to counter the fatalism that was prevalent.

Sandwell PCT consultant in public health medicine Dr Alexis Macherianakis said his results were very similar to those of the national survey carried out by the Office for National Statistics and the surveys in the North East and Doncaster. ‘It is very interesting that the results are similar, regardless of the population and the sampling methodology,’ he says. He believes the CAM is useful as an intervention in itself, as 1,200 people in Sandwell now know a lot more about cancer symptoms than they did before they took part in the telephone survey. Interviewees are asked whether they recall any symptoms of cancer and then whether they recognise any of the nine common signs.

Macherianakis is now running a number of initiatives partly based on the results of the survey, including cancer awareness road shows and cancer awareness training for community staff.

‘The CAM doesn’t make an all or nothing difference, but it contributes,’ he says. When training community staff or talking about screening, quoting the results of the CAM has ‘a different power’ to the sort of information Alexis had previously. ‘One is an anecdote, the other is much harder evidence.’

The main result for himself personally, as the lead on bowel screening, was evidence that awareness of the bowel screening programme was much less than for breast and cervical cancer, suggesting that more work was needed.

Brighton and Hove Teaching Primary Care Trust became aware of the potential of the CAM as an awareness-raising tool as its face-to-face survey of 3,000 people progressed. So the final 1,000 interviewees were provided with a handout following their interview, which gave them the answers to the questions they had been asked and listed the symptoms of cancer. People were advised to visit their GP if they had any concerns.

According to public health improvement principle Martina Pickin, ‘It would have been useful to have CAM questions and answers set out in a booklet, specifically designed for handing out to interviewees, to reinforce learning.’

When Anglia Cancer Network commissioned a network-wide survey, the results were in line with the national survey that was carried out and didn’t point to a particular disease that needed special attention.

According to network public health consultant Dr Gina Radford, what was most useful was some extra analysis she commissioned to build up a picture of the people identified by the CAM who were least likely to go to the doctor early. Using social marketing techniques, the characteristics of each group were profiled, pointing to ways they could be targeted.

The groups were those afraid or embarrassed to go to the doctor, who were predominantly young women, and those particularly lacking in awareness of symptoms and of screening programmes who tended to be young single males who were not English speakers at home. A final very small group of mainly young single men with few qualifications from urban, deprived areas could be classed as ‘GP avoiders’ who claimed they would be unlikely to go to the doctor even if they recognised a symptom as being potentially cancer.

‘What this data has revealed is that there are segments of the population who have different awareness levels, different beliefs and different behaviours. By understanding these clusters we can target messages about prevention and awareness,’ Gina says.

Peninsula Cancer Network went for a small sample, just 50 people living in deprived areas in each of the four PCTs, to allow the PCTs to get a feel for the CAM and provide some information to support an intervention on lung cancer that was already planned. Alongside the CAM, focus groups were commissioned with people aged over 50 in these target areas, to provide more in-depth information about their views.

Former Peninsula Cancer Network consultant in public health Dr Ian Mackenzie says a full representative survey might be commissioned in future, but probably only if the PCTs were planning a campaign of awareness raising and wanted to measure attitudes before and after. Alternatively, the PCTs might want to commission a survey focusing in more detail on the network’s two priorities - lung cancer because it is the biggest killer and skin cancer because Peninsula’s rates are the highest in the country.

‘We are trying to take all the steps rather than just jumping in. It has to be the will of the PCTs as well as the network,’ Ian says.

Consultant in public health, NHS County Durham, Nick Springham, nick.springham@nhs.net
Sandwell PCT Consultant in public health medicine, Dr Alexis Macherianakis, Alexis.Macherianakis@sandwell-pct.nhs.uk
Anglia Cancer Network public health consultant, Dr Gina Radford, Gina.radford@cambridgeshire.nhs.uk
Peninsula Cancer Network Commissioning Manager, Jonathan Miller, jonathan.miller@nhs.net

Case study written by Ros Bayley on behalf of the National Cancer Action Team