Summary
The Macmillan Cancer Decision Support Tool (CDS) is a symptom based software tool that aids GPs’ clinical judgement. It runs in the background of a GP’s computer system and is activated when a patient record is viewed. CDS is central to developing the area of early diagnosis of cancer by identifying and linking symptoms that may otherwise be missed in a busy surgery environment. CDS can also be used in two more explicit ways as a symptom checker and to illustrate which patients are at a higher or lower risk of cancer via its Population Risk Stratification function. CDS is currently live in over 550 practices across the UK and is being used by over 2,000 GPs during patient consultations.Challenge
People with cancer who are diagnosed early are easier to treat and more likely to recover. Over 300,000 people in the UK are diagnosed with cancer every year, but the average GP sees just eight or nine new cancer patients a year. Cancer decision support tools raise GP awareness of cancer symptoms, enabling early referral for further investigation.
The Macmillan Cancer Decision Support Tool runs two complementary algorithms (QCancer and RAT), analysing for different risk factors. Macmillan integrated them to create software suitable for daily clinical practice. Software compatible with all GP IT systems, BMJ’s Informatica iCAP, was used.
Objectives
The objective is simple. The Macmillan Cancer Decision Support Tool is designed to assist GPs in diagnosing cancer at an earlier stage. Interim findings show that the decision support tool makes a GP think more about cancer at the symptom stage; this could lead them to investigating or referring quicker.Solution
Macmillan developed a comprehensive suite of training materials to ensure that participating GPs were confident in using the CDS. This included videos, how-to guides, FAQs, and ongoing access to ad hoc advice delivered by local project leads with experience of practice engagement in their area.
Results
CDS is an efficient extension of the existing system and the ease of its integration into new GP practices has been influential in the decision for it to be rolled out across the UK by next year. From April 2014 onwards, Macmillan will be offering CDS to all GPs across the UK.Learnings
The team will share its lessons once the full report is complete.Evaluation
CDS has been in place in over 550 GP surgeries since summer 2013, showing clinical effectiveness and bringing greater awareness around early diagnosis.
In 31 per cent of cases, GPs’ perceived risk of the patient was lower than that calculated by the symptom checker. A fifth (19 per cent) of all patients that the symptom checker tool was used on were referred on for suspected cancer and nearly a quarter (23 per cent) were intended for investigation. A fifth of those referred or investigated would not have been, had the symptom checker not been used, GPs reported.
