An Initial Evaluation of the NAEDI Regional Awareness Pilots NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED

An Initial Evaluation of the NAEDI Regional Awareness Pilots

NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED ELSEWHERE

Intr

od

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ion

Background (1): Late diagnosis is a major problem

• 10,000 deaths could be avoided each year in England if our cancer survival rates matched those in the best countries (e.g. Australia, Canada and Sweden)

• Bowel cancer accounts for 1700 of these avoidable deaths

• Late diagnosis is thought to be the single most important factor underlying poor survival

• The Government has set a goal that an additional 5000 lives p.a. should be saved by 2014/15. This would bring survival in England up to the average for Europe


Be

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Background (2): Bowel cancer

• 5 year survival in England around 50%, compared with over 60% elsewhere

• Major opportunities for improving outcomes – prevention, screening, earlier diagnosis of symptomatic cases, better treatment

• But .... low public awareness and late diagnosis (25% present as emergencies)

• Hence ... Regional awareness pilots run in 2 Regions (EoE and SW) over 7 weeks in late January – March 2011

• Emphasis on 2 key symptoms: loose poo and blood in poo continuing for 3 weeks or more


Def

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Assumption: TV advertising had the most impact of all the media forms used in the campaign over the widest area.

Analysis of broadcast areas and PCT/CT boundaries using GIS allowed classification of organisations.

CATEGORY 1: PCTs in pilot area that get all print/radio media and are >=85% covered by one TV region

CATEGORY 2: Wider pilot area, PCTs get all print/radio media but may be covered by a different TV region

CATEGORY 3: PCTs outside the pilot area probably do not get any of the print media/local radio, but may be covered by TV region

CATEGORY 4: PCTs outside the pilot area probably not impacted by any of the national awareness material

CATEGORY 5: PCTs outside the pilot area in the North East, not overlapped by any media service that may have carried national campaign material

Please note there is a slight error in the map covering Milton Keynes, this has been allowed for in all analysis

Contains Ordnance Survey data © Crown copyright and database rights 2008


Evaluation: Awareness and Acceptability

Three phases of quantitative research:

• Pre/post tracking surveys with over 55s (face-to-face)– East of England and South West– c. 470 people per region per wave– Control: rest of England, c.490 per wave

• GP Survey– c. 100 telephone interviews per region (including control, rest of

England)– Post campaign fieldwork

• Face to face events– Exit interviews at events– 126 South West and 206 East of England

• All conducted by TNS BMRB


Base: All who had seen bowel cancer advertising - Regional Pilot (Control Pre/Post: 66/74) (SW Pre/Post: 85/188) (EE Pre/Post: 66/153)All who had seen bowel cancer advertising – GPs (Control: 55) (Test: 175)

To raise awareness of the link between lifestyle and

bowel cancer

To raise awareness of the signs and

symptoms of bowel cancer

To encourage people to take up the offer of a

bowel cancer screening programme

To encourage people to go and see their GP

CM3. (Regional Pilot) Which of the following were the main messages of what you recently saw, heard or read about bowel cancer? Please select up to three.; Q3. (GPs) What was the main message of what you have recently seen or heard about bowel cancer? (Unprompted)

Note: small base sizes for Control and

pre stageCONTROL SOUTH WEST EAST OF ENGLAND%

Pre

Post

Main message of bowel cancer advertising (prompted)

Significantly different (95% level) to the:

∞ Control group† pre-stage in the same area

48

44

37

31

36

49

35

39

52

33

57

44

45

45

34

23

46

40

45

52

38

28

19

55

∞

∞

∞

∞†

†


Base: All respondents – GP (Control: 116) (SW: 125) (EE: 103)All who had seen bowel cancer advertising – GPs (Control: 55) (SW: 101) (EE: 74)

…to raise awareness of the link between lifestyle

and bowel cancer

…to raise awareness of the signs and

symptoms of bowel cancer

…to encourage people to take up the offer of a bowel

cancer screening programme

…to encourage people to go and see their GP

Q1. (GP) Have you seen, heard or read any adverts, publicity or other types of information since the beginning of February about bowel cancer?; Q3. (GPs) What was the main message of what you have recently seen or heard about bowel cancer? (Unprompted)

Note: small base sizes for control

Main message of bowel cancer advertising (unprompted) – GP survey

•% of GPs aware of bowel cancer advertising and publicity:•Control: 46% South West: 79% East England: 74%

Of those GPs aware, they perceived the main message to be...

1

35

49

72

0

25

54

72

8

49

30

34 ∆

∆

∆∆

∆

∆

Control

South West

East of England

%

Significantly different at 95% to the:∆ Control group (GP)


46

40

12 10 11

7571

22

1612

75

69

22 22

14

%

TVTV RadioRadio LeafletLeafletPrintPrintAny adAny ad

Q24b-e. (Regional Pilot) Have you [seen this ad on TV/ heard this ad on the radio or anything similar/ seen any of these ads/ seen this leaflet] in the past couple of months?

Base: All respondents – Regional Pilot (Control Post: 428) (SW Post: 510) (EE Post: 475)

∞ ∞

∞ ∞

∞ ∞

∞

∞

The sample was split and each respondent was played 1 of 3 ads

The sample was split and each respondent was played 1 of 3 ads

Control

SW

EE

Prompted recognition of ads




53

72

76

94

96

47

75

76

95

96

56

65

66

92

93

%

Control

South West

East of England

Communication of ads

It is important that adverts like this are shown

This advertising is clear and easy to understand

The advertising is relevant to you

This advertising stands out from other advertising

The advertising told you something new

89% of GPs who had heard of the campaign

agreed with this(Please note: base sizes too small

to report on control)

Q.24h (Regional Pilot) Thinking about all of this advertising, please tell me to what extent you agree or disagree with each statement. Q9 (GP). Thinking back to this advertising, please tell me to what extent you agree or disagree with each statement – It is important that adverts like this are shown.

Base: All respondents - Regional Pilot (Control Post: 428) (SW Post: 510) (EE Post: 475) All who had heard of campaign – GP (Control: 18) (Test: 85)

∞

∞

∞

∞

∞∞

∞

9




%

13

7

1

3

2

4

4

7

20

10

11

38

27

25

2

2

3

3

4

5

6

6

9

13

19

25

Don't know

Going to the toilet more often

Blood when you go to the toilet

Weight loss

(Strange/change in)colour of stools

Constipation

Bleeding from back passage

Stomach/adbominal pains

Loose bowel movements

Pain/discomfort

(Change in)bowel movements/habits

Blood in stools/faeces

Bleeding/loss of blood

Pre

Post

Base: All respondents– Regional pilot : (SW Pre/Post: 475/510)

†

†

†

Q. 15 (Regional pilot): There are many signs and symptoms of bowel cancer. Please write in as many as you are aware of

Focus of publicity

10

Significantly different (95% level) to the:∞ Control group

† pre-stage in the same area

Top-of-mind knowledge of signs and symptoms: South West


Focus of publicity

%

13

4

2

1

4

3

5

5

16

9

13

32

31

25

2

2

3

3

4

5

6

7

10

11

22

27

Don't know

Going to the toilet more often

Blood when you go to the toilet

Bloating/swelling of stomach

Irregular bowel movements

Constipation

Bleeding from back passage

Stomach/adbominal pains

Loose bowel movements

Pain/discomfort

(Change in)bowel movements/habits

Blood in stools/faeces

Bleeding/loss of blood

Pre

Post

Base: All respondents – Regional pilot: (EE Pre/Post: 490/475)

†

†

†

†

Q. 15 (Regional pilot): There are many signs and symptoms of bowel cancer. Please write in as many as you are aware of11

Significantly different (95% level) to the:∞ Control group

† pre-stage in the same area

Top-of-mind knowledge of signs and symptoms: East of England


Bowel cancer awareness campaign evaluationImpact on patients attending

GP appointments

23rd June 2011


To look at the impact of the ‘Be Clear on Cancer’ bowel awareness campaign on patients visiting their GP with the symptoms highlighted in the campaign.

74 Practices included in analysis

Mount Vernon Cancer Network (23),

Anglia Cancer Network (21)

Avon, Somerset and Wiltshire Cancer Network (30)

Data extracts included

– Age and gender of the patient– Date of visit– Read code (V2) and description of symptom

Activity covered 16 months from Jan 2010 to April 2011

Introduction

Scope

Objective


Activity over 16 months Key bowel cancer symptomsActivity for the three key symptoms relating to bowel cancer shows an increase of 48% between 2010 and 2011.

Evaluation months 2010

Evaluation months 2011


Three symptoms are directly linked to the campaign.

These symptoms show a combined increase of 48%.

Compare with Diarrhoea which shows a decrease of 15%.

An unrelated control group also decreased by 12%

Year on year comparisonSymptoms directly linked to the campaign

Combined increase = 48%


For the three key symptoms there appears to be a significant increase in GP attendances resulting from the campaign.

During the three months from the start of the campaign, total attendances across the 74 practices increased by 700 (up 48%)

For the over 50s, the 74 practices saw an increase of 500 attendances (up 46%)

Equates to an additional 9 patients per practice over 3 months from start of campaign

74 practices analysed had a registered population of 640,000

Scaling up nationally:

By population gives 50,000 additional GP visits

Results


Def

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Assumption: TV advertising had the most impact of all the media forms used in the campaign over the widest area.

Analysis of broadcast areas and PCT/CT boundaries using GIS allowed classification of organisations.

CATEGORY 1: PCTs in pilot area that get all print/radio media and are >=85% covered by one TV region

CATEGORY 2: Wider pilot area, PCTs get all print/radio media but may be covered by a different TV region

CATEGORY 3: PCTs outside the pilot area probably do not get any of the print media/local radio, but may be covered by TV region

CATEGORY 4: PCTs outside the pilot area probably not impacted by any of the national awareness material

CATEGORY 5: PCTs outside the pilot area in the North East, not overlapped by any media service that may have carried national campaign material

Please note there is a slight error in the map covering Milton Keynes, this has been allowed for in all analysis

Contains Ordnance Survey data © Crown copyright and database rights 2008


Cat

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es This approach produced the following number of PCT/CTs in each category (as at April 2011):

Category Number of Organisations

Category One 5

Category Two 23

Category Three 4

Category Four 108

Category Five 12

PCT level data is still unvalidated and in the process of being analysed. As part of this process, categories One and Two are being aggregated as they were “probably impacted” by the campaign, and likewise Categories Three and Four are being aggregated as “probably not impacted”


Impact on 2ww lower GI referrals

– Comparing urgent GP referrals for suspected lower GI cancers in Q4 2009/10 and Q4 2010/11 there was a 34.4% increase in the number of patients seen. Although some trusts saw at least a doubling of referrals during the campaign period.

– The data we have so far does not show a change in number of cancers diagnosed or change in stage of diagnosis. We expect to have more complete staging data at the end of September, by which time we would expect that the majority of new patients diagnosed to be reported to the cancer registries.

PLEASE NOTE: No attempt has been made to adjust for any impact from local awareness campaigns within these data, so any changes in activity levels may be due to local pressures rather than the regional pilot campaigns


Summary

1. The regional campaigns raised awareness of the signs and symptoms of bowel cancer

2. TV advertising (as expected) had the greatest impact

3. Attendances in primary care with relevant symptoms increased, but numbers were manageable

4. 2ww colorectal referrals appear to have increased markedly during the campaign


Summary (2)

5. Colonoscopy rates increased markedly, but these are still being quantified

6. Impact on bowel screening uptake is still being evaluated

7. We do not yet have reliable data on numbers of patients diagnosed or stage at diagnosis

8. The increase in endoscopy will almost certainly have led to polyp detection and hence to cancers being prevented


Documents

An Initial Evaluation of the NAEDI Regional Awareness Pilots NB. SLIDES CONTAIN UNVALIDATED DATA NOT YET IN PUBLIC DOMAIN SO MUST NOT BE QUOTED OR PUBLISHED