Theme 3.3 - C-DAPT (cancer diagnostic pathways Improvement Project)

• Lead Investigator: Prof Greg Rubin
• Study lead Bristol: Dr Ardiana Gjini
• Study lead Durham: Prof Greg Rubin
• Co-investigators: Dr Jon Banks; Prof Willie Hamilton; Dr Fiona Walter
• Researcher: Dr Nicky Hall
• Consumer representative: Alison Clutterbuck

The aim is to develop optimum cancer diagnostic pathways for lung, colon and pancreatic cancers within two clinical commissioning groups (CCGs), using the information generated by the earlier parts of the programme. The project has been developed in line with local and national initiatives and objectives and will be undertaken in NHS Bristol and NHS Sunderland working alongside the local CCGs.

Overview

This is a two-centre study in which evidence from earlier phases of DISCOVERY, on the predictive value of symptoms and on patient preference for investigation, will inform a refinement of existing pathways for assessment of patients with suspected cancer. The exemplar cancers will be lung, colorectal and pancreas. The primary outcome of interest will be change in urgent referral metrics (referral ratio, conversion and detection rates) for practices in the two centres. Secondary outcomes will be proportion of cases diagnosed as emergency presentations. The study will take place in NHS Bristol and NHS Sunderland working alongside the local CCGs

Expert group

A multidisciplinary expert group will be constituted for each site comprising secondary care specialists, GP cancer leads and cancer network directors. The group will work alongside the Discovery team in each area to map and refine diagnostic pathways.

The reference pack

A pack of background information will be developed, to be supplied to the expert group in order to inform their planning. It will contain:

1. Information on current practice, with local and national figures to allow comparison.
2. Current pathways. To include NICE referral criteria as well as any local adaptation of 2WW pathways currently in operation. Guidance on direct access to investigations as published by DH in 2012. Map of Medicine flowcharts for the three sites.
3. Discovery findings. To include Caper study-derived RATs for all three sites with related publications; results of PIVOT; emerging findings from Discovery 3.2

Implementation

Once adapted pathways have been agreed by the expert group for each centre, they will be presented to the relevant CCG for its endorsement.

Implementation will comprise:

• Mailing to all GPs in each centre of the adapted pathways in user-friendly formats
• Engagement with GP cancer leads, who will be key influencers at local level
• Presentation at a protected learning time event for GPs and at practice manager fora
• Placing of pathways on local intranets aimed at primary care and on trust websites