Increasing faecal immunochemical test completion to improve outcomes for communities at risk of colorectal cancer

What we did:

In August 2023, Dorset Integrated Care System’s (ICS) Cancer Programme worked with Health Innovation Wessex (HIW) to engage with people across Dorset to understand awareness and experiences of using FIT. They also undertook a Dorset-wide public survey and worked with Core20PLUS5 community groups (homeless, learning disability, fishermen, farmers, and construction workers) to understand experiences and identify interventions that could improve experiences and access to the test. 

Between December 2023 and January 2024, instructional videos (the first intervention) were tested with the identified Core20PLUS5 groups and through a second Dorset survey to understand if these additional resources would meet the needs identified in August. Further work is underway to develop the second intervention – standardised patient information.

Alongside this work and with support from a GP champion and lead GPs for cancer in Dorset, the clinical decision support tool, C the Signs, was implemented in August 2023 across all Dorset primary care networks (PCNs) to enable primary care teams to track and support FIT uptake by their patients.

HIW completed an independent evaluation.

What impact did it have?

To date, the outcomes and impact of the project have included: 

• Engagement with over 900 members of the public in Dorset.
• The identification of at least two interventions that could support uptake of FIT; instructional videos and standardised patient information.
• The implementation of C the Signs across all PCNs in Dorset and its use in 68 out of 69 practices.
• Changing the transparency of the packaging for completed kits following patient feedback that it was embarrassing to return these in person, benefiting all patients across England.

Outcomes:

This project has generated two core learning outcomes: the importance of understanding incentives and the use of local champions. 

Understanding the incentives for both clinical and public engagement within projects is recognised to have a significant impact on outcomes. For example, a key challenge to the project was making meaningful links with people from under-served communities; relationships that were critical to learning from individual experiences. To enable this, the project connected with local community group leaders who helped champion the work and invited the team to join established community meetings to begin those relationships. These interactions highlighted that incentives within community members were intrinsic, driven by a desire to share their experiences and opinions on what improvements look like. This has given the project team confidence to build on these relationships and identify short-, medium- and long-term plans to test interventions with a ’You said, we did’ approach.

Similarly, the complexity of coordinating and engaging with multiple partners and stakeholders for the deployment of a primary care digital platform across an entire ICS identified both expected and unexpected challenges, such as variations in systems used and team capacity to implement the platform. To address these challenges, a core group was identified comprising of IT, primary care, and ICS team members with a dedicated Primary Care Clinical Lead, who were willing and able to engage and understand the needs of clinical teams before, during and after the system was implemented.

FIT remains a national priority and the work started with the Dorset CORE20Plus5 communities will be used and evolved by the Dorset ICS Cancer Programme and Wessex Cancer Alliance. The team have developed short-, medium and long-term approaches for continuing the engagement with, and learning, from local communities.