Our innovation is a multiplatform decision support tool, available on IOS, android and as a website. The tool uses artificial intelligence mapped with the latest evidence to help General Practitioners (GPs) identify patients with Cancer early.
C the Signs gives GPs the ability to simultaneously check combinations of signs, symptoms and risk factors, in an easy to use format. It can be used during the consultation, when the opportunity to influence decision-making is at its greatest. Covering the entire spectrum of Cancer and cross-referencing multiple diagnostic pathways, C the signs can support GPs in recommending what investigations or urgent referrals the patient may need, in under 30 seconds.
GPs can search by symptom such as ‘appetite loss’ and be shown each diagnostic pathway where appetite loss is featured. Alternatively, GPs can search by system (e.g. “Chest” or “Breast”). Once the GP enters the information, regardless of whether they are in the ‘Chest’ or ‘Breast’ section of the tool, the information is cross-checked against the entire database. This feature highlights to the GP when the patient qualifies for multiple pathways. This is important as pathways are system specific, they do not exclude Cancer entirely, only Cancer in that system. Cross-referencing gives GPs a guide to the next steps to take and any additional tests they may wish to request alongside the primary referral.
The tool also displays the relevant part of the evidence where the recommendation has been taken from, enabling the GP to learn in a clinical context, improving recognition of signs and symptoms and retention of the recommendation.
EVIDENCE FOR EARLY DIAGNOSIS
There is a coherent commitment to support early diagnosis in primary care as outlined in key policy documents such as the Five Year Forward View, the Independent Cancer Task Force Review – Achieving World-Class Cancer outcomes: a strategy for England 2015-2020 and the International Cancer Benchmarking Partnership.
The new NICE guidelines Suspected cancer: recognition and referral (NG12) have gone further than ever before to diagnose more patients early. Using primary care data and evidence, the guideline recommends more signs and symptoms that feature in the early stages of Cancer. They lower the positive predictive value ‘threshold’ of when a symptom, or collections of symptoms should trigger a referral, from 5% to 3%. This means, that any patient with a 3/100 chance of having Cancer (or higher) should be referred. Some of the recommendations for children and young people have been set lower than this.
The lowered threshold at 3% will enable more patients to be diagnosed at the early stages of Cancer. In addition to this, there are more pathways for direct access diagnostics to supports GPs to refer patients directly for scans and endoscopies. Currently 25% of patients are diagnosed in Accident and Emergency, usually as a complication of their Cancer; as such they face poorer outcomes. The guidelines plan to drive more referrals and diagnostics using dedicated patient pathways in Primary care.
Cancer patients diagnosed in A&E
Primary care is well placed, as this is where the patient presents first. GPs however, are generalist not specialists, caring for patients with a whole breadth of conditions and illnesses. The early signs and symptoms of Cancer are vague, non-specific and overlap with other long-term health conditions. On average GPs will see fewer than eight new patients with cancer each year, and may see a rare cancer once in their career.
GPs are expected to memorise a multitude of guidelines and diagnostic criteria, which they are held accountable to. This is becoming increasingly difficult in the current climate of General Practice, with rising workload and workforce shortages. Within the constraints of a 10minute appointment, this can prove extremely challenging, especially when existing decision support tools are paper base, long and inaccessible.