Background
The trust average for did not attends (DNAs) is 6-7%, the colposcopy service was identified as being an outlier with a 10% DNA rate. Missing these appointments not only increases the risk of abnormal cells in the cervix turning into a cancer, but also each missed appointment costs the trust approximately £261.
In addition, the average cost of treating cervical cancer in the NHS ranges from £1379 per person (stage 1 cancer) to £19,261 per person (stage 2 or later) (jostrust.org.uk). So, not only is it important for us to encourage those who need a colposcopy to attend for their own wellbeing, it is also a much more cost-effective approach for the trust.
We looked at non-attendance data and found that people most at risk of not attending for their colposcopy were:
- People who live in deprived areas
- People between 25-39 years old.
What we did
It was clear that there are some improvements that can be made to encourage people to attend for such an important procedure.
A project was identified to by the health inequalities programme board which was led by the public health team with support and engagement from the colposcopy team.
It was important for us to better understand any:
- barriers that prevented people from attending colposcopy appointments
- ways we can help patients to attend their colposcopy appointments.
To help us do this we:
- Carried out weekly phone calls to all patients who did not attend
- Gathered data from secretaries when patients had phoned to cancel
- Talked to patients in the colposcopy clinic waiting room
- Surveyed all members of the colposcopy team.
We found that the main reasons for not attending were:
- Anxiety
- Work
- Childcare
- Transport
- Not understanding the importance of attending a colposcopy / a lack of understanding of what one is
- Forgetting the appointment
- Booking issues.
The suggested improvements we received were:
- Text message reminders
- More information / support
- Appointment flexibility
Changes
All patients booked in for a colposcopy now receive an invite by text through our digital platform DrDoctor as well as receiving a letter.
What we have done so far:
- We have produced a new webpage with simple information on colposcopies and videos from colposcopy staff and case studies from patients. The webpage also includes numbers to call if people would like to chat about the procedure before their appointment.
- We have included a link and QR code in the patient invite letter so they can easily access the new webpage to help them understand the importance of attending.
- Engaged with service users, our target audience and some local community groups for feedback on our webpage and patient letters before we started using them.
What's next:
- We will use feedback from our engagement to produce a marketing campaign which will help us to encourage people to attend their appointments.
- We will film more case studies to help people realise the importance of attending and to help address some of their worries and concerns.
- We will work with local influencers and partners to help us spread the word.
We’re working with health psychology to develop the colposcopy teams' skills in supporting patients who have been through trauma.
A pilot is being developed to link data between primary and secondary care to help us better understand the needs of our patients.
For those who are struggling to attend for their appointment we are working with a local partner to provide support with transport costs.
What’s next?
- We will ensure feedback on our new patient letter and webpage has been considered and implemented where appropriate.
- We will use feedback to produce a detailed creative brief for a targeted campaign
- We will spread the word about our new campaign, particularly targeting those who have been identified as most at risk of not attending
- We will film more case studies
- We will evaluate all of the work and review the impact it has had
- We will share our learning across the trust and to the wider NHS
Patient stories
- Patient referred in with high-grade smear
- At initial appointment felt unable to have examination as she was alone and frightened
- Follow-up arranged where she attended with a friend, biopsies confirmed high-grade, pre-cancerous changes
- She agreed to return to colposcopy clinic for treatment
- She did not attend for two further appointments and was discharged back to her GP. GP spoke to the patient, assured she would attend
- Further DNA, at risk of being lost for follow up
- Phone call took place with patient as part of the project audit - patient expressed anxiety about appointment, offered phone call with nurse colposcopist
- Nurse spoke to patient on the phone, reassured her / answered questions. She booked her in the next day. Attended for loop treatment.
- Discharged back to GP
To read the abstract please click here.