Social marketing boosts early detection of lung cancer in Doncaster
According to social marketing expert Julia Mulligan, going out to talk to GPs was one of the key elements in the success of NHS Doncaster’s striking campaign to increase early detection of lung cancer. ‘When you are dealing with GPs, you have to have a good bedside manner,’ she says.
The campaign was planned to target the group worst affected by the disease, men aged over 50, many of whom had worked in the pits and other industrial jobs. The research that formed the starting point for the campaign showed that this group were stoical about their health, were unlikely to go to their doctor because they were afraid of lung cancer and believed that it was incurable.
Turning round these attitudes and alerting people to the first signs of lung cancer formed the consumer ‘push’ part of the campaign. Just as important was the service ‘pull’, the work that was done to ensure that GPs would refer patients and the radiology department of Doncaster Royal Infirmary would be able to cope with an increase in demand for chest X-rays.
Dr Rupert Suckling of NHS Doncaster, who masterminded the intervention, went on a roadshow with Julia Mulligan to talk to 11 general practices in the six wards with the highest incidence of lung cancer where the campaign was focused. One of the most interesting findings was that the GPs who had the best results were those who had been most sceptical initially. Suckling and Mulligan spent longer and had to engage more with these practices than with the rest and the effort paid off. Dr Suckling says: ‘It is about spending time with front line staff and having discussions, showing that it is important, rather than them just receiving an email or a letter from the PCT.’
Mulligan’s agency Sixteen Hands drew up the strategy and designed the campaign. The overall slogan reflected the two elements of push and pull: ‘We are waiting. You shouldn’t.’
The key message for the target group of older men was: ‘Cough not better after three weeks? Better go to your doctors now.’ The PR campaign was fronted by two local people who had had surgery for lung cancer, and survived, to try to counter fatalism about the disease. Media were chosen carefully. Adverts targeted at the men themselves, for instance, were placed on the sports pages of the local paper while a differently worded ad in the entertainment section was aimed at their wives and families.
None of the materials mentioned cancer or stopping smoking as the research showed that people screen out these messages while fear of cancer would make this target group less, not more, likely to go to their GP. The most memorable aspect of the campaign was coughing bus shelters – ads with a chip inserted that would cough three times – to get people laughing and talking about the campaign, while reinforcing the simple message about three weeks.
According to Dr Suckling, the results of the first year of the campaign were striking, with a shift from 11% early diagnosis to 19% in the 11 surgeries that were covered. In 2009 the change was from 21% to 23%. ‘There was a spike in April as the campaign was running then numbers fell back down for a couple of months. Our thinking is that we pulled cases forward, which is exactly what we wanted to do.’ The campaign addresses both targets for improving early detection of cancer and for reducing inequalities in health. But Suckling is cautious about claiming too much until the effect on mortality and survival rates can be measured.
One of the most encouraging outcomes is that the GPs themselves, as well as NHS Doncaster, are now mainstreaming the approach. ‘Going forward it will be about maintaining those changes in behaviour more through peer education than advertising,’ Suckling says.
Dr Rupert Suckling, Deputy Director of Public Health, NHS Doncaster
Case study written by Ros Bayley on behalf of the National Cancer Action Team
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