Tackling bowel screening inequalities

To drive forward our goal of championing early diagnosis and support the Scottish Government's commitment to reducing cancer screening inequalities, we set up a tailored training programme to educate healthcare professionals about the disease and bowel cancer screening.

People with learning disabilities have the right to good bowel health and access to the same range of health services as everybody else. We know that bowel screening is one of the best ways to detect cancer early, but it is poorly accessed and underused by people with learning disabilities compared to the general population. To help overcome the barriers, our training programme specifically focused on giving participants the knowledge and practical resources to provide the right, personalised support.

What we did

From March 2018 to January 2019, we provided 22 full day training sessions across 11 health board areas in Scotland to 304 attendees. We reached a range of healthcare professionals, including:

• 52 local authority care and support staff
• 78 community nurses
• 137 third sector care and support staff

The training sessions covered the facts about bowel cancer - symptoms, risk factors, and the new bowel screening kit – the simpler and more accurate faecal immunochemical test (FIT). To support informed choice we also focused on accessible communication and examples of tailored support.

The impact

Our evaluation model has captured a range of outcomes, from increased knowledge and confidence to awareness activities and examples of person-centred support. Throughout the twelve month project participants reported significant increases in their understanding of bowel cancer – the symptoms to look out, stages and risk factors.

• Building awareness of bowel screening: participants reported a 77% increase in knowledge from pre to post training.
• Building confidence: 100% of attendees told us that they felt confident explaining screening after their training.

"Course was relevant to practice and beneficial in laying a solid foundation in tackling the issues around bowel cancer. It offers a springboard to help practitioners tackle this subject with patients and improving chances of early diagnosis of problems."

Overcoming the barriers to screening

People with learning disabilities are not just patients or service users, they are individuals who must be supported to make personalised informed choices. As a result of our training, we have received many examples of healthcare professionals feeling more confident and successfully working alongside people with learning disabilities, their families and carers to promote informed participation in bowel screening.

Evaluations consistently show improved awareness of bowel cancer and screening, as well as proactive actions and the use of accessible information to support bowel health and uptake of bowel screening.

Within the first three months of their training, participants went on to spread awareness of bowel screening to 3,340 additional people. This includes 566 people with learning disabilities and 938 colleagues that support people with a learning disability. On average, each trainee raised awareness with 22 people.

"Bowel cancer is treatable if caught in its early stages so it is crucial that people with learning disabilities participate in bowel screening. The Bowel Cancer UK training is brilliant and equips you with the right resources and tools to help spread the word far and ensure screening is accessible."

Much more needs to be done

Reflecting on the successes of our project, it is clear that supporting both personalised informed choice and screening uptake must remain a priority.

Healthcare professionals want to provide the best possible care to help improve good bowel health and participation in screening. To ensure they have the knowledge and confidence to provide the right support, bowel cancer and screening education is vital.

Moving forward, it is important to consider the organisations best placed to invest in and deliver ongoing training and education – including NHS Health Boards, local authority or Health and Social Care Partnerships as well as the third sector and Scottish Government. We call on these organisations to prioritise how they can facilitate learning and continue to tackle health inequalities in people with learning disabilities.

Further reading and resources

• We are delighted to share the important learnings from our project in our snapshot evaluation report (click to download).
• Use the accessible information pack 'Bowel health and screening - supporting people with learning disabilities to take care of their bowel health'. Produced in partnership with NHS Heath Scotland, packs can be ordered from: nhs.healthscotland-publications@nhs.net.
• You can also download our easy read Bowel health and the bowel screening test in Scotland booklet and Bowel health and screening carers guide.
• To find out more about the project, contact Claire Finlayson, Senior Services Officer claire.finlayson@bowelcanceruk.org.uk.