Hope for patients using opioids

A new GP service offers an effective approach to address long-term opioid prescribing and dependency. In South Gloucestershire, project workers attached to general practices identify patients on prescription opioids and enrol them into a structured programme, which begins with understanding pain control needs and individual pain management planning. Subsequent sessions focus on education, medication review, pain management strategies, and goal setting supported by services such as physiotherapy, CBT, relaxation and mindfulness, and non-medical pain management. Two research papers indicate that this new service model is acceptable to patients and professionals, and also has the potential to improve health outcomes and reduce medication dosage in 40% of patients using the service.

Lung cancer symptoms to look out for

Lung cancer has a poor 5-year survival rate of around 13%. Haemoptysis (fresh blood coughed up in sputum) is generally regarded as the main symptom of lung cancer, with less emphasis on dyspnoea (shortness of breath) and cough. However, a research study from the University of Exeter examining symptoms associated with a diagnosis of lung cancer between January 2000 and December 2017 suggests that the rates of dyspnoea and cough as the index symptom increased, while the proportion of lung cancer patients with haemoptysis, along with reduced appetite, as the index symptom decreased. The authors report that symptom awareness campaigns should target cough and dyspnoea, and that medical education needs to help clinicians to avoid overlooking the importance of dyspnoea and cough as key symptoms of undiagnosed lung cancer.

Rapid diagnosis centres speed up cancer diagnosis

Building on experience in Denmark, rapid diagnosis centres (RDCs) are now being established in the NHS. Sewell and colleagues evaluated patients, referred by their GPs, with vague and non-specific symptoms that could be due to cancer. Patients were intensively reviewed by a multidisciplinary team, examined and given CT, then seen by a clinician and a Macmillan clinical nurse specialist at the end of their session to discuss and act on the findings. Mean time to a cancer or non-cancer diagnosis, or to discharge from the clinic, is reduced from 84 days to under 6 days if the diagnosis is made at the RDC appointment. If further investigations are arranged at the RDC, the time to diagnosis is just over 40 days. Researchers found that as long as the RDC runs at or near full capacity, it is less costly and more effective than standard clinical practice. As well as providing value for money and reducing diagnosis time, RDCs have the potential to improve patient outcomes.

Electronic coordination for end-of-life care

Good quality palliative care depends on recording, sharing, and acting on patients’ needs and preferences, such as their wishes about resuscitation and their preferred place of death. An electronic care coordination system known as KIS (Key Information Summary) was evaluated in Scotland by Finucane and colleagues using data from over 1300 deceased patients. Their study found that patients with a KIS record were twice as likely to die in the community, as they wished, rather than in hospital, and most had a record of their desired resuscitation status. Patients with frailty and dementia frequently had a KIS recorded a year or more before their death. Optimising use of KIS can be encouraged by carrying out computer searches of practice databases and using instruments such as the SPICT to help identify people who would benefit from a palliative approach.