Incorporating cancer risk information to promote behaviour change for cancer prevention into general practice: a qualitative study using focus groups with healthcare professionals.

Problem

It is estimated that approximately 40% of all cases of cancer are attributable to lifestyle factors such as smoking, alcohol consumption, diet, weight and physical exercise, and nearly 600,000 cancer cases in the UK could have been avoided in the past 5 years if people had healthier lifestyles. A number of risk tools are now available which enable prediction of an individual’s future risk of cancer and the contribution of their lifestyle choices to that risk. Providing people with this information has the potential to promote behaviour change and complement prevention strategies targeting the risk factors for cancer at the population level. In this study we aimed to explore the views of key stakeholders on incorporating personalised cancer risk information about an individual’s risk of developing common cancers based on lifestyle factors into general practice.

Approach

We held five focus groups with GPs, GP registrars, practice nurses, GP commissioners and non-clinical members of clinical commissioning groups. Each group was attended by between three to six participants and was guided by a schedule which covered current provision of lifestyle advice relating to cancer in general practice, their views on presenting personalised risk information about the risk of developing common cancers in general, and particularly around the practicalities of implementation within general practice. Each focus group was audio-recorded, transcribed verbatim and then analysed using thematic analysis in NVivo.

Findings

Providing lifestyle advice was generally viewed as a core activity within general practice but, with the exception of smoking and lung cancer, the influence of lifestyle on cancer risk was rarely discussed. The word ‘cancer’ was seen as a potentially powerful motivator for lifestyle change. However, the potential for discussions around cancer risk to generate health anxiety and for a high risk to lead to maladaptive behaviours was also recognised. Most felt that a numerical estimate was more likely to influence behaviour than generic information and that the focus should be on targeting younger people. All felt that general practice should be providing this information but there was a clear need for additional resources if it was going to be offered widely. These included additional funding and consultation time, referral pathways, integration into the computer system, resources for screening, and training.

Consequences

This work shows that there is support among primary care stakeholders for providing personalised cancer risk information within general practice. The findings highlight a number of potential benefits and challenges which will inform the future development of interventions of the use of personalised cancer risk information to promote behaviour change for cancer prevention in general practice.