THE EFFECTIVENESS OF ORAL CANCER SCREENING

 

Aims & Objectives

 

The clinical audit was undertaken to evaluate the quality of service that has been provided with respect to the screening of oral cancer and compare the standard attained to what was felt would be acceptable.  Once this had been done, it would be decided if any changes were required and how they would be implemented within the practice without affecting the normal running of it.

 

The main objective of this audit was to implement changes before the second cycle in order to improve the screening of oral cancer at the practice if required.  If the standard required was achieved in the first cycle then changes were to be implemented which could further enhance the service that we provide to the patients.

 

Introduction

 

Some background reading was undertaken to illustrate the importance of the screening of oral cancer by general dental practitioners.  A comparative study between GDP’s and GMP’s demonstrated that GDP’s were more likely to identify alcohol as a risk factor (GMP’s being as low as 45%), 90%+ of both fields identified smoking as a risk factor.   GDP’s are more likely to only examine tooth bearing and denture bearing areas (not the high risk sites e.g. floor of mouth) and GMP’s are better at referring early and suggesting malignancy as a diagnosis probably due to their lack of knowledge/ability to recognise but referral patterns differ all around the country.

 

Methodology

 

1.         Whether or not a soft tissue examination had been carried out

2.         Had it been identified whether or not the patient was a smoker?

3.         If the patient was a smoker, had the amount they smoked been recorded?

4.         Had it been identified whether or not the patient consumed alcohol?

5.         If the patient was a consumer, had the amount they drink been recorded?

 

The standard that was agreed on in the practice was that 95% of all patients should be having a soft tissue examination and that the drinking and smoking histories were satisfactorily recorded for >90% of all patients.

 

Based on the results of cycle 1 and, following a staff training session,  the following changes were implemented before carrying out cycle 2.

 

1.         If there is a clinical finding on the examination of soft tissues, it will be recorded using a mouth map.

 

2.         All high risk patients are required to be identified and the agreed format for their recognition is smoking 20+ cigarettes a day as well as consuming alcohol.  This is to be recorded in the medical history by shading in one of the top corners of the medical history card.

 

3.         The required standard must be attained by the practice working as a team.

 

The second audit cycle was carried out using 50 random patient record cards as selected by the practice manager for the month of January.

 

Discussion

 

From the results, it is evident that before the staff training exercise the oral cancer screening was of an unsatisfactory level. However, using the information collected and a paper released by the BDA, a management strategy was developed and the roles of each of the dental team were clearly identified and an attempt is made to try and ask all patients whether or not they smoke for the purpose of a study.

 

Further improvements / Limitations to Study

 

The idea of carrying out an audit on the screening of oral cancer first arose from an article found in the BDA news.  It was found that a “help2quit” programme in Shropshire had been set up to help stop smoking.  The persons mentioned in the article were initially contacted for help since they had a simple and effective regime under way.   As a result, liaison with the Wolverhampton Stop Smoking Service was established in order to develop a leaflet, which may be published, to cope with the stress of time management and increase the efficiency for smoking cessation advise (a first draft has been produced.)  This service has been available here since January 2001 and is therefore relatively new.  They have three full-time advisers who run specialist groups, provide one-on-one support and run training programmes to set up intermediary counselling support groups at local levels.  They are heavily involved with intermediary training of practice nurses at local GMP’s.  We are hoping to develop something for dentists within the area.

 

Conclusion

 

From our study, it can be concluded that the quality of patient care has improved with respect to oral cancer screening at the practice at which the audit was carried out.  Changes implemented have not caused any major disruption to the practice and have now become a permanent feature of the practice policy.  The audit is to be repeated in 3 months time and then yearly to ensure the standards are maintained, although further development in enhancing care is currently under way (leaflet).

 

It is important that smoking/drinking cessation within the area is enhanced, and steps are already being taken in the area of Wolverhampton to do this.  However, relative to Shropshire, we seem to be lagging behind.  It is imperative that dentists become involved to help in the area under study since the stop smoking service that has been set up appears only to be dealing with GMP’s.  We possess the knowledge to make a difference but we, as dentists, seem reluctant to take charge of the situation.

 

Hopefully the situation will change in the future.

RESULTS

 

Cycle 1:

 

 

Female

Male

Total

No. of Patients

26

24

50

STE examinations carried out?

21

22

43

Alcohol consumption noted

11

16

27

16/27 patients consumed alcohol.  Was the amount queried?

3

13

16

Smoking history noted

6

13

19

9/19 patients asked smoked.  Was the amount queried?

2

7

9

 

Analysis of results from Cycle 1:

 

 

 

Cycle 2:

 

 

 

Female

Male

Total

No. of Patients

28

22

50

STE examinations carried out?

28

22

50

Alcohol consumption noted

28

21

49

26/49 patients consumed alcohol.  Was the amount queried?

8

16

24

Smoking history noted

25

20

45

16/45 patients asked smoked.  Was the amount queried?

10

5

15

 

Analysis of results from Cycle 2: