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Cancer Screening PBLA

In preparing for these sessions, we decided that family doctors generally end up doing two things: trying to find cancers early, and caring for patients at the end of life who have completed treatment with specialists and are returned to us for terminal care. This PBLA reflects this experience.

Guidelines: This Practice Based Learning Activity relied heavily on Guidelines found at the National Guideline Clearinghouse and also from the USPHS Task Force Guide to the Clinical Preventive Services THIRD edition, which is now found online.

We began our PBLA with a little skit:

DRAGNET: WHAT CANCERS NOT TO SCREEN FOR

Elmer and Ethel attend the State Fair, and run into a huckster at the Cancers-R-Us booth, only to be rescued by Officer Friday (formerly of the LAPD) of the USPHS_TF!

Following this fun, Dr. Beef presented Cancer Screening Principles.ppt-, a discussion of the science behind cancer screening. An interesting resouce included an article on Cancer Screening in Older Adults

Over the next few days, we discussed specific cancers:

Breast Cancer.ppt - Dr. Blackman

Colon Cancer.ppt - Dr. Ahn

Prostate Cancer.ppt - Dr. Divisova

Screening for Melanoma.ppt - Dr. Divisova

Our 4th Wednesday Topic was End of Life Care. This included an interview by Dr. Zelnick of a patient who had lost her husband to cancer in the previous year, and stimulated discussion on our roles in caring for patients at the end of Life.

Dr Sladek reviewed the scant scientific evidence about End of Life Care (.ppt) and Advanced Directives. He also did a great review of the literature on the effectiveness of Reminders for Cancer Screening (.ppt).

Dr. Zelnick reviewed our performance in cancer screening in the FPC using the Practice Dashboard, an Access Database that updates performance graphs daily from our EMR. He also compared our results to published studies (.ppt).

At the last session, we discussed as a group methods to improve our performance in cancer screening, especially in terms of what we had learned. Participants agreed that we would build more systematic reminders at the point of care into our Logician EMR. We decided to defer building a reminder system to bring patients back into the office at this time. And we agreed what NOT to screen for, and reviewed educational interventions we could use with patients to help better inform them, so they could make better choices. Here were our CONCLUSIONS in table form.