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Cancer Innovation and Improvement Programme

Health Optimisation at the Point of Suspicion of Cancer – meeting our patients’ needs

Sian Lewis, Rachel Lewis, Freya Kendall, Anne May, Savita Shanbhag, Saloni Jain and Sarah Rees

Aneurin Bevan University Health Board and Hywel Dda University Health Board

National Optimal Pathways for Cancer mandate that Health Optimisation is introduced at the Point of Suspicion of cancer (PoS) (Welsh Government 2019). With over 18,000 people referred onto the Suspected Cancer Pathway (SCP) annually in Wales, it is challenging to develop an effective approach due to the high demand and limited knowledge of people’s needs on lifestyle behaviour.

Project Aims and Objectives:

Aim: To encourage people to access evidence-based health and well-being information at the PoS of cancer, enabling healthier lifestyle behavioural changes.


  1. To understand the information that people would find useful at the PoS of cancer, focussing on the five domains of patient health optimisation (diet, smoking, physical activity, alcohol and emotional wellbeing).
  2. To evaluate and critically appraise existing digital information on the five domains of patient health optimisation available to people at the PoS of cancer.
  3. To design, trial and evaluate a digital Health Optimisation Self-Assessment Tool to inform and nudge people to encourage them to think about.

Project Approach:

  • Using various digital platforms people were invited to complete an online questionnaire.
  • A focus group was conducted and the data was analysed thematically to identify key themes.
  • A digital Health Optimisation Self-Assessment Tool was developed using the findings from the questionnaire and focus groups. The tool was piloted in four GP clusters. People with an urgent suspected cancer, referred onto the SCP by their GP within the clusters, received a text containing a link to the tool, within three days, inviting them to complete the tool.


In total 50 participants responded to the questionnaire with very few receiving any information on lifestyle behaviour at the PoS (range 10-18%).

A high percentage (86%) would like to receive information in relation to lifestyle behaviour with nearly all favouring completing an online self-assessment tool (92%).

A total of 465 people were referred onto the SCP with an urgent suspected cancer, with 100% receiving the text within three days. The response rate for completion was nearly 40%. People reported that the tool was easy and simple to complete.

Graph 1: Daily amount smoked by respondents

Graph 2: Weekly physical activity levels by respondents

Project Outcomes:

This project has demonstrated successfully the proof of concept of using a digital health optimisation self-assessment tool for people with an urgent suspected cancer referred onto the SCP. The tool has been designed to incorporate the following key characteristics:

  • User-friendly, taking less than 10 minutes to complete.
  • Provides the user with a summary of evidence-based online links.
  • Contains all identified key domains of health optimisation.
  • Able to reach a high volume of people in minimum length of time.

It has provided a better understanding of the information people prefer to receive at the PoS and the availability of suitable digital resources. The project has also shown issues with the existing digital patient engagement platform and identified future developments.