Introduction The aim of the bowel screening programme in Wales is to reduce mortality from bowel cancer by 15% in the population invited for screening by 2020. Some groups of the population are difficult to reach, particularly if they are not registered with a General Practitioner (G.P.). Not all prisoners are registered with a G.P. and a task and finish group was established to develop strategies to identify and invite prisoners for screening.
Methods Contact was made with governors and health care staff at the five prisons in Wales and an education programme provided for prison staff. Data sharing agreements were developed and agreed for each prison. Protocols and care pathways were developed for screening prisoners comprising of a slightly modified service model to the standard bowel screening programme. A pilot was established in 2 prisons and the service model modified in response to issues.
It was agreed that contact with prisoners would be through health care staff. There are around 110 prisoners within the eligible age range in Welsh prisons and during the pilot prison healthcare staff notified BSW of eligible prisoners. Invitations and test kits were sent in batches to the prisoner via the medical centre where staff arranged for prisoners to be offered the opportunity to participate.
Test kits were returned individually and results issued to the health care staff who disseminated them to individual prisoners. Should a prisoner have a positive test result, arrangements will be made with prison healthcare staff for telephone assessment to be undertaken by a Specialist Screening Practitioner (SSP). Prior arrangement with the prison will ensure that the prisoner is brought to the medical centre to undergo this assessment.
Consideration has to be given to posting of bowel preparation medication and for prisoners who needed to undergo colonoscopy. Collaboration with prison staff was needed to ensure prisoners were given equal opportunity to participate in the programme without breaching prison security policies.
Results The pilot was established in two prisons and is currently being rolled out in another. Uptake has been encouraging and a complete data set for the pilot phase will be presented in June. To date all prisoners who participated have received negative results and the positive pathway has not yet been tested.
Challenges encountered included engagement of the healthcare teams within prisons due to staffing levels and varying viewpoints towards health care and the concept of informed choice and consent.
Conclusion By engaging and developing this service within Welsh prisons, BSW has extended its population based screening programme to a vulnerable group and are committed to formal evaluation and service improvement where necessary.
Disclosure of Interest None Declared.
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