Abstract
Background
The 5-year survival rate for bowel cancer in Wales is poor and lags behind the rest of the UK. The aim of the pilot phase of the Moondance Schools Initiative was to develop, deliver and assess a bowel cancer learning module for secondary school students in South Wales. Ultimately, we aim to introduce this programme into the National Curriculum across Wales.
Methods
Two programmes regarding bowel cancer and screening were designed and delivered to a cohort of secondary school pupils in South Wales. This involved interactive teaching with patients and clinicians, practical sessions and live-streamed videos of bowel cancer surgery. Feedback regarding the events and bowel screening was collected from students and their families.
Results
The programmes were delivered to 185 secondary school students and feedback was extremely positive. The students delivered a live event at the end of the programme to demonstrate their learning to their families and invited guests. Feedback from family members revealed that 100% of respondents were more likely to take a bowel screening test as a result of attending the event.
Conclusion
This project established that a pilot to create young bowel screening ambassadors is feasible and was positively received by students, their families and the local community. Future work will disseminate the programme further and correlate changes in bowel screening participation in the local area as a result of these events.
Keywords: Screening, Colorectal cancer, Education
Introduction
Bowel cancer is one of the UK’s commonest malignancies and has the best chance of being cured if caught early. Despite the introduction of bowel screening in Wales, bowel cancer remains the second most common cause of cancer deaths.1 The 5-year survival rate is poor and lags significantly behind Europe and the rest of the UK.2
The role of surgeons in public health messaging is unclear, but because of their depth of understanding of the disease and its impact they are uniquely positioned to capture the attention of the public and contribute to an educational platform.
The Moondance Bowel Cancer Project was established in 2018 and aims to improve bowel cancer survival in Wales. This project is supported by funds from the Moondance Foundation3 and the initiative has partnerships with Bowel Cancer UK, Bowel Screening Wales (BSW), University Health Boards, Pontypridd High School (PHS) and patient representatives. The key workstreams aim to improve public education and awareness of bowel cancer; uptake and quality of screening; access to timely endoscopy; and the availability of high-quality surgery.
The Moondance Schools Initiative is a novel approach to help achieve these aims. PHS is in an area with one of the lowest participation rates for bowel screening in Wales. The partnership between the school and the Moondance Bowel Cancer Project aims to create an educational scheme for school-aged children to cascade an effect within the wider family group. Collaboration between health and educational organisations could improve public health outcomes.4 The success of using children as health ambassadors has been demonstrated in smoking cessation programmes.5–7 There is no current evidence surrounding the utilisation of child ambassadors in cancer awareness and prevention. The involvement of family and friends is important in increasing colorectal cancer screening uptake8 and targeting this through young ambassadors may improve participation.
The aim of the first phase of the Moondance Schools Initiative was to develop, deliver and assess a pilot bowel cancer learning module for secondary school students in South Wales. This would then guide delivery of future programmes and aim to improve bowel screening participation in the local area.
Methods
The programme was created by collaboration of PHS and the Moondance Schools Initiative. The Welsh National School Curriculum will be updated in 20229 with schools being required to include health and wellbeing to develop a variety of skills. The team used the required elements as a focus through which the topic of bowel cancer could be explored.
Two separate programmes were planned and are described below.
Summer 2019 programme
The summer programme took place between May and July 2019.
WIMAT site visit
The programme was launched with an educational day at the Welsh Institute for Minimal Access Therapy (WIMAT). This involved a programme of presentations and practical sessions delivered by colorectal surgeons, Bowel Cancer UK and BSW. Students were shown a right hemicolectomy procedure streamed via Proximie Collaborative Software and were able to interact with the operating surgeon. Proximie is a secure platform that allows real-time remote connection and collaboration for surgical procedures. This was the first use of Proximie in a school setting. Practical sessions taught surgical skills and students were given the chance to interview a bowel cancer patient about their experience.
Classroom sessions
Over the following weeks, students had four further interactive classroom sessions at PHS, topics included: what is bowel cancer; health measures to reduce the risk; and the bowel cancer screening programme in Wales.
PHS live event and news bulletin
The live event was delivered by students at PHS in July 2019 and was attended by families, governors and other invited guests. Students created a news bulletin video to demonstrate key facts about bowel cancer and the importance of screening. There were information stands and the event was also attended by professionals from BSW and colorectal surgeons.
Spring 2020 programme
The spring programme took place between January and March 2020 and built on the experience gained from the previous year. A similar programme was delivered but included a full cohort of year 7 students.
WIMAT site visit and live streaming event
This event was delivered simultaneously across two sites at WIMAT and PHS. The sessions were facilitated by teaching staff and surgeons on both sites. Live operating was again streamed via Proximie.
Interactive classroom teaching sessions took place throughout the programme. A group of supervised students had attended University Hospital Wales before to perform video interviews of healthcare professionals involved over the entire pathway for patients with colorectal cancer from admission to discharge. These were viewed in the classroom sessions alongside exercises and interactive discussions. The students also performed a similar exercise with interviews performed with patients who had recently been treated for bowel cancer.
Outcomes
Feedback was collected from the students attending the site visits to WIMAT. Parents and carers attending the live event were also asked to complete evaluations after the event.
Consent
Parents and carers were sent information on the programme prior to the events. Written consent from parents or carers for students attending was obtained by PHS and all agreed to participate in the programme. Patients or staff members involved in video recordings were also consented with the designated Cardiff and Vale University Health Board consent form.
Results
Participants
The summer 2019 Moondance Schools Initiative was delivered to 30 students from year 8. The PHS live event was well-attended and feedback was received from 20 adult attendees.
For the spring 2020 programme, 155 students from year 7 were involved. Of these, 48 were based on the WIMAT site for the day and 107 were based at PHS.
Adequate support was provided throughout for any student who felt upset by the content. This was not needed by any of the students and the experience was reported as being overwhelmingly positive.
Feedback and outcomes
A summary of feedback collected from the students attending the WIMAT site visits and adults attending the PHS live event is shown in Tables 1 and 2 respectively. Figures 1 and 2 highlight some of the activities performed by the students during the programme. The news bulletin can be viewed at https://www.youtube.com/watch?v=MV6Vm3uxnLo.
Table 1 .
Student feedback
| Very interesting | Interesting | Not interesting | |
| How interesting was the live event? | 35% | 53% | 12% |
| What have you learnt from today’s live event? | ‘That not a lot of people in Wales get tested for bowel cancer’ ‘That bowel cancer is serious, and you can take tests to treat it early’ |
||
| Live operation | Patient journey | Patient story | |
| What was your preferred activity? | 61% | 22% | 17% |
| Why? | ‘I preferred the live operation because it is very rare to see’ ‘It was very interesting since my Nan unfortunately passed away because of bowel cancer’ |
||
| Yes | No | ||
| Do you know any of your family that have taken the screening test? | 10% | 90% | |
| Yes | Not sure | No | |
| Will you tell family members to take the screening test after today’s event? | 51% | 35% | 14% |
| Would you change anything about the live event day? | ‘To visit the hospital because I want to be a surgeon’ ‘Nothing, it was amazing by itself’ |
||
Summary of student feedback from the summer 2019 and spring 2020 WIMAT site visits
Table 2 .
Family feedback
| Yes | No | |
| Do you think the bowel screening test is well promoted? | 20% | 80% |
| Yes | No | |
| If you are eligible for bowel screening, have you taken the test? | 25% | 75% |
| Yes | No | |
| Do you think that the new screening test is more user friendly? | 100% | 0% |
| How successful has this evening been in raising your awareness of bowel cancer? Average rating out of 5 | 4.8 | |
| Yes | No | |
| Having attended this event are you more likely to take the screening test when you are eligible? | 100% | 0% |
| Yes | No | |
| Has tonight been successful in raising your awareness of preventative measures that can be taken to beat cancer? | 95% | 5% |
| ‘I was very impressed by the children’s knowledge. Hopefully this will increase awareness and be rolled out to other schools’ ‘Great to see how much work the children have put in. My daughter has really enjoyed the opportunity to watch an operation and learn how a healthy lifestyle can reduce your risk of getting these diseases.’ | ||
Summary of family feedback from the summer 2019 PHS live event
Figure 1 .
The WIMAT site visit. Students had the opportunity to watch a live laparoscopic right hemicolectomy via Proximie collaborative software.
Figure 2 .
Classroom teaching sessions. The students learn about the importance of bowel screening and had the chance to practice with the old and new testing kits.
Discussion
The Moondance Schools Initiative and PHS delivered a novel, high-quality learning programme about bowel cancer to secondary school students. Although improving public health through school education is not new,4 this appears to be the first programme promoting children as ambassadors in cancer awareness and screening. The experience gained will direct and improve future programmes as part of the second phase of the Moondance Bowel Cancer Project and contribute to improving bowel cancer outcomes in Wales.
The majority of children would now encourage family members to take a screening test.8 Parents and carers were more likely to take a screening test after the PHS live event which shows the positive influence children can have on our health. Lowering the screening age in Wales to 50 years may heighten this effect as more students will have family members in or approaching this age group.
This experience has demonstrated that a sensitive or emotional topic can be introduced effectively to a group of young people. Although we had been prepared for children to be overwhelmed or upset during the programme, this was not found to be an issue by staff, parents or carers. The ‘When Cells Misbehave’ programme aims to teach primary school children about cancer. They have also found that children engaged well, with over 90% saying they would recommend it to a friend.10
The PHS teaching staff found it an excellent learning opportunity. An additional benefit was allowing students to see clinical sites and meet healthcare professionals. This may encourage children in an area with a low socio-economic background to consider healthcare as a career option.
A number of limitations to the study have been noted. Numbers of students, parents and carers giving feedback were small and all were from a single site. Feedback was only collected after the event and a pre programme comparison questionnaire would have been beneficial. Although respondents indicated they were more likely to participate in screening, we have not assessed whether the school project has contributed to a rise in local bowel screening uptake. We would highlight that this is a pilot and the limitations identified above will be used to improve phase two of the initiative.
The initiative has potential for expansion across age groups within the school and also to other forms of cancer. The next phase of the initiative aims to create a modular learning resource that can be rolled out to other schools across Wales. PHS is an English first language school and to date bilingual learning materials have not been used. The production of Welsh language material is planned for the next phase of the project.
Conclusion
This project has established that a pilot to create young bowel screening ambassadors is feasible with positive reception by students, their families and the local community. The subject matter is well tolerated and could provide health benefits to both students and their family group.
Acknowledgements
We would like to acknowledge and thank all those that have been involved in the planning and delivery of the Moondance Schools Initiative especially Wendy Evans (Bowel Cancer UK), Julie Hepburn (patient representative), Len Richards (Cardiff and Vale University Health Board), Benji Williams (Bowel Screening Wales), The Moondance Foundation, Proximie, WIMAT and the staff and students of PHS.
Funding
J Parker’s Research Fellowship is funded through the Royal College of Surgeons of England. The Moondance Bowel Cancer Project is funded through the Moondance Foundation Charity.
Supplementary material
meet_the_author_moondance_project_final.mp4
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Supplementary Materials
meet_the_author_moondance_project_final.mp4