Primary liver cancer incidence and mortality are rapidly rising in Australia. Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. HCC surveillance is a well-established intervention to facilitate early detection through regular monitoring of populations at high risk. Evidence has shown it to be successful in detecting lesions and/or early-stage tumours, increasing the receipt of curative treatment and improving overall survival.

The Clinical practice guidelines for HCC surveillance for people at high risk in Australia have been developed in order to provide evidence-based information and recommendations to guide surveillance for people at high risk of HCC. This presentation will provide an overview of the guideline recommendations and their impact on practice.

Systematic literature reviews and cost-effectiveness modelling studies were completed, and the evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. The guidelines were developed by a multidisciplinary Working Group and overseen by an Expert Advisory Group.

The guidelines build on existing international guidelines, national consensus statements and current practice. They broadly align with current practice and consolidate guidance for the Australian context. The recommendations reinforce the necessity for HCC surveillance in high-risk patients but also highlight other aspects important for clinical practice:
1. People for whom HCC surveillance should not routinely be offered are clearly identified
2. The importance of monitoring for progression to cirrhosis is highlighted
3. Consideration of an individual’s risk and health status is recommended to inform HCC surveillance recommendations for people with advanced fibrosis.

The recommendations are intended to guide decision making in determining who should receive regular HCC surveillance and all should be considered for implementation in practice. This session will demonstrate how hepatocellular carcinoma burden in patients with liver disease can be managed effectively by providing routine surveillance.

At the conclusion of my presentation attendees will take away
1. Hepatocellular carcinoma burden in patients with liver disease can be managed effectively by providing routine surveillance where appropriate.
2. Consideration of priority populations is crucial to providing appropriate surveillance and culturally sensitive and safe care.
3. Clear and consolidated guidance can help focus liver cancer care for the Australian context.

Background
Cancer survivors are at increased risk of long-term morbidity. Modifying lifestyle behaviours, in particular physical activity, can improve morbidity associated with the physical and psychological sequelae of cancer. However, many survivors do not receive comprehensive healthy lifestyle recommendations. General practitioners (GPs) are appropriately placed to provide holistic care, such as physical activity interventions but the practicalities within the Australian setting remain unknown.

Method
We used a mixed methods study design to explore the role of general practice in implementing physical activity interventions for cancer survivors, including the barriers and enablers. GPs were asked to complete a survey before a semi-structured interview. The survey explored preferences of possible interventions arising from the findings of a realist review. The interview explored the role of general practice in physical activity interventions for cancer survivors and was underpinned by the Theoretical Domain’s Framework. Interview data was analysed inductively and deductively.

Results
We recruited 17 GPs who completed the study. Most GPs perceived physical activity promotion as an integral and appropriate part of their work. Greater engagement with physical activity promotion was reported to be influenced by patient mindset and interest, access to services, pre-morbid condition, support, and early intervention within cancer care. Barriers included cost, time constraints, patient physical capacity, perception of exercise as a treatment, and a lack of knowledge/evidence.

Discussion
Physical activity promotion for cancer survivors in primary care is influenced by individual and cultural contexts, cancer related factors, health system issues and healthcare support needs. These factors should be considered when designing models of care which support sustained behavioral change and can be integrated into existing standard holistic patient care. This study forms important pre-implementation work for a physical activity intervention that will be tailored to the needs of cancer survivors in general practice.

At the conclusion of my presentation attendees will take away:
1. Most GPs perceived physical activity promotion as an integral and appropriate part of their work.
2. Greater engagement with physical activity promotion was reported to be influenced by patient mindset and interest, access to services, pre-morbid condition, support, and early intervention within cancer care.
3. Future physical activity interventions for cancer survivors should consider individual and cultural contexts, specific cancer related factors, health system issues and healthcare support needs.

Aim
Breast cancer-related morbidity and mortality in Pakistan is a public health challenge. Due to limited resources and an irregular and poorly developed primary health care system, health professionals lack the knowledge and skills to identify and screen asymptomatic women with high-breast-cancer risk. This study explored the significance of educational sessions in improving health professionals' breast cancer knowledge, particularly screening modalities for early detection.

Content
An interventional study was conducted with 260 health professionals. An educational session on breast cancer risks and screening guidelines was developed. Health professionals' knowledge of breast cancer risk, presentation, and screening was tested by a structured questionnaire before and after the educational session. Statistical Package for the Social Sciences 26 was used for data analysis. Chi-square was used to identify differences in pre and post-test. P <0.05 was considered significant.
Final-year medical students comprised 49% (n=126), nurses 37% (n=97), and allied health professionals 14% (n=37) of the study population. A significant improvement was observed between pre-session and post-session responses in all areas of breast cancer knowledge. A significantly higher proportion of health professionals correctly identified the importance of family history in breast cancer (96% vs 61% ; p<0.0001), the importance of self-breast examination and regular screening (85% vs % 49%; p<0.0001), common breast cancer presentations, and breast cancer diagnostic tools in the post-test compared to the pretest.

Goals
Early detection of women with high breast cancer risk requires a holistic approach. Awareness campaigns and educational sessions on breast cancer risks and prevention should be implemented at the school, college, and university levels. Continued educational sessions on recent guidelines about breast cancer screening methods for health professionals at all levels are also needed. A well-functioning primary-care system and established referral systems will further minimize delays in diagnosis and reduce breast-cancer related complications and mortality.

1- Early detection and timely treatment in low‐income countries are unavailable, leading to late diagnosis of women and high morbidity and mortality. Besides, a well‐functioning primary‐care system and established referral systems need to be in place to minimize further delays.

2- Early diagnosis can be possible by knowledge of the early presentation of breast cancer and prompt referral for diagnosis and treatment.

3- Awareness campaigns and education including breast self‐examination should be strengthened at the school, college and university levels to educate public and health professionals about breast cancer and its prevention.

Background: Incidence of colorectal cancer (CRC) is increasing globally. The risk of developing CRC in people with family history (PFH) is at least doubled compared to the average-risk population; yet the screening uptake in PFH remains low. Several interventions have been tested to promote CRC screening for PFH. However, a review which systematically maps the evidence of those interventions is lacking.

Aim: A scoping review was conducted on literature related to interventions that promote CRC screening in PFH of CRC. We aimed to identify the types of interventions, the development process, their effectiveness, and the factors associated with the outcome.

Method: The Joanna Briggs Institute methodology for scoping review was followed. Six databases were searched for relevant articles in May 2022. Three researchers independently conducted the screening and data extraction. There was no restriction in language and publication date.

Outcomes: From 9279 records retrieved, 24 studies were included. The studies were published between 1995 and 2020 in 11 countries. There was wide variability across studies: the study population, screening modalities and measurement of screening outcomes. Theoretical frameworks served as a guide in intervention development in 9 studies, of which 7 used the Health Belief Model. Ten studies reported statistically significant outcomes in increasing screening uptake among PFH of CRC; all interventions used telephone as part of the intervention, either to elicit background information to tailor intervention, or to provide counselling. Five of the effective interventions involved doctor’s consultation and 4 used motivational interviewing (MI) for counselling.

Conclusion: Future development of interventions to promote CRC screening targeting PFH of CRC may consider incorporating doctor’s involvement and counselling using MI approach. Remote intervention via telephone may enhance PFH’s accessibility to counselling which will lead to an improvement in CRC screening uptake.

At the end of my presentation, attendees will be able to:
1. identify interventions which have been tested to improve CRC screening uptake among people with a family history of CRC;
2. to compare the elements of interventions which were effective in promoting CRC screening for people with family history;
3. use the findings from the review to guide the development of a future intervention to suit their local setting.

The aim of this study is to determine the skin cancer risk level, risk perceptions, and factors affecting risk perception and sun protection behaviors of
individuals.

This cross-sectional analytical study was conducted with individuals over the age of 18 who applied to family health centers.The questionnaire form, which was created by the researcher, including sociodemographic characteristics, skin cancer risk level, risk perception, and the Sun Protection Behavior Scale were applied to the individuals who volunteered to participate in the study by face-to-face interview method.

It was determined that 324 of the 490 participants participating in the study were female, the mean age was 36.27±13.38, and 37.8% had primary school or lower education level. The majority of the participants (93.2%) had medium risk in the Skin Type 3 and Skin Type 4 groups. While 67.5% of the individuals stated that they have 10 or less moles on their body, 19.6% stated that they had sunburn at least once in any period of their life. The risk perception was found to be significantly higher for those who were married, had sunspots, and had a history of skin excision. It was determined that women, single people, those with higher education and income levels, and those with a higher number of moles exhibited significantly more sun protection behavior. On the contrary, as age increases, sun protection behavior decreases significantly.

In the fight against skin cancer, it is necessary to define the risky groups in society, preventive measures, and introduce them to society. In addition to early diagnosis, it is important for people to be aware of their risk situations and to perform sun protection behaviors for secondary protection from skin cancer. In this context, it can be suggested that people should self-examine and define the risk correctly and regulate their sun protection behaviors accordingly.

1. A standard question measurement method should be determined to measure individuals' risk perceptions.
2. Different studies on the relationship between obesity and melanoma and non-melanoma skin cancers body mass index can be asked in studies that will investigate the effect of traits.
3. To increase societal understanding of the condition in the fight against skin cancer and to increase risk. It is necessary to define groups, implement protective measures, and make them known to the general public.

In 2017, a multi-disciplinary team of urologists and primary care physicians at the University of Vermont Medical Center developed a risk assessed screening and active surveillance prostate cancer protocol and study called the Modern Approach to Prostate Cancer Screening (MAPS). Our approach is to use a set of screening clinical decision support (CDS) tools that include a best practice clinical algorithm, an EMR based risk assessment tool for shared decision making, and a health maintenance reminder system. This set of CDS tools has been implemented in all primary care settings.
CDS tools can increase provider confidence in shared-decision making for prostate cancer screening. Our survey results show that CDS tools can improve primary care provider confidence and adherence to United States Preventative Service Task Force (USPSTF) recommended guidelines for PSA-based screening in the primary care population which may lead to improved early detection of disease. Risk-assessed prostate cancer screening using CDS tools may help detect prostate cancer earlier and prevent either over diagnosis or over treatment.

1. At the conclusion of the presentation attendees will be inspired to develop decision support tools to improve care delivery and provider confidence in shared decision making.
2. At the conclusion of the presentation attendees will appreciate the potential of clinical decision supports to prevent over diagnosis or over treatment.
3. At the conclusion of the presentation attendees will understand the impact of clinical decision supports as a means to increase provider adherence to recommended guidelines.

Approach to a Detached Teenager with Advanced Cancer

Background: The field of pediatric palliative care is newly emerging in the Philippines. The characteristics and medical experiences of children and teens with cancer who receive palliative care are little understood. There are seemingly insurmountable challenges in caring for them particularly with regards to effective communication.

Objective: To present the communication approach to a withdrawn, non-communicative and evasive 14-year old girl diagnosed with stage 4 yolk sac tumor with metastasis to her lung and liver. The distorted self-image brought by her enlarging abdomen was the apparent source of her detachment. She was attended to for counseling and symptom control.

Outcomes: The initial hurdle for a resident physician was the difficulty discussing the patient’s illness with her mother. Her mother felt this would only instill hopelessness, which could lead to her depression and further withdrawal. It was difficult to balance genuine concern and intrusiveness. Most distressing for a physician was standing in front of a lukewarm patient even after weeks of wooing. With the mentor’s guidance, a communication style which involved personalization, storytelling, and introduction of relatable perspectives was utilized. The resident was then able to elicit the patient’s thoughts and feelings in the presence of the mother. The patient eventually confronted the possibility of death. In the end, the mother was enlightened that her daughter was beginning to accept reality. From here on, the resident and the patient began engaging in more meaningful conversations. Expressed bucket lists were granted before she died.

Conclusion: A timely, consistent, and personalized communication style is key to breaking barriers in a patient-doctor relationship.

Takeaway:
1. Family is the most important source of emotional support for adolescent cancer patients.
2. A timely, consistent, and personalized communication style is key to breaking barriers in a patient-doctor relationship.
3. Mentoring and coaching is an effective modality in teaching communication skills.

Background: Prostate cancer is topmost in terms of incidence and mortality among men in
sub-Saharan Africa, including South Africa. Prostate cancer screening is beneficial only to
certain categories of men, making a rational screening approach necessary.
Aim: This study aimed to assess the knowledge, attitudes and practice (KAP) regarding
prostate cancer screening among primary health care (PHC) providers in the Free State,
South Africa.
Setting: Selected district hospitals, local clinics and general practice rooms.
Methods: This was a cross-sectional analytical survey. Participating nurses and
community health workers (CHWs) were selected through stratified random sampling.
All available medical doctors and clinical associates were approached to participate,
totalling 548 participants. Relevant information was obtained from these PHC providers
using self-administered questionnaires. Both descriptive and analytical statistics were
computed using Statistical Analysis System (SAS) Version 9. A p-value < 0.05 was
considered significant.
Results: Most participants had poor knowledge (64.8%), neutral attitudes (58.6%) and poor
practice (40.0%). Female PHC providers, lower cadre nurses and CHWs had lower mean
knowledge scores. Not participating in prostate cancer–related continuing medical education
was associated with poor knowledge (p < 0.001), negative attitudes (p = 0.047) and poor
practice (p < 0.001).
Conclusion: This study established appreciable KAP gaps relating to prostate cancer
screening among PHC providers. Identified gaps should be addressed through the preferred
teaching and learning strategies suggested by the participants.
Contribution: This study establishes the need to address KAP gaps regarding prostate cancer
screening among PHC providers; therefore necessitating the capacity-building roles of district
family physicians.
Keywords: Knowledge, attitude and practice; primary health care practitioners; primary
health care providers; prostate cancer screening; early diagnosis.

1. KAP gaps relating to prostate cancer
screening
2. Factors associated with
participants’ KAP.
3. Preferred teaching and learning strategies to close PCa screening knowledge gaps

Aim: An innovative shared-care model involving oncologists, family physicians (FPs), and community pharmacists via telehealth was developed for low-risk breast cancer survivors (BCS) in Singapore. This study aimed to supplement results from a piloted randomised controlled trial by gathering perspectives from participating survivors and healthcare professionals (HCPs) to elucidate the underlying logic model supporting the new model’s potential impact.

Content: This qualitative study recruited 17 BCS who were ≥21 years old, diagnosed with breast cancer, ≥3years after active primary treatment, ascertained to be low risk by an oncologist, and received the shared-care model. Additionally, 14 HCPs (9 FPs, 3 oncologists, and 2 pharmacists) involved in care delivery were recruited. In-depth virtual interviews were audio-recorded, transcribed verbatim, and analysed using deductive thematic analysis. The value of shared care in relieving the care strain in tertiary settings was echoed among participants. The central mechanism facilitating perceived care satisfaction among BCS was the psychological safety provided through a team-based care approach. Access to HCPs besides oncologists served as additional sources of information and assistance, empowering BCS to seek help for active symptoms promptly. Implementation strategies contributing to the trusting survivor-HCP relationship included HCP familiarity, regularity in scheduled tele-consults, and enhanced information transfer using survivorship care plans. However, BCS continued to ascribe oncologists’ and primary care providers’ exclusive roles in managing their cancer and chronic conditions, respectively. FPs emphasised the need for additional clinical experience accrual to build confidence in managing cancer-related issues beyond general and preventive health. Future work should address the underlying disease segmentation mentality to reinforce cancer survivorship care as a holistic concept to improve care coordination.

Goals: To examine how results from a pilot trial of a novel care model could be qualitatively mapped to construct a programme logic model by identifying underlying mechanisms and optimising implementation strategies.

1. Define cancer survivorship and the underlying principles.
2. Describe strategies to optimise primary care providers’ role in a shared-care model for cancer survivors.
3. Interpret a programme logic model to understand the connections between determinants, strategies, mechanisms, and outcomes of a shared-care model.

Liver cancer incidence and mortality rates are rapidly rising in Australia and projected to continue increasing over the next 20 years. The current 5-year survival rate is 22.0% (2014-2018). Hepatocellular carcinoma (HCC) is the most common type and its major risk factors include infections (hepatitis B, hepatitis C, liver flukes in endemic areas), behavioural factors (alcohol, tobacco), metabolic factors (excess adiposity), and aflatoxins. There is promising evidence to support prevention and early detection activities that start from infant hepatitis B vaccination to early detection interventions, which all contribute to improving liver cancer outcomes.

In 2019 a Roadmap to Liver Cancer Control in Australia project was established to identify key priority areas and strategies for collective action, and to set a shared agenda to drive improvements in liver outcomes.
This presentation will provide an overview of the four stages that informed the Roadmap development, including
1. A scoping review of screening for advanced liver disease and HCC surveillance;
2. An environmental scan of current HCC-care service delivery models;
3. Consultations with key stakeholders, including an expert Roundtable; and
4. The development of Clinical practice guidelines for HCC surveillance for people at high risk.

We will share an outline of the final Roadmap, launching in 2023, with 5-, 10- and 20-year actions. Future strategies prioritise efforts in hepatitis B vaccination (from infancy), screening and treatment for hepatitis B and C, prevention of risk factors, and surveillance, which are critical later in the life course.

The Roadmap clearly highlights the need to engage with Australians at high risk, policy makers, and clinicians to improve health literacy, awareness, understanding and utilisation of liver cancer control activities across the life course to achieve better outcomes.

At the conclusion of my presentation attendees will take away
1) A clear picture of the liver cancer burden in Australia, the key priorities for liver cancer control over the next 2, 5 and 10 years, and how improvements across the liver cancer continuum, from prevention to early intervention and treatment access can be implemented.
2) Focus for action on high-risk populations include Aboriginal and Torres Strait Islander people, culturally and linguistically diverse populations and those living in remote areas.
3) Critical importance of providing culturally sensitive and safe health care to enhancing liver cancer outcomes by improving health literacy, awareness, understanding and utilisation of liver cancer control activities by healthcare professionals.