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Kwong FL, Kristunas C, Davenport C, Aggarwal R, Deeks J, Mallett S, Kehoe S, Timmerman D, Bourne T, Stobart H, Neal R, Menon U, Gentry-Maharaj A, Sturdy L, Ottridge R, Sundar S. Investigating harms of testing for ovarian cancer - psychological outcomes and cancer conversion rates in women with symptoms of ovarian cancer: A cohort study embedded in the multicentre ROCkeTS prospective diagnostic study. BJOG 2024. [PMID: 38556698 DOI: 10.1111/1471-0528.17813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To investigate psychological correlates in women referred with suspected ovarian cancer via the fast-track pathway, explore how anxiety and distress levels change at 12âmonths post-testing, and report cancer conversion rates by age and referral pathway. DESIGN Single-arm prospective cohort study. SETTING Multicentre. Secondary care including outpatient clinics and emergency admissions. POPULATION A cohort of 2596 newly presenting symptomatic women with a raised CA125 level, abnormal imaging or both. METHODS Women completed anxiety and distress questionnaires at recruitment and at 12âmonths for those who had not undergone surgery or a biopsy within 3âmonths of recruitment. MAIN OUTCOME MEASURES Anxiety and distress levels measured using a six-item short form of the State-Trait Anxiety Inventory (STAI-6) and the Impact of Event Scale - Revised (IES-r) questionnaire. Ovarian cancer (OC) conversion rates by age, menopausal status and referral pathway. RESULTS Overall, 1355/2596 (52.1%) and 1781/2596 (68.6%) experienced moderate-to-severe distress and anxiety, respectively, at recruitment. Younger age and emergency presentations had higher distress levels. The clinical category for anxiety and distress remained unchanged/worsened in 76% of respondents at 12âmonths, despite a non-cancer diagnosis. The OC rates by age were 1.6% (95%âCI 0.5%-5.9%) for age <40âyears and 10.9% (95%âCI 8.7%-13.6%) for age â„40âyears. In women referred through fast-track pathways, 3.3% (95%âCI 1.9%-5.7%) of pre- and 18.5% (95%âCI 16.1%-21.0%) of postmenopausal women were diagnosed with OC. CONCLUSIONS Women undergoing diagnostic testing display severe anxiety and distress. Younger women are especially vulnerable and should be targeted for support. Women under the age of 40âyears have low conversion rates and we advocate reducing testing in this group to reduce the harms of testing.
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Affiliation(s)
- Fong Lien Kwong
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
| | - Caroline Kristunas
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Clare Davenport
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ridhi Aggarwal
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jon Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London, London, UK
| | - Sean Kehoe
- St Peter's College, University of Oxford, Oxford, UK
| | - Dirk Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Tom Bourne
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | | | - Richard Neal
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Usha Menon
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Alex Gentry-Maharaj
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Lauren Sturdy
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ryan Ottridge
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sudha Sundar
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Wheelwright SJ, Russ S, Mold F, Armes J, Harder H. Symptomatic presentation of cancer in primary care: a scoping review of patients' experiences and needs during the cancer diagnostic pathway. BMJ Open 2024; 14:e076527. [PMID: 38508614 PMCID: PMC10961516 DOI: 10.1136/bmjopen-2023-076527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES The objective was to map the experiences and needs of patients presenting with symptoms of suspected cancer in the primary care interval (from when they first present to primary care to their first appointment or referral to a secondary or tertiary level healthcare facility). DESIGN This was a scoping review. INCLUSION CRITERIA Studies or reports written in English which included primary data on the primary care interval experiences and/or needs of adult patients presenting with new symptoms of suspected cancer were eligible. Studies which only included patients with secondary or recurring cancer, conference abstracts and reviews were excluded. No date limits were applied. METHODS The Joanna Briggs Institute method for Scoping Reviews guided screening, report selection and data extraction. At least two independent reviewers contributed to each stage. Medline, CINAHL, PsychInfo, Embase and Web of Science were searched and several grey literature resources. Relevant quantitative findings were qualitised and integrated with qualitative findings. A thematic analysis was carried out. RESULTS Of the 4855 records identified in the database search, 18 were included in the review, along with 13 identified from other sources. The 31 included studies were published between 2002 and 2023 and most (n=17) were conducted in the UK. Twenty subthemes across four themes (patient experience, interpersonal, healthcare professional (HCP) skills, organisational) were identified. No studies included patient-reported outcome measures. Patients wanted (1) to feel heard and understood by HCPs, (2) a plan to establish what was causing their symptoms, and (3) information about the next stages of the diagnostic process. CONCLUSIONS Scoping review findings can contribute to service planning as the cancer diagnostic pathway for symptomatic presentation of cancer evolves. The effectiveness of this pathway should be evaluated not only in terms of clinical outcomes, but also patient-reported outcomes and experience, along with the perspectives of primary care HCPs.
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Affiliation(s)
| | - Stephanie Russ
- Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Freda Mold
- Department of Health Care Management & Policy, University of Surrey, Guildford, Surrey, UK
| | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Helena Harder
- Brighton & Sussex Medical School, University of Sussex, Brighton, UK
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Aggarwal A, Han L, Sullivan R, Haire K, Sangar V, van der Meulen J. Managing the cancer backlog: a national population-based study of patient mobility, waiting times and 'spare capacity' for cancer surgery. THE LANCET REGIONAL HEALTH. EUROPE 2023; 30:100642. [PMID: 37465324 PMCID: PMC10350851 DOI: 10.1016/j.lanepe.2023.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 07/20/2023]
Abstract
Background Waiting times for cancer treatments continue to increase in many countries. In this study we estimated potential 'spare surgical capacity' in the English NHS and identified regions more likely to have spare capacity based on patterns of patient mobility (the extent to which patients receive surgery at hospitals other than their nearest). Methods We identified patients who had an elective breast or colorectal cancer surgical resection between January 2016 and December 2018. We estimated each hospital's 'maximum surgical capacity' as the maximum 6-month moving average of its surgical volume. 'Spare surgical capacity' was estimated as the difference between maximum surgical capacity and observed surgical volume. We assessed the association between spare surgical capacity and whether a hospital performed more or fewer procedures than expected due to patient mobility as well as the association between spare surgical capacity and whether or not waiting times targets for treatment were likely to be met. Findings 100,585 and 49,445 patients underwent breast and colorectal cancer surgery respectively. 67 of 166 hospitals (40.4%) providing breast cancer surgery and 82 of 163 hospitals (50.3%) providing colorectal cancer surgery used less than 80% of their maximum surgical capacity. Hospitals with a 'net loss' of patients to hospitals further away had more potential spare capacity than hospitals with a 'net gain' of patients (p < 0.001 for breast and p = 0.01 for colorectal cancer). At the national level, we projected an annual potential spare capacity of 8389 breast cancer and 4262 colorectal cancer surgical procedures, approximately 25% of the volumes actually performed. Interpretation Spare surgical capacity potentially exists in the present configuration of hospitals providing cancer surgery and requires regional allocation for efficient utilisation. Funding National Institute for Health Research.
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Institute of Cancer Policy, King's College London, London, UK
| | - Lu Han
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Vijay Sangar
- The Christie NHS Trust and Manchester University NHS Foundation Trust, Manchester, UK
- Manchester University, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Haste A, Sharp L, Thomson R, Sowden S. Co-design to deliver service improvement: What does this mean and how can we do it? A qualitative study with upper gastrointestinal cancer patients and professionals. Cancer Rep (Hoboken) 2023; 6:e1748. [PMID: 36345861 PMCID: PMC10026281 DOI: 10.1002/cnr2.1748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is strategic objective to incorporate the principles and practice of co-design into routine service development and improvement. AIM The aim was to explore the concept and feasibility of service co-design with patients and health professionals with regards to the upper gastrointestinal (UGI) cancer care pathway. METHODS AND RESULTS Qualitative telephone interviews and face-to-face focus groups in one region of England. Twenty patients completed interviews. Nine patients and ten professionals formed two focus groups. Patients were referred through the urgent (two week) GP referral route and were within six months of receiving their first treatment for an UGI cancer. Professionals were working as service planners and providers of the UGI cancer care pathway. Thematic analysis was undertaken. Six themes emerged: Responsibilities and expectations, Knowledge and understanding, Valuing patient input, Building relationships, Environment for co-design activities, Impact and effectiveness. Based on the themes a checklist has been created to provide practical suggestions for both professionals and patients on approaching co-design for service improvement. CONCLUSION This study offers policy and practice partners a clearer understanding of co-design and factors to consider when approaching co-design in real life settings.
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Affiliation(s)
- Anna Haste
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Centre for Applied Psychological Science, Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Aboelkhir HAB, Elomri A, ElMekkawy TY, Kerbache L, Elakkad MS, Al-Ansari A, Aboumarzouk OM, El Omri A. A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16952. [PMID: 36554837 PMCID: PMC9778793 DOI: 10.3390/ijerph192416952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The referral process is an important research focus because of the potential consequences of delays, especially for patients with serious medical conditions that need immediate care, such as those with metastatic cancer. Thus, a systematic literature review of recent and influential manuscripts is critical to understanding the current methods and future directions in order to improve the referral process. METHODS A hybrid bibliometric-structured review was conducted using both quantitative and qualitative methodologies. Searches were conducted of three databases, Web of Science, Scopus, and PubMed, in addition to the references from the eligible papers. The papers were considered to be eligible if they were relevant English articles or reviews that were published from January 2010 to June 2021. The searches were conducted using three groups of keywords, and bibliometric analysis was performed, followed by content analysis. RESULTS A total of 163 papers that were published in impactful journals between January 2010 and June 2021 were selected. These papers were then reviewed, analyzed, and categorized as follows: descriptive analysis (n = 77), cause and effect (n = 12), interventions (n = 50), and quality management (n = 24). Six future research directions were identified. CONCLUSIONS Minimal attention was given to the study of the primary referral of blood cancer cases versus those with solid cancer types, which is a gap that future studies should address. More research is needed in order to optimize the referral process, specifically for suspected hematological cancer patients.
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Affiliation(s)
| | - Adel Elomri
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Tarek Y. ElMekkawy
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar
| | - Laoucine Kerbache
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Mohamed S. Elakkad
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Abdulla Al-Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- College of Medicine, QU-Health, Qatar University, Doha 2713, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow G12 8QQ, UK
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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Wind A, van der Linden C, Hartman E, Siesling S, van Harten W. Patient involvement in clinical pathway development, implementation and evaluation - A scoping review of international literature. PATIENT EDUCATION AND COUNSELING 2022; 105:1441-1448. [PMID: 34666931 DOI: 10.1016/j.pec.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/10/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Although various pathway design methods recognize patients as stakeholders, an overview of current practice is lacking. This article describes the results of a literature review assessing patient involvement in clinical cancer pathway development, implementation and evaluation. METHODS A scoping review was conducted following PRISMA-ScR. Two databases were searched to identify studies published in English between 2014 and 2021. RESULTS Of 12841articles identified 22 articles met the inclusion criteria and reported on one or more of the three phases: development phase (NÂ =Â 2), implementation (NÂ =Â 4), evaluation (NÂ =Â 11), development/evaluation (NÂ =Â 3), and implementation/evaluation (NÂ =Â 2) of clinical pathways. The numbers of involved patients ranged from 10 to 793, and the reported methods varied considerably. CONCLUSION This review presents a synthesis of methods for involving patients in the clinical pathway lifecycle. No relationship was found between methods and the number of involved patients or between pathway complexity and methods. Although patients are seen as valuable stakeholders in the pathway design, to involve them in practice using the best practice can be improved. PRACTICE IMPLICATIONS The lack of a clear justification for the choice of methods and number of involved patients calls for further research and framework development to inform pathway developers.
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Affiliation(s)
- Anke Wind
- Rijnstate Hospital, Arnhem, the Netherland; Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | - Elmar Hartman
- Rijnstate Hospital, Arnhem, the Netherland; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands; dept Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Wim van Harten
- Rijnstate Hospital, Arnhem, the Netherland; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands; The Netherlands Cancer Institute, Amsterdam. The Netherlands.
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Patient experiences of waiting times in standardised cancer patient pathways in Norway - a qualitative interview study. BMC Health Serv Res 2021; 21:651. [PMID: 34225705 PMCID: PMC8256611 DOI: 10.1186/s12913-021-06679-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
Abstract
Objective Standardised cancer patient pathways (CPP) are implemented within cancer care with an aim to ensure standardised waiting times for diagnosis and treatment. This article investigates how patients in Norway experience waiting times within a CPP. Methods Qualitative semi-structured interviews with 19 patients who had been through CPP for breast cancer, prostate cancer or malignant melanoma in Norway. Results Few patients knew about the term CPP but trusted that waiting times were standardised to decrease mortality. Their experiences of waiting depended on their expectations as much as the period they waited. Patients generally felt safe about the timing of treatment, but not all expectations of a rapid response from health services were met. Short waiting times were interpreted as a sign of urgency, and a change of pace between urgent action and prolonged periods of waiting were disturbing. Conclusions Patients are comforted by knowing they are within a structured CPP that ensures rapid diagnosis and start of treatment. CPPs still need to be improved to avoid delays, allow for adaptions to patient needs, and include more information to avoid stress.
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Haste A, Lambert M, Sharp L, Thomson R, Sowden S. Patient experiences of the urgent cancer referral pathway-Can the NHS do better? Semi-structured interviews with patients with upper gastrointestinal cancer. Health Expect 2020; 23:1512-1522. [PMID: 32989907 PMCID: PMC7752202 DOI: 10.1111/hex.13136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/28/2020] [Accepted: 09/08/2020] [Indexed: 01/22/2023] Open
Abstract
Background Timeliness is viewed as a key feature of healthâcare quality. Internationally, this is challenging. In England, cancer waiting time targets are currently not being met. For example, between 2015 and 2018 only 71% of patients with upper gastrointestinal (UGI) cancer started treatment within the recommended 62Â days of referral. Objective We explored patientsâ experiences to identify areas for service improvement. Design Semiâstructured interviews were conducted. Setting and participants Twenty patients who were referred through the urgent (twoâweek) GP referral route and were within six months of receiving first treatment were recruited. Data analysis Data from the interviews were analysed thematically. Results Four themes were developed: organization of care; diagnosis; support; and views and expectations of the NHS. Patients described crossâcutting issues such as complex and varied pathways and uncertainty about what would happen next. They felt daunted by the intensity and speed of investigations. They were presented with a recommended course of action rather than options and had little involvement in decision making. They were grateful for care, reluctant to complain and resigned to the status quo. Discussion and conclusions In order to meet patient needs, the NHS needs to improve communication and streamline pathways. Future cancer pathways also need to be designed to support shared decision making, be truly personâcentred and informed by patient experience.
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Affiliation(s)
- Anna Haste
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Mark Lambert
- Public Health England, North East Centre, Newcastle, UK
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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