ABSTRACT
Introduction & Objectives: One of the biggest challenges of the last 12 months has been the practical continuation of cancer diagnostic services and changes in health-seeking behaviour, with urgent 2-week-wait cancer referrals decreasing by up to 80% in response to physical distancing and concerns about contracting SARS-CoV-2. Our diagnostic service saw a 60% decrease in referrals and an appointment cancellation rate of 50% in the first 4 weeks following national lockdown. In an effort to address these concerns we sought to develop and evaluate the effectiveness of a digital solution in the form of a patient video and an information leaflet to reassure patients about their hospital attendance. Materials & Methods: We identified and recruited patients that had previously undergone prostate cancer diagnostics through the Prostate Rapid Diagnostic Clinic. Using an interview guide, an experienced facilitator conducted two 90-minute focus groups. Sessions were audiotaped, transcribed verbatim, and analysed using thematic content analysis techniques. A 3 minute patient video was developed based on the themes highlighted in the focus groups. A link to the video was emailed to patients alongside a Patient Information Sheet (PIS) prior to their appointment. The impact of the intervention was evaluated using a survey developed through a clinician and patient discussion group. A 7 point likert scale of agreement (1 strongly disagree – 7 strongly agree) was used to evaluate patient attitude to the interventions and was presented to participants in block-randomisation format. The survey was administered through the General Data Protection Regulation (GDPR - 2018) compliant smart survey website. Results: Focus Groups: Key themes emerging from the initial focus groups included;investigations required for diagnosis, timeline to diagnosis and Covid safe communication and consultations. Survey Results: Between May 4th and June 6th, 43/61 consecutive patients seen in the diagnostic clinic were invited to complete the survey. The mean age of patients was 66 years. 53/61 [87%] of patients agreed or strongly agreed that understanding the safety precautions that had been implemented in the diagnostic pathway were reassuring. 54/61 [89%] of patients agreed or strongly agreed that understanding the investigations that would be carried out during their consultation and the timeline to a diagnosis was reassuring. 42/61 [69%] of patients agreed or strongly agreed that the video had made them feel safer to come to the diagnostic centre. Whereas only 19/61 [31%] felt the same way about the PIS. With 48/61 [79%] of patients preferring the video to the PIS. Conclusions: Digital information was effectively used to deliver important messages through the peaks and troughs of the COVID-19 pandemic, and should be considered to reassure during any future pandemic waves.
ABSTRACT
Introduction & Objectives: One of the biggest challenges during the Covid-19 pandemic has been the continuation of cancer diagnostic services. Using a combination of virtual clinics and telephone triage assessments in a multi-professional team approach has allowed our haematuria pathway to continue to function. We reviewed how these interventions helped maintain the volume of patients through the haematuria service during the pandemic. Materials & Methods: We reviewed prospective audit data collected on patients referred to the haematuria service between June 2019 and January 2021. Comparison was made in respect to the pathways before and during the pandemic. Data review included: time from primary care referral to hospital clinical review, time from clinic to CT, ultrasound and/or flexible cystoscopy and time to bladder tumour resection. All patients were invited to complete an on-line survey to document their experiences and the results were reviewed. Results: 174 patients were referred via a two-week-wait cancer pathway (12 via internal pathways, 162 from primary care). Between 26/3/20 and 14/4/20 no referrals were received. Before the pandemic the number of referrals were 93 over 9 months (10.3 referrals per month), post-covid 81 referrals were sent over 9.5 months (8.5 referrals per month). 12 patients were not investigated in the usual timeframe (COVID positive, shielding, patient choice and non-attendance) and were excluded from final analysis. Of 162 patients, 51 were women, and 111 were men. The average age was 64.4 years (SD+/-14.51, range 20-91). Table 1 shows the relative timing of investigations and treatment pre and during the Covid pandemic: (Table Presented) 69 patients completed the online patient experience survey during the pandemic, with an age range of 19 to 88. 15% of participants received a cancer diagnosis during this time. 55% were happy to have received results virtually with 97% reporting that this was done sensitively. 84% of patients reported that they understood the next steps in their management pathway and 74% were clear about the supportive care available to them. An equal number of patients were reviewed by nurses and doctors. Conclusions: The adaptation to our services may have resulted in several improvements, namely in the time frames of patients being seen and assessed. Reducing clinic burden by creating virtual follow-ups is acceptable to patients and utilising nurse practitioners, doctors and supportive staff may help to improve pathways in the long-term beyond the present pandemic.