Transcript SETTING UP THE SERVICE

SETTING UP THE
SERVICE
BY
LYNN TOBIN
HOW DID WE GET
HERE?
ABUNDENCE OF EVIDENCE
PROVIDING JUSTIFICATION
FOR BOWEL CANCER
SCREENING
BOWEL CANCER-THE
FACTS
• THIRD MOST COMMON FORM OF
CANCER
• SECOND LEADING CAUSE OF
CANCER RELATED DEATHS IN THE
WEST
• USUALLY ASYMPOTOMATIC IN
EARLY STAGES
• 95% OF COLO-RECTAL CANCERS
ARISE FROM ADENOMATOUS
POLYPS
BOWEL CANCER- THE
FACTS
IN THE UK
1 IN 20 FEMALES AND 1 IN 18
MALES WILL DEVELOP BOWEL
CANCER IN THEIR LIFETIME
EVERY DAY 50 PEOPLE DIE FROM
BOWEL CANCER
THIS EQUATES TO 18,000
DEATHS PER YEAR
SYMPTOMATIC PATIENTS
DUKES STAGES
• DUKES A = 13%
• DUKES B = 38%
• DUKES C = 49%
SCREENING PATIENTS
DUKES STAGES
• DUKES A = 48%
• DUKES B = 25%
• DUKES C = 27%
C & M DUKES STAGES
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DUKES A = 53%
DUKES B = 21.4%
DUKES C = 21.4%
DUKES D = 4.2%
THESE STATS ARE BASED UPON
THE FIRST 115 PATIENTS IN THE
PROGRAMME BUT WE HAVE HAD
247 CANCERS TO DATE
BOWEL CANCER SCREENING PROGRAMME PATIENT JOURNEY
SETTING UP THE
SERVICE
1st nurse clinic appointment letter sent
to patient from Rugby
Rugby rebook 1st
nurse clinic
appointment
1st appointment nurse clinic
DNA
Administrator to phone patient and
offer new appointment
Attended
Pre appointment
Cancelled
Day of appointment
• PUT OVERALL PATHWAY SLIDE
IN HERE
Patient refuses
colonoscopy
Listed for
colonoscopy
Unfit for
colonoscopy
Nurse to discuss assessment
with BCSP clinician
Disclaimer
Routine
screening
2 year FOBT
invitation
DNA
NAD
Nurse telephone
Clinic
Screening centre
to offer 2nd
appointment
Incomplete
colonoscopy
Ba Enema
within 2 weeks
Polyps
Surveillance
colonoscopy
Suspected tumour
Colonoscopy GP
information fax
Routine screening
2 year FOBT
Invitation
NAD
Routine screening
2 Year FOBT
invitation
Abnormal repeat
colonoscopy
Administrator to phone
patient and offer new
appointment
Low risk polyps routine
screening 2 year FOBT
invitation
Intermediate risk polyp
repeat colonoscopy 3
yearly
3 Yearly surveillance until
2 normal examinations
Referral for
CT ACE
Other
Referral to local
MDT for CT
staging.
Histology within 1
week.
Referral back to
local speciality
High risk polyp repeat
colonoscopy 1 year
3 Year surveillance until 2 no
examinations
SETTING UP CLINICS.
CONSIDERATIONS;
• HOW MANY CLINICS WILL YOU NEED
TO FACILITATE YOUR POPULATION?
• WHERE WILL YOU HOLD CLINIC?
• IF YOU HAVE A SURGE IN FOBT + DO
YOU AVAILABILTY FOR EXTRA
CLINICS?
• DO YOUR PATIENTS HAVE A CHOICE
OF WHICH CLINIC THEY WISH TO
ATTEND?
WHAT MUST BE IN PLACE
BEFORE WE SEE A
PATIENT
• AGREED PATHWAYS/ PROFORMAS
• AGREED MANAGEMENT PLANS FOR PATIENTS
WITH COMPLEX CO-MORBIDITY
• PGD
• TCI PATHWAY
• ANTI-COAGULATION POLICY (NEW BSG
GUIDELINES)
• DIABETIC POLICY
• NOMINATED LEADS FOR;
• CT
• X-RAY
• PATHOLOGY
• PHARMACY
WHAT DO I NEED TO
BRING TO CLINIC WITH
ME?
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PATIENT ASSESSMENT FORMS/LAPTOPS
MOBILE PHONES
PATIENT JOURNEY STORY BOOKS
AGREED HEALTH PROMOTION LEAFLETS
CONSENT INFORMATION LEAFLETS
RELEVENT LOCAL HOSPITAL
INFORMATION
• C&M HAVE CONDENSED THIS
INFORMATION INTO BOOKLETS SPECIFIC
TO EACH SCREENING SITE
WHO IS INELIGABLE?
• IBD PATIENTS ALREADY IN
SURVEILLANCE PROGRAMME
• BARIUM ENEMA WITH FLEXI
SIGMOIDOSCOPY OR
COLONOSCOPY WITHIN PAST 2
YEARS
• CURRENTLY UNDER TREATMENT
FOR COLO-RECATL CANCER OR
ALREADY IN SURVEILLANCE
PROGRAMME
• TOTAL COLECTOMY
COMMONLY ASKED
QUESTIONS/ANSWERS
• WHAT IS MY CHANCE OF
HAVING;
• CANCER = 1 IN 10 (10%)
• POLYPS = 1 IN 4 (40%)
• NORMAL RESULT = 1IN 5 (50%)
COMMONLY ASKED
QUESTIONS/ANSWERS
• HOW MANY PEOPLE HAVE
ABNORMAL FOBT RESULTS?
• 2 OUT OF 100 WILL HAVE
ABNORMAL RESULTS SO 98
OUT OF 100 WILL BE NORMAL
HOW RELIABLE/EFFECTIVE
IS THE FOBT TEST KIT?
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PROS;
NON-INVASIVE
CAN DO AT HOME
REFLECTS COMPLETE
COLON
• CHEAP AND EASY (£5)
• COLONOSCOPY £424
• CONS;
• POOR SENSITIVITY
AND SPECIFICITY
• - 10% FOR Ca
• - 40% FOR ADENOMAS
• SENSITIVITY
• 55-92% COLORECTAL
CANCERS
• 10-32% ADENOMAS
• 12-53% ADENOMAS
GREATER THAN 1 CM
COMMONLY ASKED
QUESTIONS/ANSWERS
• IF MY COLONOSCOPY IS
NORMAL, WILL YOU DO ANY
FURTHER INVESTIGATIONS TO
LOOK FOR POSSIBLE
EXPLANATIONS OF FOBT
POSITIVITY?
COLONOSCOPY
• INVESTIGATION DATASET
• CONSENT
• MDT PATHWAYS, REFERRAL FORMS
AND PATIENT CONTACT LETTERS
POST SUSPECTED DIAGNOSIS
USEFUL TO HAVE AT EACH
SCREENING SITE.
• BCSP STAMPS
• POST COLONOSCOPY
DOCUMENTATION
POST COLONOSCOPY/
TELEPHONE CLINICS
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IT PROFORMAS
POST INVESTIGATION DATASET
SIGNED/DISCUSSED HISTOLOGY
8 PATIENTS PER CLINIC WITH 20/30
MINUTE SLOTS (DEPENDING UPON
EXPERIENCE OF SSP)
MALIGNANT POLYPS. WHO
TELLS THE PATIENT?
• LIAISE WITH SCREENING
CONSULTANT RE; MALIGNANT
HISTOLOGY
• ASSESS SUITABILITY OF SSP
GIVING THE RESULT
• BRING THE PATIENT INTO FACE
TO FACE CLINIC
WHAT THE SSP MUST
UNDERSTAND BEFORE
GIVING MP DIAGNOSIS;
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CLINICAL DETAILS
MACROSCOPIC DESCRIPTION
TYPE OF CARCINOMA
DIFFERENTIATION
RESECTION MARGINS
HAGITT STAGE
KIKUCHI STAGE
NO SPECULATION ON PART OF SSP
BCSP CHALLENGES
• AGE EXTENSION >74 2010-2014
• 62 DAY TARGET DEC 2008
• THIRD WAVE ACTIVITY, WILL
LAST FEW SCREENING
CENTRES SLIP INTO 2009/2010
• CAREER DEVELOPMENT FOR
SSP