Patient-initiated Follow-up Research Articles

305 Improving Clinic DNA Rates with a Patient Initiated Follow Up Pathway: A Cohort Study

Abstract Introduction A Patient Initiated Follow-Up (PIFU) pathway was implemented in 2019; this enabled patients with specific plastic surgery trauma diagnoses to request a consultant clinic review within 3 months, without a routine follow-up appointment being made. PIFU aims to reduce ‘did not attend' (DNA) rates in line with the Royal College of Surgeons of England Outpatient Clinics Guide. Aim To assess the impact of PIFU on DNA rates of plastic surgery trauma clinics. Method A prospective cohort study of plastic surgery PIFU outpatient clinic DNA rates was undertaken (1st January–31st October 2021) and compared to data held for pre-PIFU pathway DNA rates (1st January–30th June 2018); inclusion dates for 2021 were extended to achieve comparable sample sizes for patient numbers routinely booked into clinics. DNA rates were collected from the hospital clinic database. Data were analysed using IBM®SPSS®. The Kolmogorov-Smirnov test was performed to assess sample population distribution, and the Chi2 test was used to compare categorical data. Results A total of 1702 patients were included in the study. Pre-PIFU, there was an 18% (149/823) DNA rate for patients (31.4 years ± 18.45 years) (mean age ± SD) booked into routine Consultant clinic follow-up. Post-PIFU, there was a 9% (77/879) DNA rate for patients (31.1 years ± 20.77 years) booked into routine Consultant clinic follow-up. This represents a significant reduction in DNA rates by 9% (Chi2=7.49, p<0.01); non-operatively managed hand fracture patients were the most frequent non-attenders. Conclusions The PIFU pathway has significantly reduced trauma clinic DNA rates.

SP7.12 Patient Initiated Follow-Up (PIFU)

IntroductionThere is a drive within the National Health Service towards a more personalised approach to healthcare. Patient-centred care gives individuals more control over their mental and physical health. We have implemented a patient-initiated follow-up (PIFU) system, within our trust. This provides patients with autonomy for arranging follow-up appointments when needed and saves unnecessary routine reviews.MethodsTwo consultant surgeons have offered a ‘PIFU style’ follow-up. Selected patients seen in clinic were discharged but provided with a PIFU card. Patients returned this card if they needed to be seen again in clinic for the same complaint.ResultsDuring the study period 149 patients were discharged with a PIFU card. There were 1370 appointments (New and Follow-up) over the same period. Only 17% of PIFU patients (twenty-six) returned within six months. One hundred and twenty-three patients (83%) sought no further appointments. This reduced unnecessary, routine follow-up visits. If a greater proportion of patients were discharged in a timely fashion and offered a PIFU card, then outpatient clinic efficiency would be further improved.ConclusionThe potential benefits of a PIFU system include: financial savings, patient autonomy, more clinic availability and fewer wasted GP appointments for re-referrals. Adopting a PIFU based system, helps to reduce service waiting times. PIFU is an important tool both for improving outpatient clinic efficiency and increasing patient autonomy. PIFU should be used widely, to help recovery after COVID-19.

Exploring the views of patients' and their family about patient-initiated follow-up in head and neck cancer: A mixed methods study.

The objective of this work was to explore head and neck cancer (HNC) patients' and their family members' views on acceptability and feasibility of patient-initiated follow-up (PIFU), including concerns and anticipated benefits. Patients were recruited from UK HNC clinics, support groups and advocacy groups. They completed a survey (n= 144) and/or qualitative interview (n= 30), three with a family member. Qualitative data were analysed thematically, quantitative data using descriptive statistics. Preference for follow-up care in HNC was complex and individual. Many patients thought PIFU could beneficially reallocate health care resources and encourage self-management. Patients' main concerns with PIFU were losing the reassurance of regular clinic appointments and addressing mental well-being needs within PIFU, possibly using peer support. Patients were concerned about their ability to detect recurrence due to lack of expertise and information. They emphasised the importance of a reliable, direct and easy urgent appointment service and of feeling supported and heard by clinicians. Patients believed family and friends need support. PIFU may be feasible and acceptable for certain HNC patients, providing it addresses support for mental well-being, provides quick, reliable and direct clinician access and information on "red flag" symptoms, and ensures patients and their caregivers feel supported.

Patient Initiated Follow-Up (PIFU) Within Adult Secondary Care Mental Health Services

AimsThe traditional ‘one size fits all’ model within secondary care mental health (MH) settings of regular appointments scheduled by a clinician at defined intervals isn't always responsive to an individual's changing needs. Previous reviews have shown significant levels of patient and clinician satisfaction with Patient initiated models of review in a variety of healthcare settings but its use within secondary care MH settings has been relatively limited. We describe the development and implementation of a Patient initiated follow-up (PIFU) pathway within MH services in NHS Greater Glasgow and Clyde (GG&C).MethodsThe pathway was developed by a small working group of clinicians with input from local management and eHealth colleagues with an emphasis on the principles of Realistic Medicine. There was input from peer support workers and the Mental Health network, a local service user organisation, into the development of the pathway. The pathway underwent a ‘test of implementation’ within three adult CMHT's with support from the development group. Feedback from the test sites was used to modify the pathway and ultimately support the wider rollout of the model across all seventeen CMHTs within NHS GG&C over the course of 2021. Formal evaluation of the pathway, including patient and clinician satisfaction, service utilisation as well as safety measures, is due to be undertaken at 12 months after full implementation.ResultsThe tests of implementation identified a range of factors that needed to be considered as part of the introduction of a PIFU model into MH settings.Patient choice and shared decision making along with other clinical factors such as level of insight, availability of other supports, shared risk assessments and current clinical need were identified as relevant patient related factors. Clinician related factors included concerns about applicability within MH settings, perception of risk, increase in workload and appropriate identification of suitable patients. Regular meetings between the clinicians in the test sites and members of the development group as part of the implementation process helped address clinicians concerns and ultimately supported uptake of the model.ConclusionOur experience highlighted the potential for a personalised approach to care planning in empowering patients have a more active role in the way they access services as part of their recovery journey. It also highlighted patient and clinician related factors that need to be considered for a successful adoption of the model.

Virtual management of clinically suspected scaphoid fractures.

The aim of this study was to describe the introduction of a virtual pathway for the management of patients with a suspected fracture of the scaphoid, and to report patient-reported outcome measures (PROMs) and satisfaction following treatment using this service. All adult patients who presented with a clinically suspected scaphoid fracture that was not visible on radiographs at the time of presentation during a one-year period were eligible for inclusion in the pathway. Demographic details, findings on examination, and routine four-view radiographs at the time of presentation were collected. All radiographs were reviewed virtually by a single consultant hand surgeon, with patient-initiated follow-up on request. PROMs were assessed at a minimum of one year after presentation and included the abbreviated version of the Disabilities of the Arm, Shoulder and Hand Score (QuickDASH), the EuroQol five-dimension five-level health questionnaire (EQ-5D-5L), the Net Promoter Score (NPS), and return to work. A total of 221 patients were referred to the virtual pathway. Their mean age was 41 years (range 16 to 87) and there were 99 male patients (45%). A total of 189 patients (86%) were discharged with advice and 19 (9%) were recalled for clinical review: seven with an undisplaced scaphoid fracture, six with another fracture of the hand or wrist, two with a scapholunate ligament injury, and four in whom no abnormality was detected. A total of 13 patients (6%) initiated follow-up with the hand service: no fracture or ligament injury was identified in this group. PROMs were available for 179 patients (81%) at a mean follow-up of 19 months (range 13 to 33). The median QuickDASH score was 2.3 (interquartile range (IQR) 0 to 15.9), the median EQ-5D-5L was 0.85 (IQR 0.73 to 1.00), the NPS was 76, and 173 patients (97%) were satisfied with their treatment. There were no documented cases of symptomatic nonunion one year following injury. We describe the introduction of a virtual pathway for the management of patients with a suspected scaphoid fracture. We found high levels of patient satisfaction, excellent PROMs, and no detrimental effects in the vast majority of cases. Cite this article: Bone Joint J2022;104-B(6):709-714.

P015 Rheumatology Patient Initiated Follow-Up (PIFU) in a busy urban district general hospital - a scoping exercise

Abstract Background/Aims A recent report from British Society of Rheumatology (2021) highlighted severe national shortages in the rheumatology workforce. Patient Initiated Follow-Up (PIFU) is an innovative strategy for stable patients, reducing the need for “routine follow-up”. PIFU allows patients to contact their local department and organise a clinical review if they have a disease flare. In our model, a back-up appointment is made to allow ongoing future management such as drug de-escalation. PIFU has been trialled successfully in other trusts, where 20% of follow-up patients were deemed suitable. Our aim was to perform a scoping exercise to determine if PIFU would be suitable for our multi-ethnic diverse cohort in a busy urban district general hospital. Methods PIFU inclusion, exclusion and disease-related criteria were developed with input from departments already running PIFU. Patients were considered for PIFU if over 18 years old with a diagnosis of stable inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, axial spondyloarthropathy) evidenced by low disease scores, no change in disease modifying drugs or steroid use in the last 12 months. Our criteria were applied retrospectively to all patients who attended consultant and registrar General Rheumatology clinics from 20th-31st January 2020. Data were collected on demographics, rheumatological diagnosis and suitability of eligible patients for PIFU. Results 340 follow-up patients attended clinic during the 2-week period, of which 136 did not have a rheumatological condition suitable for PIFU (including osteoporosis, osteoarthritis and connective tissue disease). 42 (20.6%) of the 204 patients with eligible conditions were deemed suitable for PIFU. This represented 12.4% of our total follow-ups. In our current practice, the routine follow-up for the 42 suitable patients was arranged for a median time of 9 months (IQR: 7.75-12 months). If PIFU patients were allocated a back-up appointment at 3 years, PIFU would represent a saving of 3 routine appointments per patient over 3 years. For a full-time consultant, seeing 40 follow-ups per week, this would save 4.9 appointments per week or 198 appointments per year. Conclusion 12.4% of our follow-up patients were deemed eligible for PIFU, which was lower than other trusts. This may be due to the low sample size or increased diversity and social complexity of our local population. Even with this lower percentage of eligible patients, PIFU may allow freeing of nearly five appointments per full-time consultant per week. PIFU may also empower patients to take ownership of their condition and enable confidence in self-management. If a PIFU service was set up locally, a robust pathway would be needed to ensure that patients could contact the department when required. The need for annual disease review would also need to be considered using primary care or IT solutions. Disclosure N. Mothojakan: None. L. St.Aimee: None. C. Quieros: None. N. Horwood: None. S. Levy: None. R. Sathananthan: None.

Changing the routine: a move to patient initiated follow up to improve surgical outpatient clinic

IntroductionPatient initiated follow up (PIFU) allows patients to initiate a hospital follow up appointment on an ‘as required’ basis in contrast to the traditional physician‐initiated model. We present a clinical pathway for patients referred with rectal bleeding at a large tertiary public hospital in South Auckland, New Zealand and demonstrate the utility of PIFU and its impact on reducing follow up appointments.MethodThe purpose of the pathway was to allow standardized care by the clinicians and allow for PIFU. Two separate protocols were developed ‐ ‘Painful PR bleeding’ and ‘Painless PR bleeding’. A new clinic (NC) was started following these protocols, and this was compared to historical controls (HC). The primary outcome was the rate of follow up appointments.ResultsThere were 133 patients in the NC and 135 in the HC, with significantly less follow ups in the NC (6% versus 45%, p < 0.0001). A small percentage of patients in the NC group were directly discharged (10%) whilst 70% of patients were discharged with a PIFU card. Thirty phone calls were made using PIFU, with 10 patients returning to clinic and 20 requiring advice and reassurance only. At 5 year follow up, there was a single colorectal malignancy found in both groups.ConclusionInitiating a protocol that includes patient initiated follow up vastly reduces the need for routine return to clinic for the majority of patients, without sacrificing patient care. A protocolised approach to clinic for other areas in general surgery should be considered.

Patient-initiated follow up as a means of reducing pressures in secondary care.

Outpatient services, largely dedicated to routine follow up, have been under increasing pressure in recent years. The growing and ageing UK population has been a large driver of this pressure, requiring a significant increase in annual outpatient appointments. Many of these appointments, however, may be guided by organisational, rather than clinical need, and as a result, some evidence indicates patient attendance rates have fallen, demonstrating a need for more effective, patient-centred care models. One such model, patient-initiated follow up (PIFU) has shown significant promise, empowering patients while simultaneously reducing appointment numbers and increasing attendance rates. However, for PIFU to be implemented nationwide several key considerations must be made to ensure patients are appropriately engaged, and supported, in directing their own care.

292 Patient Centred Care in the Outpatient Department

Abstract Aim The NHS long term care plan recognises the need for a personalised approach to healthcare. Patient initiated follow up (PIFU) is one way in which the NHS can support patients with becoming more autonomous in decisions about their own health. Method Our trust implements PIFU in 2 ways. Firstly, patients considering an elective operation were provided with a clinic letter detailing the treatment options and a PIFU card. They were discharged and asked to return the card if they wished to proceed to surgery, at which point they were added to the waiting list. Secondly, patients discharged from clinic were provided with a card which they returned if they needed to be seen again for the same complaint. Results 95 patients were recruited for the operative pathway. 38 (40%) requested surgical treatment within 6 months. 149 patients were recruited for the clinic pathway, of which 17% returned for the same condition within 6 months. Conclusions This study has shown that 60% of patients choose, after meaningful dialogue and time to reflect, to avoid surgical treatment. In all cases the surgeon would have “added to the waiting list” had a joint decision been made at the end of the consultation. Furthermore, 83% of patients who would ordinarily have had a routine follow-up appointment did not return to clinic. This PIFU system empowers patients to make decisions about treatment. Offering direct access to the operative waiting lists and clinics has multiple benefits: fewer primary care and hospital appointments; reduced waiting times and reduced costs.

Clinicians' Views of Patient-initiated Follow-up in Head and Neck Cancer: a Qualitative Study to Inform the PETNECK2 Trial

AimsCurrent follow-up for head and neck cancer (HNC) is ineffective, expensive and fails to address patients' needs. The PETNECK2 trial will compare a new model of patient-initiated follow-up (PIFU) with routine scheduled follow-up. This article reports UK clinicians' views about HNC follow-up and PIFU, to inform the trial design. Materials and methodsOnline focus groups with surgeons (ear, nose and throat/maxillofacial), oncologists, clinical nurse specialists and allied health professionals. Clinicians were recruited from professional bodies, mailing lists and personal contacts. Focus groups explored views on current follow-up and acceptability of the proposed PIFU intervention and randomised controlled trial design (presented by the study co-chief investigator), preferences, margins of equipoise, potential organisational barriers and thoughts about the content and format of PIFU. Data were interpreted using inductive thematic analysis. ResultsEight focus groups with 34 clinicians were conducted. Clinicians highlighted already known limitations with HNC follow-up – lack of flexibility to address the wide-ranging needs of HNC patients, expense and lack of evidence – and agreed that follow-up needs to change. They were enthusiastic about the PETNECK2 trial to develop and evaluate PIFU but had concerns that PIFU may not suit disengaged patients and may aggravate patient anxiety/fear of recurrence and delay detection of recurrence. Anticipated issues with implementation included ensuring a reliable route back to clinic and workload burden on nurses and allied health professionals. ConclusionsClinicians supported the evaluation of PIFU but voiced concerns about barriers to help-seeking. An emphasis on patient engagement, psychosocial issues, symptom reporting and reliable, quick routes back to clinic will be important. Certain patient groups may be less suited to PIFU, which will be evaluated in the trial. Early, meaningful, ongoing engagement with clinical teams and managers around the trial rationale and recruitment process will be important to discourage selective recruitment and address risk-averse behaviour and potential workload burden.

Optimizing orthopedic trauma care delivery during the COVID-19 pandemic. A closed-loop audit of implementing a virtual fracture clinic and fast-track pathway in a Dutch level 2 trauma center

BackgroundGuidelines concerning outpatient management of patients during the coronavirus pandemic required minimized face-to-face follow-up and increased remote care. In response, we established a virtual fracture clinic (VFC) review for emergency...

Stage one endometrioid endometrial adenocarcinoma: is there a role of traditional hospital follow-up in the detection of cancer recurrence in women after treatment?

ObjectiveTo investigate the rate of asymptomatic recurrence of stage 1 endometrioid endometrial cancer and assess the role of routine hospital follow-up after treatment.MethodsWe performed a retrospective case-note review study of women who were diagnosed with stage 1 endometrioid endometrial adenocarcinoma at Queen’s Hospital, Romford, between January 2008 and December 2016.ResultsWe included 299 patients with a median follow-up period of 44.4 months. All the patients underwent total hysterectomy and bilateral salpingo-oophorectomy. Adjuvant radiotherapy was offered to the patients subsequent to discussions in the multidisciplinary team meeting in accordance with the risk stratification criteria. There was no significant correlation between the risk factors and disease recurrence. In total, 11 patients presented with recurrent disease with original staging: 1a, n=6/199; and 1b, n=5/100. Four patients presented with vaginal bleeding due to vault recurrence and one patient with abdominal pain due to pelvic mass. Locoregional recurrence was an incidental finding in two other patients. Four patients presented with symptomatic distant metastases to the lung (n=2), liver (n=1), and bone (n=1). No asymptomatic recurrences were identified on routine follow-ups, despite several hospital appointments and clinical examinations. The recurrence rate for patients with stage 1a and 1b, grade 1, and grade 2 disease was 3.53%, and that for patients with stage 1a, grade 1, and grade 2 disease was 2.7%.ConclusionRoutine clinical examinations have a low yield in finding recurrence in asymptomatic women and should be questioned for their value, considering the limited resources of the National Health Service (NHS). Larger studies are required to support a stratified follow-up, which will include telephone and patient-initiated follow-up.

Patient-initiated follow-up of early endometrial cancer: a potential to improve post-treatment cardiovascular risk?

PurposeIs patient-initiated follow-up, post-surgical treatment of early endometrial cancer safe and can it be used holistically to improve cardiovascular health? What are the cost implications of this model of follow-up?MethodsRetrospective data of 98 patients discharged to patient-initiated scheme since 2012. Service evaluation by anonymous patient feedback including physical health effects of the programme including weight loss. Financial cost was compared to traditional hospital-based follow-up over five years.ResultsNo evidence of recurrence over 54 months median follow-up in low-risk endometrioid endometrial cancer. Patient feedback indicates that the exercise course helped women reduce their BMI. Over one third women felt happier and one fifth felt more confident and had a better ability to cope with stress. Total of 91% patients would recommend this model of follow-up to friends or family in the same circumstance. European Society for Medical Oncology guidance suggests the number of hospital-based follow-up appointments required for this cohort would cost £109,760. Calculations in this paper examine the cost of patient-initiated follow-up and reflect an overall saving of around 96.5%.ConclusionThis service evaluation supports the claim that patient-initiated follow-up represents a safe alternative to the traditional hospital-based protocol. There is a potential for additional services to be offered to encourage and promote a healthy lifestyle linked to improving quality of life and cardiovascular survival following surgery for endometrial cancer.Implications for cancer survivorsCardiovascular morbidity is the most common cause of death in endometrial cancer survivors. Incorporating an exercise course as part of routine follow-up can help reduce this risk. The friendships formed by this communal follow-up can contribute towards emotional health and recovery. This holistic approach should be incorporated into novel follow-up strategies to help reduce patient BMI and reduce cardiovascular risk.

Teleclinics in rheumatology introduced during the first lockdown phase of the COVID-19 pandemic of 2020

The COVID-19 pandemic has led to a crisis in the provision of usual services, including face-to-face (FTF) outpatient clinics. The need for change came abruptly in late March 2020 as routine clinics were cancelled. We accelerated the delivery of our teleclinics (telephone and video) in rheumatology, which we had started doing prior to the pandemic. 396 patients were reviewed during the lockdown by teleclinics. 39 (10%) of patients were discharged, 102 (26%) had treatment adjusted without bringing forward their appointment, 39 (10%) had tests ordered and prescriptions issued, 160 (40%) were reviewed and booked for a future appointment, thus reducing the current waiting list, and 22 (6%) were placed a patient-initiated follow-up plan. Only 10 (3%) required a conversion from the teleclinic to a FTF clinic in the near future. The COVID-19 crisis offered us the opportunity to do things we had been considering for some time. Our aim is now to continue with this new way of working as we move to the recovery phase and beyond. We would suggest that adoption of these changes in other trusts could significantly improve the quality of the care for patients not only in rheumatology but also throughout the NHS.

Post-Treatment Head and Neck Cancer Care: National Audit and Analysis of Current Practice in the United Kingdom.

We aimed to audit current United Kingdom (UK) practice of Head and Neck Cancer (HNC) post-treatment surveillance against national guidelines and determine the outcomes of these practices in detecting recurrence. National cross-sectional study of current HNC surveillance practice. UK HNC outpatient departments. HNC patients reviewed for post-treatment surveillance. Compliance with UK multidisciplinary guidelines and rates of cancer recurrence detection by time, clinic type and symptoms. Data were analysed from 5,123 consultations across 89 UK centres. 30% of consultations were in dedicated multidisciplinary clinics, with input fromallied health professionals (AHPs) available on the day in 23% of allconsultations. Recurrence was suspected in 344 consultations and investigated with MRI in 29.6% (n=102) and PET-CT in 14.2% (n=49). Patient education regarding recurrence symptoms, and smoking and alcohol advice, was provided in 20.4%, 6.2% and 5.3% of cases, respectively. Rates of recurrence detected were 35% in expeditedappointments and 5.2% in planned follow-ups (P=.0001). Of theexpedited appointments, 63%were initiated by patients and37% by clinicians. Recurrence was higher in those with new symptoms (7.1% versus 2.2%). The strongest predictors of recurrence were dyspnoea (positive predictive value (PPV)=16.2%), neck pain (PPV=10.4%) and mouth/throat pain (PPV=9.2%). Dedicated multidisciplinary clinics comprise a minority of consultations for HNC surveillance in the UK, with low availability of AHPs. PET-CT and MRI were underutilised for the investigation of suspected recurrence. There may be scope for greater emphasis on patient education and consequent patient-initiated symptom-driven follow-up.

Patient-Initiated Follow-Up (PIFU) as reorganized support for increased patient involvement \u2013 focus group discussions among patients\u2019 with inflammatory arthritis

BackgroundInflammatory Arthritis is characterized by lifelong medical treatment and an unpredictable trajectory because of the fluctuating nature of the diseases. Proactive disease management is recommended, which includes close monitoring of disease activity that traditionally has been ensured by outpatient visits to rheumatologists at various fixed intervals. Internationally, there is a growing interest in how healthcare systems can be more flexible, individual-oriented and increasingly involve patients with lifelong diseases in their own treatment and care. We aimed to explore how patients with Inflammatory Arthritis with low disease activity or remission (DAS-CRP < 2.9) experience patient involvement in a reorganized follow-up care based on flexibility and patient-initiated contact.MethodsWe conducted a qualitative study based on four mixed group discussions focused on patients with inflammatory arthritis (rheumatoid arthritis [n = 21], axial spondyloarthritis [n = 3] and psoriatic arthritis [n = 1]) participating in a reorganized follow-up care. Changes in follow-up included access to a nurse and patient-initiated follow-up (PIFU). The analysis was based on content analysis. The reporting adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ).ResultsIn total, 25 patients (20 females (80%), mean age 61.8 [range 28–79]) participated. We identified three categories. 1) Patient-Initiated Follow-Up do not affect patients’ perceived support in disease control; this refers to patients’ experience of more time available through better resource utilization, as well as trust that access to professional support would be available whenever needed. The category 2) Information is valued by patients to delineate responsibilities in a new patient role reflects patients’ uncertainty in the transition to PIFU, combined with confusion about the distribution of responsibilities. 3) Patients need both extended perspectives of their arthritis and focused dialogue is about expanding patients’ understanding of their arthritis by interaction over time with both a rheumatologist and a rheumatology nurse in a focused dialogue to involve the patient.ConclusionsPatients participating in PIFU welcome the flexibility and involvement. However, patients need relevant information to act adequately within a new patient role. Interaction with both rheumatologists and nurses, combined with sufficient time for dialogue, broaden patients’ perspective, make opportunities for action visible, and contribute to patients’ ability to participate in follow-up care.

Patient-initiated follow-up for low-risk endometrial cancer: a cost-analysis evaluation

ObjectiveRisk stratification has resulted in patient-initiated follow-up being introduced for low-risk endometrial cancer in place of routine hospital follow-up. The financial benefit to the patient and the healthcare economy of...

Patient-initiated follow-up after treatment for low risk endometrial cancer: a prospective audit of outcomes and cost benefits

ObjectiveRecurrence of low-risk endometrioid endometrial cancer is rare, and traditional hospital follow-up has a cost to both the patient and the healthcare system, without evidence of benefit. We examined the...

Patient initiated follow up after gynaecological malignancy: National survey of current UK practice

ObjectiveTo establish the prevalence of follow up regimes following treatment for gynaecological malignancies in the UK. Study designOnline questionnaire Survey of gynaecological cancer centres across the UK. All members of the British Gynaecological Cancer Society (BGCS) and the National Forum of Gynaecological Oncology Nurses (NFGON) were invited to complete the survey between 12/07/2018 and 12/04/2019. Responses were grouped into cancer centres for analysis. Results90 % (44/49) of cancer centres from across the UK responded. All centres offer consultant follow up, most commonly for 5 years (77 %). Routine CA125 surveillance was performed for ovarian cancer in 27 % and cervical or vault cytology for cervical cancer in 9 %. Cancer centres also utilised patient initiated follow up (PIFU) (42 %), telephone follow up (36 %) and nurse led follow up (45 %). PIFU was most commonly offered in endometrial cancer (100 %) but also in vulval (26 %), cervical (32 %) and ovarian (26 %) cancer. Timing of PIFU initiation following completion of treatment varied by cancer stage and grade in endometrial cancer. For patients with grade 1 stage 1a endometrial cancer, PIFU was initiated within 3 months in 82 % of centres that use PIFU. ConclusionNon hospital based follow up regimes are increasingly prevalent in the UK following gynaecological malignancy. The appointment and cost savings in secondary care may be significant however there is likely to be a substantial impact on the primary care sector. There is no evidence regarding the impact of PIFU on overall survival and a randomised controlled trial is strongly recommended.

Endometrial cancer patients' preferences for follow-up after treatment: A cross-sectional survey.

Alternatives to hospital follow-up (HFU) following treatment for cancer have been advocated. Telephone follow-up (TFU) and patient-initiated follow-up are being implemented but it is unclear if these approaches will meet the preferences and needs of patients. This study aimed to explore the preferences of endometrial cancer patients and their levels of satisfaction with HFU and nurse-led TFU. A cross-sectional survey design was utilised and a questionnaire was administered to 236 patients who had participated in a randomised controlled trial comparing HFU with TFU for women diagnosed with Stage I endometrial cancer (ENDCAT trial). 211 (89.4%) patients returned the questionnaire; 105 in the TFU group and 106 in the HFU group. The TFU group were more likely to indicate that appointments were on time (p<0.001) and were more likely to report that their appointments were thorough (p=0.011). Participants tended to prefer what was familiar to them. Those in the HFU group tended to prefer hospital-based appointments while the TFU group tended to prefer appointments with a clinical nurse specialist, regardless of locality. To provide patient centred follow-up services we need to ensure that patient preferences are taken into account and understand that patients may come to prefer what they have experienced. Patient initiated approaches may become standard and preferred practice but TFU remains a high-quality alternative to HFU and may provide an effective transition between HFU and patient-initiated approaches.