Quality Of Care For Women Research Articles

Deciding Our Future: Consensus Conference Summary Report.

There are few quality measures that allow for optimization of care for pelvic organ prolapse (POP). In coordination with the American Urogynecologic Society (AUGS), a prior group agreed upon health care provider-reported data elements that are important for large-scale quality measurement. The primary objective was to review existing patient-reported outcome (PRO) measurement tools for POP and consider where improvements are needed for inclusion in a quality measurement tool. A secondary objective was to discuss enhanced strategies to improve the quality of care for women with mesh complications. The AUGS Scientific Committee convened a 1-day meeting titled "Deciding our Future: Consensus Conference on Prolapse Outcomes and Best Practices for Mesh Complications." Speakers discussed the current state of POP outcome measurement and meaningful ways of measuring and improving quality. Furthermore, past and future work for standardization of care regarding mesh complications was discussed. Conference participants included invited speakers, representatives from AUGS and partner societies, 5 patient representatives from the AUGS Patient Advisory Committee, and 38 registered participants from academic institutions, community practices, and industry. Participants developed a roadmap for incorporating PROs into a national POP quality improvement registry. Participants also discussed important gaps in our knowledge of treatment of mesh complications and previewed proposed terminology and treatment algorithms. Using appropriate methodology, existing PRO measurement tools can be collapsed into one concise tool for POP quality measurement. Over the next year, work will continue toward this goal. Proposed updates to mesh terminology and treatment algorithms will be published separately.

CURRENT ISSUES ON PROVISION OF SERVICES TO WOMEN DURING PREGNANCY AND POSTPARTUM PERIOD BY FAMILY DOCTORS

The aim is to determine the types of medical services that family doctors should provide to women during pregnancy and in the postpartum period and the competencies they should have to provide these services and the most acceptable ways to acquire them. Materials and methods: During the study, the method of expert assessment, statistical method and method of structural and logical analysis were used. 50 obstetricians and gynaecologists who provide women with outpatient care and 50 family doctors acted as independent experts in the study. Results: The types of medical services that family doctors should provide to women during pregnancy and in the postpartum period and the competencies that they should have to ensure the provision of these services were determined by experts. The most acceptable ways to acquire the necessary competencies, as well as the benefits and risks of providing these services at the primary level of health care were designated. Conclusions: The implementation of the proposed types of medical care by family doctors will increase the availability and quality of medical care for women during pregnancy and in the postpartum period.

How to improve the quality of care for women with postpartum haemorrhage at Onandjokwe Hospital, Namibia: quality improvement study

BackgroundPostpartum haemorrhage (PPH) is the leading direct cause of maternal morbidity and mortality worldwide. The sustainable development goals aim to reduce the maternal mortality ratio to 70 per 100,000 live births. In Namibia, the ratio was reported as 265 per 100,000 live births in 2015 and yet little is published on emergency obstetric care. The majority of deliveries in Namibia are facility-based. The aim of this study was to assess and improve the quality of care for women with PPH at Onandjokwe Hospital, Namibia.MethodsA criterion-based audit cycle in all 82 women with PPH from 2015 using target standards for structure, process and outcomes of care. The audit team then planned and implemented interventions to improve the quality of care over a 10-month period. The audit team repeated the audit on all 70 women with PPH from the same 10-month period. The researchers compared audit results in terms of the number of target standards achieved and any significant change in the proportion of patients’ care meeting the predetermined criteria.ResultsIn the baseline audit 12/19 structural, 0/9 process and 0/3 outcome target standards were achieved. On follow up 19/19 structural, 6/9 process and 2/3 outcome target standards were met. There was one maternal death in the baseline group and none in the follow up group. Overall 6/9 process and 2/3 outcome criteria significantly improved (p < 0.05) from baseline to follow up. Key interventions included training of nursing and medical staff in obstetric emergencies, ensuring that guidelines and standard operating protocols were easily available, reorganising care to ensure adequate monitoring of women postpartum and ensuring that essential equipment was available and functioning.ConclusionThe study demonstrates that the quality of care for emergency obstetrics can be improved by audit cycles that focus on the structure and process of care. Other hospitals in Namibia and the region could adopt the process of continuous quality improvement and similar strategies.

Optimising the Management of Late Term Pregnancies: Inconclusive Evidence and High Induction Rates Affect Quality of Care for Women

(BMJ. 2019;364:1681) Most pregnant women want clear and accurate evidence-based information to help them make decisions about their labor and delivery experience. When confronted with a “postterm” pregnancy, which poses increased risks for women and their babies, this information is especially important. A recent Cochrane systematic review reported that induction at or beyond the due date was associated with fewer perinatal deaths, neonatal admissions to intensive care, and cesarean sections but more operative vaginal births when compared with expectant management. This editorial discussed previous studies and the current study by Keulen and colleagues.

Women's preferences and experiences of cervical cancer screening in rural and remote areas: a systematic review and qualitative meta-synthesis.

Cervical cancer is one of the leading causes of mortality in women. Population-based cervical cancer screening programs have been highly effective in reducing the incidence and mortality of cervical cancer worldwide. However, disparities remain in women's cervical cancer screening participation rates, especially in rural and remote areas, where access to health care may be circumscribed due to logistical barriers. Until now, there has been no effort to review and synthesize the perspectives and experiences of women accessing cervical cancer screening in rural and remote areas. This systematic review and qualitative meta-synthesis of 14 studies aimed to describe and elaborate the issues women face when accessing cervical cancer screening in rural and remote areas. This study used the qualitative meta-synthesis approach to review 14 studies on rural women's participation in cervical cancer screening. This research approach synthesized findings from multiple, primary qualitative studies to produce a new interpretation of the phenomenon while retaining the original meaning of each qualitative study. After 4937 citations were screened by database searching, 117 were retrieved for full-text review, of which 14 studies were included. This study identified two themes that modulate rural women's access to cervical cancer screening: interactions with healthcare providers and healthcare system access. Furthermore, this study found that women frequently expressed issues around patient-centered care in their interactions with healthcare providers. The implications of these findings for program design and delivery efforts in rural and remote areas are discussed. This article provides the foundation for tailoring interventions and programming to increase cervical cancer screening rates in women who reside in rural and remote areas. This review also clarifies the factors of patient-centered care that may be adopted to enhance the quality of care for women in rural and remote areas. In summary, this systematic review and qualitative meta-synthesis provide information about women's perspectives and experiences accessing cervical cancer screening in rural and remote areas. The review has strong implications for this population and can be used to inform future research and program design initiatives.

Current FIGO Staging for Carcinoma of the Cervix Uteri and Treatment of Particular Stages.

Here, we present a review of the revised FIGO (International Federation of Gynecology and Obstetrics) staging system for carcinoma of the cervix uteri, explaining the reasons for the changes and summarizing suitable diagnostic methods and treatment options for particular stages of disease according to current guidelines. The FIGO staging system has been revised as follows. Measurement of lateral extension has been removed from stage IA; the only criterion is a measurement for the deepest invasion of &lt; 5.0 mm. Stage IB has been divided into three subgroups: IB1, tumors with a largest diameter measuring 5 mm and &lt; 2 cm; IB2, tumors measuring 2-4 cm; IB3, tumors measuring 4 cm. Stage IIIC includes an assessment of retroperitoneal lymph nodes: IIIC1 if only pelvic lymph nodes are involved, and IIIC2 if para-aortic nodes are infiltrated. The revised staging system does not mandate the use of a specific imaging method or surgical assessment of the extent of the tumor. The method used to assign a stage should be recorded and reported. The European Society of Gynaecological Oncology, the European Society for Radiotherapy and Oncology, and the European Society of Pathology have developed clinically relevant and evidence-based guidelines to improve the quality of care for women with cervical cancer. These guidelines cover comprehensive staging, management, and follow-up for patients with cervical cancer. The guidelines are intended for use by gynaecologic oncologists, general gynaecologists, surgeons, radiation oncologists, pathologists, clinical oncologists, radiologists, general practitioners, palliative care experts, and other health professionals. We summarize the new FIGO classification system, including diagnostic methods and treatments for particular stages. We also discuss the main changes and their clinical impact. This work was supported by the Charles University project UNCE 204065. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Quality of care for women with uterine cancer at US safety net hospitals

Quality of care for women with uterine cancer at US safety net hospitals

An Interprofessional Approach to Improving Identification and Time to Treatment of Severe Hypertension in Pregnant Women

To develop and implement a protocol to improve the quality of care for women with severe hypertension during pregnancy and reduce adverse outcomes. Severe maternal morbidity associated with preeclampsia and eclampsia occurs in 12%–22% of pregnancies and is a leading cause of maternal death, contributing to 18% of maternal deaths in the United States. Other adverse outcomes include abruption, hemorrhage, disseminated intravascular coagulation, intrauterine growth restriction, intrauterine death, and increased health care costs. Organizational factors that contribute to adverse outcomes include delayed diagnosis and ineffective treatment. In Illinois, the goal is to treat 80% of women within 60 min of identification of severe hypertension. This quality improvement project was conducted in a Level III perinatal center in a community-based hospital with 2,600 births annually. In in March 2016, a multidisciplinary team was created that reviewed baseline data, identified areas for improvement in the care processes, and developed a treatment protocol followed by implementation of a multimodal educational strategy for physicians and nurses. An order set was created in the electronic medical record and visual reminders of the new protocol were posted. Data were collected from Calendar Year 2015 through the first quarter of 2018. Time-to-treatment within 1 hr was 8% in 2015 and 2016 and 90% in 2017; 100% of women were treated within 30 min in 2018. Rates of adverse maternal outcomes were at 17% (2016), 18% (2017), and 7% (2018). Findings support the effectiveness of our strategies to develop and implement a protocol to improve the quality of care for women with severe hypertension during pregnancy and reduce adverse outcomes. It is important to use an interprofessional approach to protocol development and education and to offer intensive initial education as well as ongoing education to sustain practice change. Use of the protocol was critical for empowering nurses to communicate more effectively with physicians about the status of patients and subsequent timely treatment to improve maternal outcomes.

Implementation of an Obstetric Hemorrhage Risk Tool to Improve the Care of High-Risk Obstetric Patients Who Experience a Postpartum Hemorrhage

Grady Memorial Hospital (GMH) had more than double the national and regional benchmarks for postpartum hemorrhage (PPH). GMH serves a very-high-risk, inner city minority population and has a closed medical staff from Morehouse and Emory Schools of Medicine. The GMH leaders took action to reduce PPH in this population by hiring a women's health consulting firm to conduct a perinatal and neonatal quality assessment and develop and implement a perinatal and neonatal improvement plan during an 18-month period. The specific goal of the PPH Improvement Project was to improve the quality of care for women who experience PPH within 24 hours of birth while receiving care at GMH. A multidisciplinary team was developed and cochaired by a nurse and physician to build a culture of professional collaboration. Also supporting the team was a doctorally-prepared nurse consultant and a physician from the GMH quality department. Quality improvement methodology was used. Adherence to the PPH Risk Assessment Tool (RAT) was measured and reconciled daily. The PPH rate was measured monthly, and every PPH occurrence had an immediate debrief session and a root cause analysis (RCA) within 1 week. To engage the entire care team, the RAT was presented at all medical, nursing, and faculty meetings. The RAT score for every patient is included in the shift report, huddles, transfer reports, safety board, and the listed labor and delivery unit board. To increase situational awareness, a red, yellow, or green heart is placed on each patient’s door to visually indicate that patient’s level of risk. On the back of each heart is a reminder of all of the interventions related to that level of risk. Ninety-two percent increase in adherence to the RAT in 6 months and a 3% decrease in the PPH rate. In addition to the clinical improvement in PPH, this project fostered a multidisciplinary culture of collegiality and problem solving. An unexpected outcome was the opportunity to teach patients and families about PPH when they inquire about the hearts on the doors.

Deep infiltrating endometriosis: Interest of the robotic approach for a fledgling team

Introduction: Mini-invasive surgery of deep endometriosis is challenging. Surgical difficulties related to the technical limitations of classical laparoscopic approach might be overcome with the use of robotic assistance. The aim of this study was to evaluate the safety and feasibility of robotic surgery for deep infiltrating endometriosis in the learning phase of our team. Methods: The 20 first cases of robotic-assisted laparoscopies for endometriosis were included over a 2-year period. Baseline characteristics of patients and surgical data were reviewed. Surgical outcomes and follow-up information of the patients were analyzed. Results: Twenty women were included. The mean age was 31.9 years (range: 25–44) and mean body mass index was 23 kg/m2 (range: 16–35). Ten patients had rectovaginal or uterosacral location only (50%) and nine women had deep infiltrating endometriosis with digestive or urinary tract lesions (45%). In addition to the gynecologic surgeon, urologic or visceral surgeons were required in 10 cases, and there were 3 cases where the three specialties were needed. The mean operative time was 183.9 min (range: 85–398) and no difference was observed between the first five cases and the last five cases. There was one laparoconversion, and only two urologic postoperative complications occurred. Conclusion: Thanks to the use of robotic surgical assistance and a multidisciplinary approach, and despite the start of the team for deep endometriosis care, no learning curve effect was observed regarding surgical procedures’ success, safety, or duration. The use of robotic assistance might improve the quality of care for women facing deep endometriosis.

Impact of window views on recovery—an example of post-cesarean section women

The objective of this study was to examine the impact of urban landscape from window views on quality of care for women who underwent Cesarean Section (C-section) in Taiwan. The participants were randomly assigned into 46 different hospital rooms to see the effects of various window views and daylight exposure on women's recovery from post C-section care. We carried out this study in the obstetrics departments of three tertiary hospitals located in two major cities of Taiwan: Taipei City and New Taipei City. A total of 296 women who underwent C-sections and used patient-controlled analgesic (PCA) for pain control after their surgery during the 10-month data collection period were recruited for this study. The 46 different patient rooms provided diverse window views and different daylight exposure for the participants. Recovery for the women who underwent C-sections in this study was defined as PCA usage and perceived pain measured by Brief Pain Inventory (BFI). Higher satisfaction of window view significantly decreased analgesic usage (P = 0.057), reduced the scores of overall perceived pain (P = 0.046), pain severity (P = 0.004), and 'pain's interference with relations with others, enjoyment of life, and mood (REM).' (P = 0.095). To maximize benefit and well-being of patients recovering from surgery, health care architects should design patient rooms to create maximum satisfaction with visual impacts and optimize window views. By doing so, it may decrease the use of pain medication and substantially reduce healthcare costs.

ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease.

The development of guidelines is one of the core activities of the European Society for Medical Oncology (ESMO) and European Society of Gynaecologial Oncology (ESGO), as part of the mission of both societies to improve the quality of care for patients with cancer across Europe. ESMO and ESGO jointly developed clinically relevant and evidence-based recommendations in several selected areas in order to improve the quality of care for women with ovarian cancer. The ESMO-ESGO consensus conference on ovarian cancer was held on April 12-14, 2018 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of ovarian cancer. Before the conference, the expert panel worked on five clinically relevant questions regarding ovarian cancer relating to each of the following four areas: pathology and molecular biology, early-stage and borderline tumours, advanced stage disease and recurrent disease. Relevant scientific literature, as identified using a systematic search, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. The recommendations presented here are thus based on the best available evidence and expert agreement. This article presents the recommendations of this ESMO-ESGO consensus conference, together with a summary of evidence supporting each recommendation.

Reducing maternal deaths by skills-and-drills training in managing obstetric emergencies: A before-and-after observational study.

The institutional maternal mortality ratio (iMMR) in South Africa (SA) is still unacceptably high. A key recommendation from the National Committee on Confidential Enquiries into Maternal Deaths has been to improve the availability and quality of care for women suffering obstetric emergencies. To determine whether there was a change in the number of maternal deaths and in the iMMR over time that could be attributed to the training of &gt;80% of healthcare professionals by means of a specifically designed emergency obstetric care (EmOC) training programme. A before-and-after study was conducted in 12 healthcare districts in SA, with the remaining 40 districts serving as a comparison group. Twelve 'most-in-need' healthcare districts in SA were selected using a composite scoring system. Multiprofessional skills-and-drills workshops were held off-site using the Essential Steps in Managing Obstetric Emergencies and Emergency Obstetric Simulation Training programme. Eighty percent or more of healthcare professionals providing maternity care in each district were trained between October 2012 and March 2015. Institutional births and maternal deaths were assessed for the period January 2011 - December 2016 and a before-and-after-training comparison was made. The number of maternal deaths and the iMMR were used as outcome measures. A total of 3 237 healthcare professionals were trained at 346 workshops. In all, 1248333 live births and 2 212 maternal deaths were identified and reviewed for cause of death as part of the SA confidential enquiries. During the same period there were 5 961 maternal deaths and 5439870 live births in the remaining 40 districts. Significant reductions of 29.3% in the number of maternal deaths (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.66 - 0.77) and 17.5% in the number of maternal deaths from direct obstetric causes (RR 0.825, 95% CI0.73 - 0.93) were recorded. When comparing the percentage change in iMMR for equivalent before-and-after periods, there was a greater reduction in all categories of causes of maternal death in the intervention districts than in the comparison districts. Implementing a skills-and-drills EmOC training package was associated with a significant reduction in maternal deaths.

No. 377-Hysterectomy for Benign Gynaecologic Indications.

To assist physicians performing gynaecologic surgery in decision making surrounding hysterectomy for benign indications. Physicians, including gynaecologists, obstetricians, family physicians, general surgeons, emergency medicine specialists; nurses, including registered nurses and nurse practitioners; medical trainees, including medical students, residents, and fellows; and all other health care providers. Adult women (18 years and older) who will undergo hysterectomy for benign gynaecologic indications. The approach to hysterectomy and utility of concurrent surgical procedures are reviewed in this guideline. For this guideline relevant studies were searched in the PubMed, Medline, and Cochrane Library databases. The following MeSH search terms and their variations for the last 5 years (2012-2017) were used: vaginal hysterectomy, laparoscopic hysterectomy, robotic hysterectomy, laparoscopically assisted vaginal hysterectomy, total laparoscopic hysterectomy, standard vaginal hysterectomy, and total vaginal hysterectomy. The content and recommendations were drafted and agreed upon by the principal authors and members of the Gynaecology Committee. The Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework (Tables 1 and 2). The Summary of Findings is available upon request. Hysterectomy is common, yet surgical practice still varies widely among gynaecologic physicians. This guideline outlines preoperative and perioperative considerations to improve the quality of care for women undergoing benign gynaecologic surgery. This Society of Obstetricians and Gynaecologists of Canada clinical practice guideline will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter. This guideline was developed with resources funded by the Society of Obstetricians and Gynaecologists of Canada. RECOMMENDATIONS.

Coordination of care and quality of healthcare for women and children in the PMAQ

The study aimed to identify the association between coordination of care and quality of healthcare for women and children in primary healthcare in Brazil. A cross-sectional study was performed with data from 30,523 teams that participated in the Program for Improvement in Access and Quality of Basic Care (PMAQ) in 2013. Logistic regression was performed, in which the dependent variable was quality of healthcare for women and children and the independent variable was level of coordination of care. The multivariate analysis included variables that presented p < 0.05. The model's fit was assessed with the Hosmer-Lemeshow test. The study assessed the results of 28,056 teams that conducted activities in coordination and healthcare for women and children simultaneously. In Brazil, the largest percentage of teams displayed low levels of coordination (68.5%). The highest levels of coordination were found in stratum 6 (57.2%) and the lowest in stratum 1 (78.5%). Among the major geographic regions, the North of Brazil showed the highest percentage of teams with low coordination (89.1%), while the Southeast had the most teams with high coordination (37.6%). More than two-thirds (70.5%) of the teams showed low quality of care in women's health, while 63.5% showed high level of care in children's health. High level of coordination is associated with high quality of care both in women's health (OR = 11.85) and children's health (OR = 8.79). The predominance of low levels of coordination of care in Brazil and low quality of healthcare for women reflect the need for coordinated action in this area.

Are there preferred coping and communication strategies while undergoing IVF, and do cognitive behavioral interventions help?

PurposeCoping and communication strategies affect how one perceives potentially stressful life events, such as infertility. Cognitive behavioral interventions (CBI) can reduce the distress related to undergoing in vitro fertilization (IVF). The purpose of this paper is to examine the effect of CBI on the coping and communication skills as well as perceived stress and depressive symptoms of women undergoing IVF treatment. The authors also explored the relationship between coping strategies and pregnancy rates.Design/methodology/approachThe authors conducted a randomized controlled trial of CBI in 50 women undergoing IVF (NCT00685282).FindingsThe authors found that CBI was associated with reductions in active-confrontive coping among over 50 percent of participants, which was also found to be positively related to depressive symptoms. Furthermore, high meaning-based coping at baseline and high-avoidant coping at the end of IVF treatment were associated with increased pregnancy rates.Research limitations/implicationsCBI can be helpful in reducing the perceived stress of women undergoing IVF; however, the adaptiveness of individual coping skills and communication skills vary. Since different coping strategies seem to be of benefit at different time points, further studies might benefit from the examination of engaging in context-dependent coping strategies.Practical implicationsIntegrating mental health care on infertility units may assist in reducing the stress and thus quality of care in women undergoing IVF. Mental health care can be tailored to meet the individual needs of infertility patients based on their preferred coping strategies and communication style. Further research is needed to examine the cost benefit of reducing perceived stress in fertility patients.Social implicationsInfertility is a social and medical problem that has vast implications on the mental health of individuals. Providing support along with practical tools for stress reduction and improved coping and communication can result in reduced stress and improved coping.Originality/valueThis paper examined the effect of a cognitive behavioral intervention on the coping strategies and communication skills of women undergoing IVF and can contribute to our understanding of the value of integrating mental health and medical care.

When things fall apart: local responses to the reintroduction of user-fees for maternal health services in rural Malawi

Despite the strong global focus on improving maternal health during past decades, there is still a long way to go to ensure equitable access to services and quality of care for women and girls around the world. To understand widely acknowledged inequities and policy-to-practice gaps in maternal health, we must critically analyse the workings of power in policy and health systems. This paper analyses power dynamics at play in the implementation of maternal health policies in rural Malawi, a country with one of the world’s highest burdens of maternal mortality. Specifically, we analyse Malawi’s recent experience with the temporary reintroduction of user-fees for maternity services as a response to the suspension of donor funding, a shift in political leadership and priorities, and unstable service contracts between the government and its implementing partner, the Christian Health Association of Malawi. Based on ethnographic research conducted in 2015/16, the article describes the perceptions and experiences of policy implementation among various local actors (health workers, village heads and women). The way in which maternity services “fall apart” and are “fixed” is the result of dynamic interactions between policy and webs of accountability. Policies meet with a cascade of dynamic responses, which ultimately result in the exclusion of the most vulnerable rural women from maternity care services, against the aims of global and national safe motherhood policies.

Inequalities in the access to and quality of healthcare in Mozambique: evidence from the household budget survey.

To assess the inequalities in the access to and quality of care and its related direct payments. Secondary analysis of the cross-sectional Mozambican Household Budget Survey (HBS). Nationally-representative sample of households in Mozambique. 11 480 households (58 118 individuals) interviewed during HBS 2014/15. None. Equity, utilization of healthcare, access to quality care and direct payments. About 12.2% of women and 10.1% of men of the survey report a perceive health need. About 72.1% of women and 72.9% men use healthcare. Population in a disadvantaged position living in rural areas have less probabilities of using healthcare for equal health compared to the individuals of a wealthier position and living in urban settings. With regard to quality care, 47.7% women and 46.8% men do not report quality problems. No differences for women's wealth. Men in a disadvantaged position report less chances of accessing quality care compared to men of advantaged position. Also, women and men living in rural areas have less probabilities of accessing quality care. Finally, the majority of people who access healthcare paid 1 Mt during their visit. This study tackles a fundamental policy concern for health systems of Sub-Saharan Africa and points to areas that urge action to address the existent of socioeconomic and geographical inequalities in the access to and quality of care for women and men, including the strengthening of health facilities in rural and deprived areas to ensure that access to adequate care of acceptable quality is distributed according to need.

Pathology Cancer Clinic—An Innovative Model to Enhance the Quality of Patient Care for Women With Gynecologic Cancer at The Ottawa Hospital

Pathology Cancer Clinic—An Innovative Model to Enhance the Quality of Patient Care for Women With Gynecologic Cancer at The Ottawa Hospital

The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients with Cervical Cancer.

Despite significant advances in the screening, detection, and treatment of preinvasive cervical lesions, invasive cervical cancer is the fifth most common cancer in European women. There are large disparities in Europe and worldwide in the incidence, management, and mortality of cervical cancer. The European Society of Gynecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) jointly develop clinically relevant and evidence-based guidelines in order to improve the quality of care for women with cervical cancer across Europe and worldwide. The ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of cervical cancer (23 experts across Europe). To ensure that the guidelines are evidence based, the current literature identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 159 international reviewers, selected through ESGO/ESTRO/ESP and including patient representatives. The guidelines cover comprehensively staging, management, and follow-up for patients with cervical cancer. Management includes fertility sparing treatment; stage T1a, T1b1/T2a1, clinically occult cervical cancer diagnosed after simple hysterectomy; early and locally advanced cervical cancer; primary distant metastatic disease; cervical cancer in pregnancy; and recurrent disease. Principles of radiotherapy and pathological evaluation are defined.