Aims The COVID-19 pandemic necessitated introduction of revised diagnostic pathways for assessing Urgent Suspected Cancer (USC) referrals. Combinations of FIT and MPCT were used to manage referrals and prioritise access to clinical services or invasive tests. The effectiveness of these pathways are evaluated in this study. Methods All consecutive patients referred from primary care on the USC pathway between 15th March – 15th June 2020 were included to reflect the effect of full lockdown measures. Data collected included demographics, presenting symptom(s), investigations and timelines and patient outcomes up to 90 days following initial referral. Results 816 patients across 8 sites in Wales were included in this initial analysis. 52.7% of patients were female with median age 69 (21 – 97) years. Of the 50.7% who had first-line clinical review, 70.5% were virtual consultations. 49.3% had primary investigations, with FIT in 31% of patients and MPCT in 18.3%. This was compliant with locally agreed pathways for 77.3% of referrals. COVID-response pathways achieved a 28.5% reduction in use of colonoscopy as first-line investigation and 84.3% of patients avoided face-to-face consultations altogether during this first wave of the pandemic. Overall, 5.6% of USC referrals were diagnosed with CRC. Median timescale from diagnosis to treatment for CRC was 82 (4 – 175) days. The NPV for FIT in this cohort was 99.5%. MPCT as the first modality had a NPV of 99%. Conclusion A modified investigation pathway maintained cancer diagnosis during the pandemic with improved resource utilisation to that used previously.
Introduction Emergency laparotomy (EmLap) is a “life-saving” procedure, but little is known about how “life-changing” it can be. This study aims to establish the impact of EmLap on PROMs and PREMs. Methods All surviving patients who had an EmLap from 2016–2019 were included. Eligible patients were invited to complete a postal questionnaire. Responses underwent qualitative and logistical regression analysis. Results Response rate was 42.6% (n=310). 11.3% reported that they had not resumed intimacy post-op. Patients were less likely to resume intimacy if they were >80 years (OR 10.500, p0.003), had a return to theatre (OR 5.111, p0.017), IBD diagnosis (OR 5.00, p0.009) or stoma (OR 4.906, p0.003). Patients were more likely to change employment if female (OR 2.858, p0.009), more comorbid (ASA3 OR 5.000, p0.024), had a stoma (OR 4.006, p<0.001), or incisional hernia (OR 4.228, p<0.001). Qualitative analysis revealed deconditioning, lack of employer support, and delays to reconstructive surgery were the main reasons for not returning to work. Qualitative analysis of experience exposed a number of unmet needs: surgical “debrief” and “what to expect” (33.6%), surgical aftercare (25.2%), mental-health support (22.6%) and timely restorative surgery (11.7%). 88.1% felt a specialist nurse would have improved their experience. Patients were more likely to have reported a negative experience if they had benign disease (p0.010). Conclusion This is the first study to describe PROMS and PREMS following EmLap, and also to identify patients at risk of poor outcome. It advocates the need for an EmLap specialist nurse to facilitate holistic care.
Aim Recent focus on Emergency Laparotomy outcomes has improved mortality, but little attention has been given to recovery. The aim of this qualitative study was to explore recovery after EmLap. Method A focus group was established of ten EmLap patients. Inclusion criteria: EmLap<5 years ago, non-palliative. Patients were selected to provide balance of age, sex and pathology. Thematic qualitative analysis was performed by two researchers. Results Several key themes were highlighted; Lack of communication on diagnosis/expectations after surgery. Little continuity of care. Long delays in seeing doctors after surgery and no way to contact them and GPs unable to help. Financial consequences are significant, with no guidance. Took longer to recover than expected, difficult to explain to employer. Led to early retirement or change of hours/role. Hernias; Some patients aware of hernia risk but given conflicting advice, e.g avoid lifting and rest for 6 weeks, others told to exercise regularly. Difficult to access support garments. Diet – Conflicting advice on what they could/couldn't eat, especially fibre. Felt more by patients who had stoma or bowel resection. Poor quality food in hospital and lack of options for diet (e.g. vegan, coeliac). Poor mental health after surgery with anxiety, depression and loss of confidence all having large impact, especially on relationships and intimacy. Key issues lack of access to services and waiting times. Too ‘complex’ for primary care. Conclusions The impact of emergency surgery on patients is significant, particularly mental health and financial impact. Recommend standardised information (leaflets/website/signposting) and key support worker.
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