Case study: ADENOMA – impact case study

NIHR | September 2019 | Case study: ADENOMA – impact case study

NIHR has produced an impact case study on adenoma, a polyp that grows in the bowel that has become cancerous.  Currently, a colonoscopy is regarded as the ‘gold standard’ treatment for adenoma.

Although experienced endoscopists perform the colonoscopies, polyps can get missed for various reasons including the size, shape and location of the lesions, and many colorectal cancer screening programmes have been proposed to improve adenoma detection rate (ADR). Improving the ADR and cancer detection through increased colonoscopy performance brings patient benefits, and earlier diagnosis of cancer is also associated with lower healthcare costs (Cancer Research UK 2014).

The study recruited 1800 participants from across seven sites, with patients being referred to the trial because of symptoms, surveillance or following a positive faecal occult blood test as part of the Bowel Cancer Screening Programme.

These patients were randomized across two arms of the trial: with one group having treatment as usual (the colonoscopy) and the other having the Endocuff Vision arm

The researchers report that the participants in the Endocuff Vision arm of the trial, had a higher Adenoma Detection Rate, increased globally from 36.2 per cent to 40.9 per cent (P=0.02). the increase was driven by a 10.8 per cent increase in FOBt-positive screening patients (50.9 per cent vs 61.7 per cent, P less than 0.001).

The research team conclude that the ADENOMA trial showed that Endocuff Vision significantly improved ADR in bowel cancer screening patients and should be used to improve colonoscopic detection.

The success of the trial led to NHS England announcing Endocuff Vision as one of only four technologies to be fast-tracked into use through NHS England’s Innovation and Technology Payment programme in April 2018.

NICE updated its guidelines for use in June 2019 and NHS trusts across England have significantly increased use of the product.
The Endocuff Vision device has also been adopted internationally and there has been a large rise in the use of the device over the last four years (Source: NIHR).

Read the full story from NIHR

 

Improving the care of head and neck cancer patients with collaborative dietetics and speech and language therapy intervention

NICE | April  2019 | Improving the care of head and neck cancer patients with collaborative dietetics and speech and language therapy intervention

NICE’s shared learning database highlights the work and benefits to patients of  a project at the University Hospital Birmingham NHSFT; where patients are being seen by Speech and Language Therapists and Dietitians whilst they have radiotherapy (plus or minus chemotherapy) to minimise the morbidity associated with oncology treatments to the head and neck.

The paper describes the individual and operational benefits of this clinical intervention, including reduced weight loss, and admissions to hospital as well as a shortened length of stay for patients who were admitted.   

Improving the care of head and neck cancer patients with collaborative dietetics and speech and language therapy intervention

Introducing group consultations for cancer care reviews

NHS England | January 2019 | Introducing group consultations for cancer care reviews

A new case study has been published on NHS England’s Shared Atlas of Learning; it underlines the impact of a general practice nurse (GPN) at Lancaster Medical Practice idea to address unwarranted variation relating to cancer care reviews by introducing a group consultation model at the surgery. 

Following completion of an accredited education programme on group consultations, the practice nurse established a gynaecological cancer group consultation at the surgery as a trial. Patients with similar cancers who were living with and beyond cancer were invited to attend.

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Due to the success of the initial trial, a further group consultation session was arranged to roll-out the offer of support, review progress and identify new needs as well as ensuring previous concerns had been addressed.

The new approach has led to consistency in cancer care reviews and information given to patients about cancer and the impact on their health. 25% capacity saving has been achieved and time spent consulting has had greater impact and service improvements can be seen now that all information and peer support is provided.

Challenges and lessons learnt for implementation

It can be challenging when working with a large team from different backgrounds but it is worth it.

There is reinforced learning in recognising the need to improve practice and lead on change for the benefit of patients and communities even when this change is outside of your comfort zone.

Speaking with stakeholders will support successful improvements to be implemented on a broader scale to reduce unwarranted variation.

Due to the success of the programme, the practice nurse and practice manager won the ‘Most Innovative Group Consultation’ award from Health Education England (HEE) at the North-West Group Consultation Celebration Event in October 2017, and in November 2017 won the ‘Supporting Families and Carers’ award at the NHS England Regional General Practice Nursing Conference (Source: NHS England).

Read the full,unabridged case study at NHS England