Introduction: To accommodate for the rapidly increasing patient volume and followup visits of men with prostate cancer on active surveillance (AS), we carried out a quality improvement project to secure high-quality care and enhance patient experience. Methods:We proposed an innovative clinic systems redesignd"shared medical appointments" (SMAs)din which multiple patients were seen in a group format at the same time by the health care team led by a urologist leading the Institution's AS program.Results: We piloted four SMAs during JulyeNovember 2019. Running the SMAs was feasible and improved the contact time for each patient while at the same time being time and resource efficient for the health care providers and using the standard billing processes. The group dynamic was open and pleasant. The majority of patients rated their overall experience with SMA as excellent. Almost all patients responded that they were likely or very likely to attend another SMA in the future. All patients said that they would either definitely or probably recommend this visit type to a friend of family member with prostate cancer. Most patients rated their overall satisfaction with the SMA as extremely high.Conclusions: Utilizing SMAs for AS followup visits was feasible and acceptable. Our promising findings suggest that SMAs can ensure high-quality patient care. Well-controlled studies comparing SMAs to individual usual care visits should be conducted with end points including knowledge, patient and staff satisfaction, anxiety and quality-of-life outcomes, AS adherence, process measures and resource utilization.

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INTRODUCTION AND OBJECTIVE: Active surveillance is now the primary approach for men with low risk prostate cancer. To accommodate for the rapidly increasing patient volume and frequent follow-up visits, we carried out a quality improvement project to secure high-quality care and enhance patient experience. We proposed an innovative clinic systems redesign e "Shared Medical Appointments" (SMAs) e in which multiple patients were seen in a group format at the same time by the health care team. METHODS: The SMAs followed guidelines for conducting SMAs. Patients were invited to SMAs with 6-8 men in each group. Caregivers were welcome to accompany patients as well. The SMAs took place in a conference room. Patients received an information sheet and agreed to a confidentiality and privacy statement. The SMAs comprised: patient education (w20 minutes), a common clinical management discussion and support from the medical team and peers (w20-30 minutes), and one-on-one physical examinations in a Urology clinic room (w20-30 minutes). In addition to meeting patients' psychosocial and educational needs, the SMA allowed for the medical team to review the patients' medical charts, answer questions, discuss symptoms and treatment options, change or refill prescriptions, order tests, and review test results. At the end of the SMA, patients filled out a survey, adapted from Rhee et al.RESULTS: We piloted 4 SMAs during July-November 2019 (3x6 and 1x8 patients). Of 64 patients approached, 50 (78%) expressed interest. Running the SMAs was feasible and timeefficient. The group dynamic was open and pleasant. The length of the SMAs varied from 60e86 minutes (average 71 minutes). The majority of patients rated their overall experience with SMA as excellent. Almost all patients responded that they were likely or very likely to attend another SMA in the future. All patients said that they would either definitely or probably recommend this visit type to a friend of family member with prostate cancer. Most patients rated their overall satisfaction with the SMA as extremely high.CONCLUSIONS: Utilizing SMAs for active surveillance followup visits was feasible and acceptable. Our findings are very promising and suggest that SMAs can ensure patient satisfaction with care, improve the contact time for each patient (e.g., 60 mins in the SMA instead of 15 mins with their urologist in individual appointments) while at the same time being time-and resource efficient for the healthcare providers (e.g., 8 visits in 60 mins instead of 120 mins) and using the standard billing processes.