Improvement in quality of colorectal cancer pathology reporting with a standardized proforma – a comparative study

Beattie, G. C.; McAdam, Tim; Elliott, Stuart W.; Sloan, James M.; Irwin, S. T.

doi:10.1046/j.1463-1318.2003.00466.x

Cited by 41 publications

(49 citation statements)

References 11 publications

(10 reference statements)

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“…However, narrative reports inadequately and inconsistently provide the information required to understand the disease and to make informed patient care decisions 2,3 .…”

Section: Resultsmentioning

confidence: 99%

Factors Related to the Implementation and Use of an Innovation in Cancer Surgery

2011

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ConclusionsAn improved understanding of the multilevel factors influencing the implementation of innovations is critical to planning effective change interventions in health care. Further study is needed to explore differences in the use of the innovation between breast and colorectal cancer surgeons. Findings will inform the study of additional cases of synoptic reporting implementation, enabling cross-case analyses and identification of higher-level themes that may be applied in similar settings or contexts. KEY WORDSImplementation, synoptic reporting, cancer, surgery BACKGROUNDThe operative report records details of a surgical procedure and findings, and thus documents information that is important to subsequent patient care and management. The traditional method of reporting findings from surgery is the narrative report, involving a descriptive free-text account of the procedure, suspected or confirmed findings, and proposed treatment. Although report dictation is an important practice, a survey of academic general surgeons found that only 18% of general surgery programs provide training in this skill 1 . As medicine becomes increasingly multidisciplinary and technology-supported, several issues related to narrative reporting provide an impetus to change reporting mechanisms.First, for patients with cancer, a clear and thorough record of the surgical procedure and findings supports accurate diagnosis and staging, and therefore facilitates improved estimates of prognosis and postoperative treatment planning. The completion of a cancer operation is a unique point in time at which the surgeon has not only specific knowledge of the technical details of the procedure, but also detailed knowledge of important presentation, diagnostic, staging, and presurgical care ABSTRACT ObjectiveNationally, efforts to implement an innovation in cancer surgery-a Web-based synoptic reporting tool-are ongoing in five provinces. The objective of the present study was to identify the key multilevel factors influencing implementation and early use of this innovation for breast and colorectal cancer surgery at two academic hospitals in Halifax, Nova Scotia. MethodsWe used case-study methodology to examine the implementation of surgical synoptic reporting. Methods included semi-structured interviews with key informants (surgeons, implementation team members, and report end users; n = 9), nonparticipant observation, and document analysis. A thematic analysis was conducted separately for each method, followed by explanation-building to integrate the evidence and to identify the key multilevel factors influencing implementation. An audit was performed to determine use. ResultsKey factors influencing implementation were these: In a 6-month period after implementation, 91.2% and 58.0% respectively of eligible breast and colorectal cancer surgeries were reported using the new tool.

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“…However, narrative reports inadequately and inconsistently provide the information required to understand the disease and to make informed patient care decisions 2,3 .…”

Section: Resultsmentioning

confidence: 99%

Factors Related to the Implementation and Use of an Innovation in Cancer Surgery

2011

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“…Subsequent studies have emphasized the importance of synoptic (structured, proforma) reporting in areas of colorectal [12][13][14][15][16][17], breast [15,18,19], lung [20], melanoma [21], and hematolymphoid malignancy [22]. The completeness of reporting and ease of use of the information are points emphasized in these articles.…”

Section: Discussionmentioning

confidence: 99%

Standardized synoptic cancer pathology reporting: A population‐based approach

Srigley

McGowan

MacLean

et al. 2009

Journal of Surgical Oncology

170

134

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Cancer pathology reports contain information which is critical for patient management and for cancer surveillance, resource planning, and quality purposes. The College of American Pathologists (CAP) has defined scientifically validated content of checklists that form the basis for synoptic cancer pathology reporting. We outline how the CAP standards were implemented in a large Canadian province over a 3-year period resulting in improvements in rates of synoptic reporting and completeness of cancer pathology reporting.J. Surg. Oncol. 2009;99:517-524. ß 2009 Wiley-Liss, Inc. KEY WORDS: cancer pathology; standardization; synoptics; population study; outcomes INTRODUCTIONThe great majority of cancers are diagnosed through the combined efforts of surgeons and pathologists. A clear and thorough recording of the surgical and pathological findings allows assessment of diagnosis and prognosis, and thus facilitates treatment decisions for patients. In recent years, the complexity of cancer pathology reporting has significantly increased. The adequate surgical pathology report not only documents the presence and accurate typing of cancer but also contains information related to tumor grade, size, local extent, vessel involvement, marginal status along with other morphologic and sometimes ancillary results including tumor markers. In some tumor types, for instance breast cancer, the list of carcinoma descriptors can be quite daunting [1].There are four essential elements of quality in cancer pathology reporting: timeliness, accuracy, completeness, and usability. The timeliness or turnaround time of a cancer pathology report is clearly important as is the accuracy of the diagnostic and prognostic observations. The completeness of a cancer pathology report relative to an accepted standard is also an important reflection of overall quality. Cancer pathology reports should be timely, correct, and contain all the relevant information required for diagnosis, prognosis, and further treatment decisions. A fourth dimension of quality is the usability or accessibility of the data in the report.There is a spectrum of cancer pathology reporting which is shown in Table I. The range includes simple narrative reporting using a single text field of data without mandatory scientifically validated data elements as defined by the College of American Pathologists (CAP) (level 1 reporting) to sophisticated synoptic reporting with drop down menus, standardized language, discrete data fields, and automated ICD-O and/or SNOMED CT encoding (level 6). In practice most cancer pathology reports lie somewhere in the middle.Cancer pathology reports given in a synoptic format are intuitively easier to decipher than ones that are presented in a narrative or paragraphic style, minimizing the risk of misinterpretation and clinical error. Synoptic reporting can save time since all important diagnostic and prognostic factors are laid out in a list or table with headers and responses rather than being buried in paragraphic text fields. While cancer patholog...

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“…This had also been proven by Beattie et al [3] they noticed that the introduction of the standardized proforma in reporting colorectal cancer improves the quality of histopathological reporting, which aids decision-making regarding adjuvant chemotherapy or radiotherapy and further surveillance. Our study results showed that histological differentiation was commented on in 86% of reports before and100% after the proforma , apical lymph nodes were commented on in 40% before and 99% after the proforma , while complete resection was mentioned in 86% of reports before and 100% of reports after the introduction of the proforma.…”

Section: Discussionmentioning

confidence: 74%

“…Many studies have shown that adherence to a minimum dataset proforma for colorectal cancer reporting significantly improves the rate of inclusion of all crucial features. The adoption of proforma reporting has shown improvement of completeness of dataset from 0% to 98% when compared to nonproforma reporting [3,4].…”

Section: Discussionmentioning

confidence: 99%

Surgeons’ Evaluation of Colorectal Cancer Resections Against Standard HPE Protocol—Auditing the Surgeons

et al. 2011

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The survival of Colorectal Cancer patients is very much dependent on complete tumor resection and multimodality adjuvant treatment. However, the main determinants for management plan of these patients rely heavily on accurate staging through histopathological examination (HPE). A reliable standard HPE protocol will be a significant impact in determining best surgical outcome. We evaluate surgeons' intra-operative judgment and the quality of resected specimens in the treatment of colorectal cancers. To quantify the quality of surgery by applying standard HPE protocol in colorectal cancer specimens and to assess the use of new format for pathological reporting in Colorectal Cancer using a formulated standard proforma. We perform a prospective observation of all colorectal cancer patients who underwent surgical resection over 8 month duration. Surgeons are required to make selfassessment about completion of tumor excision and possible lymph nodes or adjacent organ involvement while all pathologists followed standard reporting protocol for examination of the specimens. We evaluate the accuracy of surgeons judgment against HPE. The study involved 44 colorectal cancers comprising of 23 male and 21 female patients. The majority of these patients were Malay (50%) followed by Chinese (43%) and Indian (7%). The main presenting symptoms were bleeding (32%), intestinal obstruction (29%) and perforation (7%). Sixteen (36%) patients underwent emergency surgery.Rectal tumor was the commonest (53%) followed by sigmoid colon (22.7%). Neoadjuvant Chemoradiation were given to 8 patients and complete pathological response was observed in 1 (12.5%) of these. The final TNM classification for staging were; stage I (22.7%), stage IIa (18.2%), stage IIb (11.4%), stage IIIa (2.3%), stage IIIb (25%), stage IIIc (13.6%) and stage IV (6.8%).The commonest surgery performed was anterior resection with mesorectal excision (43.2%). Ten patients (22.7%) had laparoscopic surgery with 3 (30%) patients converted to open surgery. The surgeons claimed to have performed a curative resection with complete excision and clear margin in 40 (90%) patients. Of these, only 1 (2.5%) patient had a positive resection margin. Meanwhile, the surgeons reported involvement of resection margins in 4 cases but this was disputed by the HPE in all 4 cases. Lymph nodes involvement was detected intra-operatively in 13 (29.5%) of the cases and all were proven positive for metastases through HPE. On the other hand, of the remaining 31 patients who were reported as no obvious lymphadenopathy by the surgeons, lymph nodes positvity was found in 7 (22.5%) cases. Using standard HPE reporting protocol brings suitable evaluation of surgery in colorectal cancer treatment. Although surgeons' judgment is fairly accurate in predicting margin clearance and complete specimen excision, complete mesocolic and mesorectal excision is of utmost importance since lymph nodes metastatic involvement may not be obvious at surgery.

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Improvement in quality of colorectal cancer pathology reporting with a standardized proforma – a comparative study

Abstract: The introduction of a standardized proforma for reporting CRC resection specimens improves the quality of histopathological reporting. This aids decision-making regarding adjuvant chemotherapy or radiotherapy and further surveillance.

Cited by 41 publications

References 11 publications

Factors Related to the Implementation and Use of an Innovation in Cancer Surgery

Factors Related to the Implementation and Use of an Innovation in Cancer Surgery

Standardized synoptic cancer pathology reporting: A population‐based approach

Surgeons’ Evaluation of Colorectal Cancer Resections Against Standard HPE Protocol—Auditing the Surgeons

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