Patient initiated follow up in Obstetrics and Gynaecology: A systematic review

Kershaw, Victoria; Chainrai, Mira; Radley, Stephen

doi:10.1016/j.ejogrb.2022.02.181

Cited by 10 publications

(15 citation statements)

References 20 publications

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“…A study in ovarian cancer found no evidence of a survival benefit with early treatment based on raised CA125 levels compared with delayed treatment based on symptoms 64 . A recent systematic review by Kershaw et al found that PIFU did not have a negative impact on the detection of recurrence in gynaecological cancers but that the psychological impact was conflicting 9 . There is also uncertainty around whether patient‐initiated appointment systems specifically lead to reduced service utilisation or costs in chronic disease, including cancer 5 .…”

Section: Discussionmentioning

confidence: 99%

“…Patient‐initiated follow‐up (PIFU) could potentially improve the efficiency of follow‐up by avoiding costs of missed or unnecessary appointments, with comparable clinical outcomes across different types of cancer 5,8 . It also has the potential to meet the needs of patients in a more flexible and targeted way, for example seeing a specialist sooner than planned FU would have allowed, which in turn could improve patient satisfaction 9 . Studies in gynaecological cancer patients have found that a majority of patients experience symptomatic recurrence, but many fail to recognise the significance of these symptoms and/or fail to make an appointment earlier than scheduled, suggesting that routine FU can delay the diagnosis of recurrence 10,11 .…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of patients’ and healthcare professionals’ views on patient‐initiated follow‐up in treated cancer patients

et al. 2023

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BackgroundCurrent follow‐up models in cancer are seen to be unsustainable and inflexible, and there is growing interest in alternative models, such as patient‐initiated follow‐up (PIFU). It is therefore important to understand whether PIFU is acceptable to patients and healthcare professionals (HCPs).MethodsStandard systematic review methodology aimed at limiting bias was used for study identification (to January 2022), selection and data extraction. Thematic synthesis was undertaken for qualitative data, and survey findings were tabulated and described.ResultsNine qualitative studies and 22 surveys were included, mainly in breast and endometrial cancer. Women treated for breast or endometrial cancer and HCPs were mostly supportive of PIFU. Facilitators for PIFU included convenience, control over own health and avoidance of anxiety‐inducing clinic appointments. Barriers included loss of reassurance from scheduled visits and lack of confidence in self‐management. HCPs were supportive of PIFU but concerned about resistance to change, unsuitability of PIFU for some patients and costs.ConclusionPIFU is viewed mostly positively by women treated for breast or endometrial cancer, and by HCPs, but further evidence is needed from a wider range of cancers, men, and more representative samples.A protocol was registered with PROSPERO (CRD42020181412).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Systematic review of patients’ and healthcare professionals’ views on patient‐initiated follow‐up in treated cancer patients

et al. 2023

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“…Many studies have explored alternative models in both cancer and other chronic conditions, including nurse‐led FU, GP‐led FU, models of shared FU across primary and secondary care, different frequencies of FU and patient‐initiated FU (PIFU). Several systematic reviews exist of such studies, for example focussing on chronic conditions 3,5 or cancer 2,6,12,13 . One of these systematic reviews had a similar aim to ours but includes fewer RCTs 13 .…”

Section: Introductionmentioning

confidence: 99%

“…This generally involves patients triggering FU appointments according to their individual needs and symptoms (‘on‐demand’) with subsequent rapid access to specialist care, while routine clinic appointments are no longer, or less frequently, scheduled. Rapid access to appointments can be difficult where clinics are primarily dedicated to scheduled FU, so any reduction in such appointments may free up availability for ‘on‐demand’ appointments 6 . Patients are provided with information on signs and symptoms of recurrence to help them decide when to initiate contact with a designated health care professional (such as a specialist nurse).…”

Section: Introductionmentioning

confidence: 99%

“…There is uncertainty however around the effectiveness and cost‐effectiveness of PIFU. It is thought that PIFU may reduce diagnostic delay by enabling more rapid access to specialist care when needed 6 . Foregoing scheduled visits (and potentially missed appointments) is likely to reduce costs and avoid unnecessary visits by patients who are potentially well 3 .…”

Section: Introductionmentioning

confidence: 99%

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A systematic review of the effectiveness of patient‐initiated follow‐up after cancer

Dretzke,

Chaudri,

Balaji

et al. 2023

Cancer Medicine

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BackgroundThe traditional cancer follow‐up (FU) model for cancer survivors is by scheduled clinic appointments; however, this is not tailored to patient needs and is becoming unsustainable. Patient‐initiated follow‐up (PIFU) may be a more effective and flexible alternative. This systematic review aims to analyse all existing evidence from randomised controlled trials (RCTs) on the effectiveness of PIFU compared with other FU models that include routinely scheduled appointments in adults who have been treated with curative intent for any type of cancer.MethodsStandard systematic review methodology aimed at limiting bias was used for study identification, selection and data extraction. MEDLINE, Embase, CINAHL, the Cochrane Database of Systematic Reviews and Epistemonikos were searched for systematic reviews to March 2022, and Cochrane CENTRAL was searched for RCTs from 2018 (April 2023). Ongoing trial registers were searched (WHO ICTRP, ClinicalTrials.gov, April 2023). Eligible studies were randomised controlled trials comparing PIFU with an alternative FU model in adult cancer survivors. Risk of bias assessment was via the Cochrane risk of bias tool‐2. Meta‐analysis was precluded by clinical heterogeneity and results were reported narratively.ResultsTen RCTs were included (six breast, two colorectal, one endometrial cancer and one melanoma, total n = 1754); all studies had risk of bias concerns, particularly relating to how missing data were handled, and populations were unlikely to be representative. Limited findings in breast cancer suggested that type of FU does not affect recurrence detection or patient‐related outcomes, while PIFU may reduce the number of clinic visits. Adding patient‐led surveillance to routine FU may increase melanoma detection. Evidence for other types of cancer is too limited to draw firm conclusions.ConclusionsPIFU may be a viable FU model in breast cancer, but further research is needed for other types of cancer and on long‐term outcomes. A protocol was registered with PROSPERO (CRD42020181424).

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Practices and Barriers in Developing and Disseminating Plain-Language Resources Reporting Medical Research Information: A Scoping Review

Pal,

Arnet,

Elger

et al. 2024

Patient

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Background The intent of plain-language resources (PLRs) reporting medical research information is to advance health literacy among the general public and enable them to participate in shared decision-making (SDM). Regulatory mandates coupled with academic and industry initiatives have given rise to an increasing volume of PLRs summarizing medical research information. However, there is significant variability in the quality, format, readability, and dissemination channels for PLRs. In this scoping review, we identify current practices, guidance, and barriers in developing and disseminating PLRs reporting medical research information to the general public including patients and caregivers. We also report on the PLR preferences of these intended audiences. Methods A literature search of three bibliographic databases (PubMed, EMBASE, Web of Science) and three clinical trial registries (NIH, EMA, ISRCTN registry) was performed. Snowball searches within reference lists of primary articles were added. Articles with PLRs or reporting topics related to PLRs use and development available between January 2017 and June 2023 were identified. Evidence mapping and synthesis were used to make qualitative observations. Identified PLRs were quantitatively assessed, including temporal annual trends, availability by field of medicine, language, and publisher types. Results A total of 9116 PLRs were identified, 9041 from the databases and 75 from clinical trial registries. The final analysis included 6590 PLRs from databases and 72 from registries. Reported barriers to PLR development included ambiguity in guidance, lack of incentives, and concerns of researchers writing for the general public. Available guidance recommendations called for greater dissemination, increased readability, and varied content formats. Patients preferred visual PLRs formats (e.g., videos, comics), which were easy to access on the internet and used short jargon-free text. In some instances, older audiences and more educated readers preferred text-only PLRs. Preferences among the general public were mostly similar to those of patients. Psychology, followed by oncology, showed the highest number of PLRs, predominantly from academia-sponsored research. Text-only PLRs were most commonly available, while graphical, digital, or online formats were less available. Preferred dissemination channels included paywall-free journal websites, indexing on PubMed, third-party websites, via email to research participants, and social media. Conclusions This scoping review maps current practices, recommendations, and patients’ and the general public’s preferences for PLR development and dissemination. The results suggest that making PLRs available to a wider audience by improving nomenclature, accessibility, and providing translations may contribute to empowerment and SDM. Minimizing variability among available guidance for PLR development may play an important role in am...

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Patient initiated follow up in Obstetrics and Gynaecology: A systematic review

Cited by 10 publications

References 20 publications

Systematic review of patients’ and healthcare professionals’ views on patient‐initiated follow‐up in treated cancer patients

Systematic review of patients’ and healthcare professionals’ views on patient‐initiated follow‐up in treated cancer patients

A systematic review of the effectiveness of patient‐initiated follow‐up after cancer

Practices and Barriers in Developing and Disseminating Plain-Language Resources Reporting Medical Research Information: A Scoping Review

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