The multidisciplinary colposcopy meeting: recommendations for future service provision and an analysis of clinical decision making

Palmer, James K.; Wales, Keren E; Ellis, Kay; Dudding, N.; Smith, J. Bruce; Tidy, JA

doi:10.1111/j.1471-0528.2010.02651.x

Cited by 13 publications

(17 citation statements)

References 26 publications

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“…To reduce the emotional burden of decision-making, health care providers will defer decision-making [ 47 ] and the majority of our participants felt a reduction in emotional burden following an MDT decision to offer excision, particularly in young and/or nulliparous women. This finding is supported by studies which have shown that the use of the MDT reduces overtreatment in the colposcopy setting [ 48 ] and potential heterogeneity in care. Although it should be noted, that with a paucity of evidence to guide this expert body’s management, homogeneity of care may be achieved within departments or regions but may not occur at a national level.…”

Section: Discussionsupporting

confidence: 56%

Unsatisfactory colposcopy: clinical decision-making in conditions of uncertainty

Manley

Simms

Platt

et al. 2017

BMC Med Inform Decis Mak

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BackgroundUnsatisfactory colposcopy, where the cells of interest are not visible in women with a positive cervical screening test, is a common area of clinical uncertainty due to the lack of clear evidence and guidance. Colposcopists’ opinions and experiences are likely to have a significant influence on service provision and the development of national policy. The aim of this study was to analyse decision-making when applied to women with unsatisfactory colposcopy.MethodsA multi-centre qualitative study utilizing a series of focus groups in an English healthcare region. Sampling aimed to ensure heterogeneity of experience and healthcare provider demographics. A topic guide covered a range of clinical and cytological variables and was compiled by the researchers and three expert Colposcopists. Using an iterative approach, thematic analysis was selected as the most appropriate method to identify factors affecting decision-making.ResultsTwenty-three Colposcopists from four units participated. The decision to treat was easier in women with high-grade cytology and high risk women with low-grade cytology such as heavy smokers, poor attenders, older women, those who had completed their families and women opting for treatment. Where decision-making was more complex, intuition and a multi-disciplinary approach were used to guide management. Areas of dissonance, which are affected by paucity of evidence and emotive factors, included cytological collection device, clinical setting and length of conservative follow-up and depth of excision in women at high risk of treatment-related morbidity.ConclusionsAnxiety of missing a cancer deters long-term cytological follow-up, resulting in heterogeneity of care and higher than anticipated excisional treatments in women with low-grade screening and unsatisfactory colposcopy. In areas of clinical uncertainty when decisions are dominated by affect, clinical guidance can reduce the difficulty and anxiety of decision-making.

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Section: Discussionsupporting

confidence: 56%

Unsatisfactory colposcopy: clinical decision-making in conditions of uncertainty

Manley

Simms

Platt

et al. 2017

BMC Med Inform Decis Mak

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“…The introduction of HPV primary screening has increased the proportion of women reviewed in colposcopy 10 and the outcomes of current studies may affect future recommendations for national [11][12][13][14][15] Current NHS CSP guidance recommends colposcopy and appropriate biopsy. In the USA, colposcopy with endocervical sampling is recommended for all women with glandular changes on cytology, irrespective of the grade.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the evidence discussed, it is the authors' opinion that in the presence of normal colposcopy and a normal diagnostic biopsy, efforts be made to rule out endometrial pathology and these women should be discussed at the local MDT meeting, as per BAC guidance. 9,15 In women >40 years or those with risk factors such as obesity or diabetes, an endometrial pipelle would appear prudent. This is particularly important as the prevalence of endometrial hyperplasia and adenocarcinoma is increasing in the UK, in line with the rise in obesity.…”

Section: Discussionmentioning

confidence: 99%

An audit of liquid‐based cytology samples reported as high‐risk human papillomavirus and borderline nuclear change in endocervical cells

2020

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Introduction Primary human papillomavirus (HPV) screening, testing for the virus responsible for 99% of cervical cancers, was introduced in 2018‐2020 in the UK. This was preceded by HPV triage of low‐grade cytology from 2012. Much of the evidence incorporated into current National Health Service (NHS) colposcopy guidance assessed outcomes prior to this change in screening. The aim of this paper is to assess adherence to NHS cervical screening programme standards, determine the incidence of cases reported as high‐risk HPV plus borderline nuclear change in endocervical cells, to calculate colposcopic accuracy and assess histological outcomes in this cohort. Method A retrospective audit of women referred to a colposcopy clinic in one NHS trust from 2016 to 2018. Data relating to histological outcomes, cytological follow‐up and demographics were collected. Results Of 2001 referrals, 22 data sets identifying HPV‐positive borderline endocervical change were eligible for analysis (1.2% incidence). Median age was 29.5. Two‐thirds (68.2%, n = 15) had high‐grade dysplasia at diagnostic biopsy. Those women with reassuring histology had normal cytological follow‐up. Colposcopic accuracy was moderate (positive predictive value 43.8%, negative predictive value 100%). Conclusions Borderline nuclear change in endocervical cells is an uncommon condition but should be treated as a high‐grade referral. All women should be offered a diagnostic biopsy at the initial colposcopy; if no histopathological abnormality is identified, alternative sources of pathology should be considered. Excisional treatment should be recommended to unreliable attenders, those with a complete family and inadequate colposcopy (TZ3) and considered in younger women with a TZ3.

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“…This Multidisciplinary Meeting (MDM) became a focal point to discuss cases by different professionals with the ultimate goal to establish a consensus on the diagnosis and the optimization of the patients' treatment (Kane and Luz, 2009). These clinical meetings can be used either for the education of patients (Rosen et al, 1998;Wilson et al, 2007;Burton et al, 2009;Ortega-Solano et al, 2011) or the evaluation and treatment of patients (Cook et al, 1996;Howard et al, 1997;Wright et al, 2009;Palmer et al, 2010;Moss, 2010;Roffey et al, 2011); so somebody could say they are service meetings.…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary meeting (MDM) can provide education and reinforcement of inter-professional development

Zafiropoulos¹,

Byfield²

2016

Educ. Res. Rev.

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The introduction of a multidisciplinary meeting (MDM) was analysed through a retrospective empirical study. The question of using it as a valuable tool to reinforce inter-professional development was made. The data was collected from 60 forth year Chiropractic students, who were at the end of their education and who were practicing their discipline under supervision. They were chosen because they fulfilled the World Health Organisation's criteria, as they had formed their professional identity. Data was collected via two-stage feedback interviews and was analysed qualitatively. Kirkpatrick's hierarchy was then used. Findings were grouped in the hierarchy's categories and analysed in a quantitative manner. It was found that the majority of the interviewees' opinions supported the MDM as an educational tool and a number of them believed that cognitive learning was achieved, influencing their behaviour. They supported that it helped them understand other professionals. In addition, they transferred and applied knowledge and practices to their professional environment, improving their collaboration with other health-workers, potentially improving the quality of their service.

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The multidisciplinary colposcopy meeting: recommendations for future service provision and an analysis of clinical decision making

Cited by 13 publications

References 26 publications

Unsatisfactory colposcopy: clinical decision-making in conditions of uncertainty

Unsatisfactory colposcopy: clinical decision-making in conditions of uncertainty

An audit of liquid‐based cytology samples reported as high‐risk human papillomavirus and borderline nuclear change in endocervical cells

Multidisciplinary meeting (MDM) can provide education and reinforcement of inter-professional development

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