A novel prostate cancer rapid diagnosis pathway (PROSTAD)
Savita Shanbhag, GP Lead Cancer, Hywel Dda University Health Board
Introduction
Delays in diagnosing prostate cancer, the most common male cancer in the UK, negatively impact patient outcomes and quality of life. Despite targets, diagnostic waiting times in Wales exceed the 28-day recommended timeline.
Recognising the negative impact of prolonged waiting times, Hywel Dda University Health Board HDUHB, Swansea University, and Cancer Research UK's TET Programme launched the PROSTAD pathway in June 2023 to improve prostate cancer diagnosis in West Wales.
Methods
Stakeholder engagement, including healthcare professionals and patient advocacy groups, was crucial for successful implementation. Collaboration with Swansea University and Cancer Research UK provided academic support and resources for evaluation and validation.
We used the Plan Do Study Act (PDSA) framework for the PROSTAD pathway, with a dedicated cancer pathway navigator improving patient communication. A LEAN Sigma expert from Swansea University used swim lane mapping to identify all touch points of the patient journey to identify inefficiencies and reduce waiting times. Quantitative data and qualitative feedback were collected throughout the cycle.
Outcomes
“I am quite impressed by the speed and efficiency of it all."
- GP referral to MRI time decreased from 22 days to 14 days.
- MRI reporting time reduced from 8 days to 1 day.
- Clinical review and biopsy decision now occur 1 day after MRI.
- Patients preferred receiving MRI results and discussing biopsy requirements via telephone.
- Improvements provide faster access to radiological investigation and biopsy decisions.
- Positive patient feedback highlights the importance of timely diagnosis.
- Urology staff reported improved workflow efficiencies.
Learnings
- Stakeholder engagement and collaboration were crucial, incorporating diverse perspectives enhanced understanding within prostate cancer diagnosis.
- Leadership was vital for driving and sustaining change, with ongoing support necessary for continuous improvement.
- Clear communication is key and will be maintained and addressed.
- Robust project management and governance were effective, but more frequent communication and checkpoints are needed.
- Evaluation used quantitative and qualitative measures, showing progress but identifying areas for further improvement, particularly in resource allocation and systemic barriers.
What next?
- Continue to refine and optimise the pathway based on ongoing feedback and evaluation data
- Disseminate learnings and best practices to other Welsh and UK NHS organisations.
- Present our findings to the Urology Clinical Site Group
- Continue to monitor and evaluate the impact of the PROSTAD pathway, within our own service.
