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NP-Led Suspicion of Cancer Clinic Improves Timeliness of Care for Veterans
Clinical Situation
Delays in diagnosis affect outcomes in veterans with cancer. Veterans sent into the community for suspected cancer frequently experience delays in diagnosis and treatment. This is further complicated by inappropriate workup, resulting in additional delays. Retaining veterans within the VA system for care and providing guidance to primary care providers (PCPs) to assist with expedited workup was an identified need. The Suspicion of Cancer Clinic (SOCC) was developed to address barriers to timely cancer diagnosis and care.
Literature
Researched private sector models of rapid cancer diagnostic and suspicion clinics. Literature analyzed showed improved outcomes through reduction of diagnostic delay. Nurse practitioner (NP)-led clinics were determined to be effective in expediting diagnosis and reducing cancer care delays.
Intervention
The Suspicion of Cancer Clinic is a tele-clinic, staffed with a NP. Diagnostic consult for the NP to assume the workup upon discovery of high suspicion of cancer, or via non-visit consult (NVC) to provide diagnostic guidance are available to PCPs. Outreach and education were performed prior initial clinic launch and post-launch, when need for further clarification of role and scope of the clinic was identified, based on consult trends.
Outcomes/Implications
The SOCC received 133 consults between 9/1/2021 and 6/6/2022 for veterans ranging age 29-94 years. Of these consults, 25 were expedited, diagnostic workups, 47 were NVCs, eliminating unnecessary or incomplete workups, yielding 23 veterans diagnosed with one of 8 types cancer. An additional 34 consults were forwarded to other appropriate service, and 27 were not appropriate for clinic and cancelled. Further outreach and education resulted in a 55% decrease in inappropriate consults. The NP retained 10 veterans (50%) within the VA for diagnostics, who had planned to receive community workup, which is an average four-week delay to schedule in the community. The SOCC was developed utilizing existing staff. The tele-clinic relieves workspace burden. Veterans received timely and appropriate cancer workups, reducing diagnostic delays. PCPs received additional support and guidance. Veterans retained within the VA system is more cost-effective and avoids community care delays. NP-led suspicion/rapid diagnostic clinic effectively reduced care delays by immediate initiation of further diagnostics and appropriate utilization of resources.
References
Campbell C, Nowell A, Karagheusian K, Giroux J, Kiteley C, Martelli L, McQuestion M, Quinn M, Rowe Samadhin YP, Touw M, Moody L. Practical innovation: Advanced practice nurses in cancer care. Can Oncol Nurs J. 2020 Jan 1;30(1):9-15. doi:10.5737/23688076301915. PMID: 33119001; PMCID: PMC7585714.
Drudge-Coates L, Khati V, Ballesteros R, Martyn-Hemphill C, Brown C, Green J, Challacombe B, Muir G. A nurse practitioner model for the assessment of suspected prostate cancer referrals is safe, cost and time efficient. Ecancermedicalscience. 2019 Dec 18;13:994. doi:10.3332/ecancer.2019.994. PMID: 32010218; PMCID: PMC6974368.
Nixon S, Bezverbnaya K, Maganti M, Gullane P, Reedijk M, Kuruvilla J, Prica A, Kridel R, Kukreti V, Bennett S, Rogalla P, Delabie J, Pintilie M, Crump M. Evaluation of Lymphadenopathy and Suspected Lymphoma in a Lymphoma Rapid Diagnosis Clinic. JCO Oncol Pract. 2020 Jan;16(1):e29-e36. doi:10.1200/JOP.19.00202. Epub 2019 Oct 1. PMID: 31573831.
Vasilakis C, Forte P. Setting up a rapid diagnostic clinic for patients with vague symptoms of cancer: a mixed method process evaluation study. BMC Health Serv Res. 2021 Apr 17;21(1):357. doi: 10.1186/s12913-021-06360-0. PMID: 33865373; PMCID: PMC8052708.
Clinical Situation
Delays in diagnosis affect outcomes in veterans with cancer. Veterans sent into the community for suspected cancer frequently experience delays in diagnosis and treatment. This is further complicated by inappropriate workup, resulting in additional delays. Retaining veterans within the VA system for care and providing guidance to primary care providers (PCPs) to assist with expedited workup was an identified need. The Suspicion of Cancer Clinic (SOCC) was developed to address barriers to timely cancer diagnosis and care.
Literature
Researched private sector models of rapid cancer diagnostic and suspicion clinics. Literature analyzed showed improved outcomes through reduction of diagnostic delay. Nurse practitioner (NP)-led clinics were determined to be effective in expediting diagnosis and reducing cancer care delays.
Intervention
The Suspicion of Cancer Clinic is a tele-clinic, staffed with a NP. Diagnostic consult for the NP to assume the workup upon discovery of high suspicion of cancer, or via non-visit consult (NVC) to provide diagnostic guidance are available to PCPs. Outreach and education were performed prior initial clinic launch and post-launch, when need for further clarification of role and scope of the clinic was identified, based on consult trends.
Outcomes/Implications
The SOCC received 133 consults between 9/1/2021 and 6/6/2022 for veterans ranging age 29-94 years. Of these consults, 25 were expedited, diagnostic workups, 47 were NVCs, eliminating unnecessary or incomplete workups, yielding 23 veterans diagnosed with one of 8 types cancer. An additional 34 consults were forwarded to other appropriate service, and 27 were not appropriate for clinic and cancelled. Further outreach and education resulted in a 55% decrease in inappropriate consults. The NP retained 10 veterans (50%) within the VA for diagnostics, who had planned to receive community workup, which is an average four-week delay to schedule in the community. The SOCC was developed utilizing existing staff. The tele-clinic relieves workspace burden. Veterans received timely and appropriate cancer workups, reducing diagnostic delays. PCPs received additional support and guidance. Veterans retained within the VA system is more cost-effective and avoids community care delays. NP-led suspicion/rapid diagnostic clinic effectively reduced care delays by immediate initiation of further diagnostics and appropriate utilization of resources.
References
Campbell C, Nowell A, Karagheusian K, Giroux J, Kiteley C, Martelli L, McQuestion M, Quinn M, Rowe Samadhin YP, Touw M, Moody L. Practical innovation: Advanced practice nurses in cancer care. Can Oncol Nurs J. 2020 Jan 1;30(1):9-15. doi:10.5737/23688076301915. PMID: 33119001; PMCID: PMC7585714.
Drudge-Coates L, Khati V, Ballesteros R, Martyn-Hemphill C, Brown C, Green J, Challacombe B, Muir G. A nurse practitioner model for the assessment of suspected prostate cancer referrals is safe, cost and time efficient. Ecancermedicalscience. 2019 Dec 18;13:994. doi:10.3332/ecancer.2019.994. PMID: 32010218; PMCID: PMC6974368.
Nixon S, Bezverbnaya K, Maganti M, Gullane P, Reedijk M, Kuruvilla J, Prica A, Kridel R, Kukreti V, Bennett S, Rogalla P, Delabie J, Pintilie M, Crump M. Evaluation of Lymphadenopathy and Suspected Lymphoma in a Lymphoma Rapid Diagnosis Clinic. JCO Oncol Pract. 2020 Jan;16(1):e29-e36. doi:10.1200/JOP.19.00202. Epub 2019 Oct 1. PMID: 31573831.
Vasilakis C, Forte P. Setting up a rapid diagnostic clinic for patients with vague symptoms of cancer: a mixed method process evaluation study. BMC Health Serv Res. 2021 Apr 17;21(1):357. doi: 10.1186/s12913-021-06360-0. PMID: 33865373; PMCID: PMC8052708.
Clinical Situation
Delays in diagnosis affect outcomes in veterans with cancer. Veterans sent into the community for suspected cancer frequently experience delays in diagnosis and treatment. This is further complicated by inappropriate workup, resulting in additional delays. Retaining veterans within the VA system for care and providing guidance to primary care providers (PCPs) to assist with expedited workup was an identified need. The Suspicion of Cancer Clinic (SOCC) was developed to address barriers to timely cancer diagnosis and care.
Literature
Researched private sector models of rapid cancer diagnostic and suspicion clinics. Literature analyzed showed improved outcomes through reduction of diagnostic delay. Nurse practitioner (NP)-led clinics were determined to be effective in expediting diagnosis and reducing cancer care delays.
Intervention
The Suspicion of Cancer Clinic is a tele-clinic, staffed with a NP. Diagnostic consult for the NP to assume the workup upon discovery of high suspicion of cancer, or via non-visit consult (NVC) to provide diagnostic guidance are available to PCPs. Outreach and education were performed prior initial clinic launch and post-launch, when need for further clarification of role and scope of the clinic was identified, based on consult trends.
Outcomes/Implications
The SOCC received 133 consults between 9/1/2021 and 6/6/2022 for veterans ranging age 29-94 years. Of these consults, 25 were expedited, diagnostic workups, 47 were NVCs, eliminating unnecessary or incomplete workups, yielding 23 veterans diagnosed with one of 8 types cancer. An additional 34 consults were forwarded to other appropriate service, and 27 were not appropriate for clinic and cancelled. Further outreach and education resulted in a 55% decrease in inappropriate consults. The NP retained 10 veterans (50%) within the VA for diagnostics, who had planned to receive community workup, which is an average four-week delay to schedule in the community. The SOCC was developed utilizing existing staff. The tele-clinic relieves workspace burden. Veterans received timely and appropriate cancer workups, reducing diagnostic delays. PCPs received additional support and guidance. Veterans retained within the VA system is more cost-effective and avoids community care delays. NP-led suspicion/rapid diagnostic clinic effectively reduced care delays by immediate initiation of further diagnostics and appropriate utilization of resources.