Remote PSA monitoring for Prostate Cancer patients using digital platforms – A safe and efficient follow up alternative to traditional ‘face to face’ outpatients.
RCSEd Communications Team
This year's theme for the World Health Organization's World Patient Safety Day (17 September) is Engaging Patients For Patient Safety, in recognition of the crucial role patients, families and caregivers play in the safety of health care. Active patient involvement, both in their own personal care as well as at a strategic organisational level, is vital to help improve healthcare provision, and the RCSEd is delighted to support this year's WPSD theme.
The RCSEd Patient Safety Group have produced a number of blogs as part of a campaign to mark World Patient Safety Day. In this blog, Neil Fenn, Consultant Urologist and Chair of the College’s SSB in Urology, shares the great success of his unit’s patient directed blood monitoring in prostate cancer surveillance.
Empowering patients to play an active role in their health and wellbeing is advantageous on many levels. The National Health Service [NHS] constitution states that patients have the right to be involved in discussions and decisions about their healthcare and to be given information, to enable them to do this. NICE cover this topic in their CG 138, first published in 2012 [1].
With an aging population and improved outcomes for patients receiving treatment for prostate cancer, the volume of patients requiring follow up has increased. These regular, protocol driven follow up appointments, are often only required to relay a Prostate Specific Antigen (PSA) blood test result. Depending on the treatment these may last for last for up to 10 years. Well before Covid 19, the NHS was struggling to keep pace with these appointments with a resultant impact on patient safety. In addition, as time goes by patients find these appointments costly in both time and monetary terms.
The NHS long term plan published in 2019 suggested exploring alternatives to the traditional ‘face to face’ (F2F) appointment system [2]. The NHS England Covid recovery plan to deal with the backlog of elective cases published in 2022, went further to include an ambitious target of reducing traditional F2F follow up numbers by 25% to release capacity for increased new patient assessment has further compounded the problem [3]. Suggested alternatives to facilitate this reduction include the use of remote monitoring in certain clinical scenarios.
Prostate cancer patients are treated in a number of ways including watchful waiting, active surveillance, radiation therapy or surgery. As mentioned, the mainstay of monitoring is via PSA blood testing. Depending on the treatment plan, certain levels of PSA can be set to either reassure patients or indicate the need for further assessment, imaging or treatment. This personalised, stratified follow up plan lends itself to supported self-management using remote digital platforms. These ideally should integrate with hospital IT and biochemistry systems allowing patients secure access to their correspondence and their PSA results, whilst remaining safe in the knowledge their results are being reviewed centrally. Additionally, patients should have the ability to contact the service to arrange review either virtually or F2F, as a safety net or backstop.
A number of different platforms are available to support remote monitoring. These include more generic systems such as ‘My Medical Records’ [4] developed by the University of Southampton and ‘Patient Knows Best’ (PKB) [5], started as a social enterprise and which can be accessed through the NHS App. A more specific online portal called ‘True North’ [6] was developed by a collaboration between the University of Southampton, Prostate Cancer UK, the Movember Foundation, the University of Surrey and 5 NHS Trusts. This latter system has been shown to be an effective and safe alternative to standard follow up with high patient satisfaction [6].
In our department we currently use the PKB model with over 300 patients registered to date. Clinically stable patients are selected and offered the option of registering. An individualised plan for the PSA testing with clear triggers for clinical review are explained. Following the initial offer of joining, patients are provided with a Clinical Nurse Specialist [CNS] or our dedicated clerks point of contact, if further information is required. They are then taken through the on-line registration process and the first round of testing by our dedicated clerk who co-ordinates the system.
Patients are able to access their own results 7 days after the test. The clerk also reviews results and, if in line with the protocol, a letter and blood test form for the next round of testing is produced. Built in safety mechanisms include chasing up patients who are late with their testing, a contact system (telephone and email) for patients with issues and escalation protocol to our prostate cancer specific CNS or consultant urologists. If required, patients can be offered a F2F appointment within 2 weeks. To date, satisfaction levels have been very good for the service and we continue to offer it to all new patients and suitable longer term patients.
In conclusion, the volume of patients requiring regular follow-up within the NHS continues to increase. This has safety implications as the demand is greater than traditional systems can provide. Using novel approaches such as remote monitoring provide a safe and efficient alternative service for prostate cancer patients.
- https://www.nice.org/guidance/cg138/ifp/chapter/involving-you-in-your-care
- https://www.longtermplan.nhs.uk/
- http://www.england.nhs.uk/coronavirus/publication/delivery-plan-for-tackling-the-covid-19-backlog-of-elective-care
- https://mymedicalrecords.uhs.nhs.uk
- https://patientknowsbest.com
- https://prostatecanceruk.org/for-health-professionals/resources/personalised-stratified-follow-up
- https://doi.org/10.1186/s12885-019-5561-0
