Disclosure under a new patient-requested review process, commenced by CervicalCheck, will be communicated by a specially trained team in the programme/National Screening Service (NSS).
The doctors attending the review disclosure meetings will be specialists in population-based cervical screening, according to CervicalCheck. Bespoke training on communication during the disclosure process has been developed.
According to Prof Nóirín Russell, Clinical Director of CervicalCheck, it has consulted with a “diverse” range of stakeholders, including women from the 221+ group, to develop the new “holistic” review process.
The development of a patient-requested review process was recommended by an expert reference group (ERG) report on interval cervical cancers, which was published in 2020. Expert reports on interval cancer review in the three national screening programmes were commissioned arising from the Scally review. Last month, CervicalCheck announced the launch of its new process on its website.
Mandatory open disclosure of a patient-requested review of a cancer screening was included in the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023.
Women who develop, or have developed, cervical cancer and who participated in CervicalCheck in the 10 years before diagnosis can request a “personal cervical screening review”. The review will encompass the screening invitation process, the screening test results (HPV and cytology), colposcopy care, and histology results. The findings will be fully disclosed, according to CervicalCheck. A woman who requests a review will have a designated and named point-of-contact from the NSS (but not from CervicalCheck). The review process will take approximately 12-to-18 months.
The NSS has engaged an independent advocacy service, which will offer free and confidential support during the process. The NSS will also signpost the existing cancer support services available to women and their families.
The programme has communicated with clinicians involved in the care of women with cervical cancer to share information about the review process, and it has communicated with advocacy and support groups.
The external reviewers will be independent from the NSS/CervicalCheck, according to Prof Russell. The cytology reviewers will be UK-based, histology review will be conducted through the Faculty of Pathology, RCPI, and colposcopy review through the Institute of Obstetricians and Gynaecologists, RCPI.
CervicalCheck has updated its leaflet and online literature to outline the review process. The literature also sets out the benefits and limitations of screening, a topic which is being covered in training of GPs/sample-takers, confirmed Prof Russell. The introduction of primary HPV screening in 2020 will help prevent more cervical cancers compared with primary cytology, but it also has limitations. The benefits of screening outweigh the limitations for most people.
It is not yet known how many review requests will be received per annum. Approximately 290 women are diagnosed with cervical cancer annually, and about 170 have participated in CervicalCheck at some point. Around 120 of these cases are screen-detected, and 50 cases are diagnosed after women present with symptoms to the health service.
The ERG report also recommended that retrospective programmatic review of cytology in patients with invasive cancers “will be conducted which will be anonymised and blinded or under an agreed legislative framework, to ensure that the key deliverables of quality assurance and professional education are sustained”.
According to Prof Russell, audits provide an opportunity for evaluation and improvement by health professionals, working towards delivery of safe, high-quality care for patients. The results of audit are usually anonymised and are not designed to be shared with individual participants.
“When considering the usefulness of clinical audit in quality improvement, we must consider whether it is acceptable to women that we conduct a clinical audit where we don’t disclose the results. As we consider this further, our current and important focus is on developing quality in our systems and processes in real-time.”
She said the programme continuously audits its processes. This encompasses several areas, including laboratory quality assurance and regular review and publication of rates of low- and high-grade abnormalities.
A key recommendation in the ERG report was that CervicalCheck develop an international definition of an interval cervical cancer and guidance on calculation of a rate which can be used to benchmark cervical screening programmes. CervicalCheck is collaborating with the International Agency for Research on Cancer to develop an agreed definition of an international interval cancer rate.
For further information, visit Cervical screening – CervicalCheck – HSE.ie
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