B Thompson1, S Philcox2, B Devereaux3, A Metz4, D Croagh5, J Windsor6, A Davaris7, S Gupta8, J Barlow9, J Rhee10, P Tagkalidis11, A Zimet12, A Sharma13, R Manocha14, R E Neale15. 1. Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia. Electronic address: bridie.thompson@qimrberghofer.edu.au. 2. Gastroenterology Department, John Hunter Hosptial, New South Wales, Australia. 3. The Gastroenterology and Hepatology Department, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Clinical Medicine, University of Queensland, Queensland, Australia. 4. Gastroenterology and Hepatology, Royal Melbourne Hospital, Victoria, Australia. 5. Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Victoria, Australia. 6. School of Medicine, University of Auckland, Auckland, New Zealand. 7. Royal Australian College of General Practitioners, Australia. 8. Sydney Adventist Hospital, Sydney, New South Wales, Australia. 9. Bankstown Family Medical Practice, Sydney, Australia. 10. Royal Australian College of General Practitioners, Australia; General Practice Academic Unit, Graduate Medicine, University of Wollongong, New South Wales, Australia. 11. Royal Melbourne Hospital, Melbourne, Victoria, Australia. 12. Epworth Hospital, Victoria, Australia. 13. School of Clinical Medicine, University of Queensland, Queensland, Australia. 14. HealthEd, Melbourne, Victoria, Australia. 15. Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia; School of Public Health, University of Queensland, Queensland, Australia.
Abstract
BACKGROUND/ OBJECTIVES: Diagnosis of pancreatic cancer is often delayed, contributing to patient and family distress and leading to worse survival. We aimed to develop a decision support tool to support primary care providers to identify patients that should undergo investigations for pancreatic cancer, and to recommend initial diagnostic pathways. METHODS: A modified Delphi process, including a series of three surveys, was undertaken to ascertain clinical expert opinion on which combinations of signs, symptoms and risk factors should be included in a tool for the early identification of pancreatic cancer. A group of clinical specialists finalised the development of the tool during a focus group meeting. RESULTS: The tool presents individual or combinations of signs, symptoms, and risk factors in three tiers which direct the urgency of investigation. Tier 1 includes 5 clinical presentation and risk factors clusters that indicate the need for urgent investigation of the pancreas. A further five clusters are included as Tier 2 aiming to elimate other causes and reduce the time to investigating the pancreas. Tier 3 includes a list of non-specific signs, symptoms and risk factors that indicate the need to consider pancreatic cancer as a potential diagnosis, but without specific recommendations for investigation. CONCLUSIONS: Prospective validation studies are now required prior to implementation in the primary care setting. Implementation into primary care practice and as an educational resource may facilitate rapid diagnosis and improve outcomes such as distress and survival.
BACKGROUND/ OBJECTIVES: Diagnosis of pancreatic cancer is often delayed, contributing to patient and family distress and leading to worse survival. We aimed to develop a decision support tool to support primary care providers to identify patients that should undergo investigations for pancreatic cancer, and to recommend initial diagnostic pathways. METHODS: A modified Delphi process, including a series of three surveys, was undertaken to ascertain clinical expert opinion on which combinations of signs, symptoms and risk factors should be included in a tool for the early identification of pancreatic cancer. A group of clinical specialists finalised the development of the tool during a focus group meeting. RESULTS: The tool presents individual or combinations of signs, symptoms, and risk factors in three tiers which direct the urgency of investigation. Tier 1 includes 5 clinical presentation and risk factors clusters that indicate the need for urgent investigation of the pancreas. A further five clusters are included as Tier 2 aiming to elimate other causes and reduce the time to investigating the pancreas. Tier 3 includes a list of non-specific signs, symptoms and risk factors that indicate the need to consider pancreatic cancer as a potential diagnosis, but without specific recommendations for investigation. CONCLUSIONS: Prospective validation studies are now required prior to implementation in the primary care setting. Implementation into primary care practice and as an educational resource may facilitate rapid diagnosis and improve outcomes such as distress and survival.
Authors: Thavavel Vaiyapuri; Ashit Kumar Dutta; I S Hephzi Punithavathi; P Duraipandy; Saud S Alotaibi; Hadeel Alsolai; Abdullah Mohamed; Hany Mahgoub Journal: Healthcare (Basel) Date: 2022-04-03