TABLE OF CONTENTS

Introduction

We have worked closely with NHSE to develop resources to support the NHS Cancer Programme for pancreatic cancer case finding. These resources aim to assist clinicians in identifying eligible patients for the pilot and provide guidance on the next steps. Additionally, we have developed a reporting dashboard in Ardens Manager, enabling participating cancer alliances to aggregate data from multiple PCNs, ensuring more comprehensive and reliable data.


1. Identify Patients

The eligibility criteria for the pilot are patients aged 60 years and over who either have a raised HBA1c or a new diagnosis of diabetes in the last year. These patients are split into two groups:


  • Group 1: where unintentional weight loss is already documented
  • Group 2: where no weight loss is recorded, these patients can then be proactively identified to determine their weight trend. 


Ardens has built Case Finder reports to easily identify these groups of patients.


To find these reports, navigate to Clinical Reporting > Arden's Ltd > Conditions I Cancer > Pancreatic Cancer Case Finder Pilot folder.

  • The Case finder | Group 1 - ?Assess + refer USCR/CT/MRI as unintentional weight loss recorded report will identify patients who are 60 years and over, diagnosed with Diabetes or have an HbA1c >48 recorded in the last year, and have been recorded as having unintentional weight loss. These patients are eligible for the pilot, barring any exclusions listed on the template.

  • The Case finder | Group 2 - ?Assess + record weight + refer USCR/CT/MRI if unintentional weight loss report will identify patients who are 60 years and over, diagnosed with Diabetes or have an HbA1c >48 recorded in the last year, but have NOT had any weight loss recorded. These patients can be proactively assessed to record their weight and determine if there has been any unintentional weight loss to be included in the pilot. 


Additionally, there are useful 'For review' reports which can be run to identify patients you may wish to include in the pilot or chase an outcome.


  • For review | ?Follow-up as PCCF assessment + USCR referral 1-12m ago + no outcome report will identify patients who have been referred for an ultrasound scan from the pilot but there has been no outcome recorded. You may wish to follow-up on these patients to understand why an outcome has not been recorded.

  • For review | ?Review as excluded from case finders as EOL, pancreatic cancer, Rockwood 8-9 or USCR in last 2m report will identify patients who are excluded from the case finder reports because they have been coded with End of Life, Pancreatic Cancer, have  a Rockwood frailty score of 8-9 or ultrasound in the last 2 months. You may wish to include these patients in the pilot if deemed clinically relevant. 


2. Record Consultation

Once the patients have been identified for the pilot, the Ardens "Pancreatic Cancer Case Finding Pilot" template can be used to assess the patient and record the outcome.


To access this template, when in a patient record, simply search for 'Pancreatic Cancer Case Finding Pilot' using the F12 Launcher, where you can add it to your favourites list. It can also be accessed by going to Auto Consultation > ardens CONDITIONS CANCER > Pancreatic Cancer Case Finding PILOT. Alternatively you can search for it in the bottom left search box in SystmOne.


Home

The first page on the template allows you to navigate to the other tabs on the left hand side, as well as display information on existing codes in the patient record, such as any existing cancer diagnosis and  treatments they may be recieving. 


Group 1

The 'Group 1' page of the template allows an assessment of any patient that falls into the Group 1 reports mentioned above. 


The page is divided into 3 sections:


Assessment - The first tick box with the red !! must be ticked for all other options on this page to become available to be selected. 


This icon will appear next to the free text box - by clicking on this, the exclusion criteria (shown in the image below) can be viewed and selected if necessary. If no exclusion criteria is met, then the 'Absence of exclusion criteria' option can be selected.


Impression - Depending on the exclusion criteria, the relevant option will then be selected here. Depending on the option, the relevant guidance in the 'Management' section will then become available to be selected. 


Management - This section allows for coding of the next steps. If the patient is eligible for the pilot and the 'Pancreatic cancer case finding criteria met + no exclusions present' tick box is ticked in the Impression section,  the relevant codes can be recorded for a fast track referral. This will enable 'Direct access imaging' codes to be added, along with any blood tests requested and any cancer safety netting. There is also a 'Plan' box at the bottom for any additional free text notes.. Additionally, there are buttons to launch the Phlebotomy and Radiology templates, where an Electronic Pathology Request can be launched, as well as a button to create a Referral Advice letter for the patient.


If the patient is deemed to be excluded from the pilot by selecting the 'Pancreatic cancer case finding criteria met + exclusions present' option in the 'Impression' section, then the next steps will be to code their exclusions from the pilot, add a discussion code, and include any additional notes in the 'Plan' free text box.


Group 2

The 'Group 2' page of the template allows an assessment of any patient that falls into the Group 2 reports mentioned above. 


The template will walk through the assessment of the patient to determine if they have had any unintentional weight loss, and take appropriate action regarding their eligibility for the pilot.  


The page is divided into 3 sections:


Assessment - Here the patient can be assessed to work out if their weight has increased or remained steady, as well as if there has been any intentional or unintentional weight loss. There are also numeric boxes to the right that allow HbA1c, weight and height to be recorded. By recording the weight and height here, the BMI box will automatically calculate.


As mentioned above, the exclusion criteria can then be viewed by clicking on this icon, and can then be selected from the list to populate this box.


Impression - Depending on the information entered in the Assessment section, the correct 'Impression' will automatically become active here to determine what to do next. If the criteria is met, then it still needs to be determined here if any exclusion criteria is present or not by ticking the relevant option.


Management - This section allows for coding of the next steps. If the patient is eligible for the pilot and the 'Pancreatic cancer case finding criteria met + no exclusions present' tick box is ticked in the Impression section,  the relevant codes can be recorded for a fast track referral. This will enable 'Direct access imaging' codes to be added, along with any blood tests requested and any cancer safety netting. There is also a 'Plan' box at the bottom for any additional free text notes.. Additionally, there are buttons to launch the Phlebotomy and Radiology templates, where an Electronic Pathology Request can be launched, as well as a button to create a Referral Advice letter for the patient.


If either of the 'Pancreatic cancer case finding criteria met + exclusions present' or the 'Pancreatic cancer case finding criteria not met - no unintentional weight loss' options in the 'Impression' section are selected, then the next steps will be to code their exclusions from the pilot, add a discussion code, and include any additional notes in the 'Plan' free text box.


3. Review Outcomes

Once the patient has been referred to the pilot, the Outcomes page of the same template can be used to record any referrals completed, treatment decisions or investigations done. 

Again, the box next to the red !! must be ticked for all other options to become available. Then, the relevant codes can be selected depending on the outcome for the referral, such as the CT/MRI that was done, the CT/MRI result as well as the cancer outcome and any treatment decisions if applicable. There is also a free text 'Other note' box at the bottom to add any narrative if needed.


To monitor the patient outcomes, there are searches available in the Clinical Reporting > Arden's Ltd > Conditions I Cancer > Pancreatic Cancer Case Finder Pilot.


These searches will report on any data recorded via the template, including any assessments and investigations done, plus diagnoses made within 3 months.


If you require any further assistance please contact Ardens SystmOne support:  support-systmone@ardens.org.uk