A decision support tool for the detection of pancreatic cancer in general practice: A modified Delphi consensus.
Delayed diagnosis
Early detection of cancer
Pancreatic neoplasm
Primary health care
Journal
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
ISSN: 1424-3911
Titre abrégé: Pancreatology
Pays: Switzerland
ID NLM: 100966936
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
02
06
2021
revised:
12
08
2021
accepted:
17
08
2021
pubmed:
7
9
2021
medline:
1
3
2022
entrez:
6
9
2021
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND/OBJECTIVES
OBJECTIVE
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
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
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
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.
Identifiants
pubmed: 34483054
pii: S1424-3903(21)00530-5
doi: 10.1016/j.pan.2021.08.007
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1476-1481Informations de copyright
Copyright © 2021 IAP and EPC. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest Healthed organises GP education seminars that receive financial support from a wide variety of industry stakeholders, including Viatris (formerly Mylan). None of this event support was directed at any aspect of this study's design or execution. Healthed facilitated data collection from its lists of workshop participants described in round 1 pro bono. Ben Devereaux received a consultancy fee from Viatris for involvement on the expert panel: diabetes of the Exocrine Pancreas, as well as an educational grant (Handbook of Clinical Pancreatology) and a travel grant from Viatris. Stephen Philcox received a consultancy fee from Viatris for involvement on the expert panel: diabetes of the Exocrine Pancreas. Andrew Metz received a consultancy fee from Viatris for involvement on the expert panel: diabetes of the Exocrine Pancreas. For the remaining authors none were declared.