- Initial 6 month visit at Beatson
- Follow up schedule
- 6 monthly prostate-specific antigen (PSA) check for 5 years then annual to 10 years telephone/letter review.
Patient has access to CNS team via direct telephone number.
Welcome to the Right Decision Service (RDS) newsletter for April 2024.
Tactuum has been working hard to address the issues experienced during the last week. They have identified a series of three mitigation measures and put the first of these in place on Friday 3rd May. If this does not resolve the problems, the second mitigation will be actioned, and then the third if necessary.
Please keep a lookout for any slowing down of the system or getting locked out. Please email myself, mbuchner@tactuum.com and onivarova@tactuum.com if you experience any problems, and also please raise an urgent support ticket via the Support Portal.
Thank you for your patience and understanding while we achieve a full resolution.
A rotating carousel presenting some of the key RDS tools and capabilities, and an editable slideset, are now available in the Resources for RDS providers section of the Learning and Support toolkit.
The redesign of RDS Search and Browse is still on-track for delivery by mid-June 2024. We then plan to have a 3-week user acceptance testing phase before release to live. All editors and toolkit owners on this mailing list will be invited to participate in the UAT.
The archiving and version control functionality is also progressing well and we will advise on timescales for user acceptance testing shortly.
Tactuum is also progressing with the deep linking to individual toolkits within the mobile RDS app. There are several unknowns around the time and effort required for this work, which will only become clear as the work progresses. So we need to be careful to protect budget for this purpose.
These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.
Many thanks to those of you completed the value and impact survey we distributed in February. Here are some key findings from the 65 responses we received.
Figure 1: Impact of RDS on direct delivery of care
Key figures
Figure 2 shows RDS impact to date on delivery of health and care services
Key figures
These data show how RDS is already contributing to NHS reform priorities and supporting delivery of more sustainable care.
Saving time and money
Quality assurance and governance
Service innovation and workforce development
A few examples of toolkits published to live in the last month:
Some of the toolkits the RDS team is currently working on:
Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.
Thanks to all of you who have responded to the retrospective quality audit survey and to the follow up questions. We still have some following up to do, and to work with owners of a further 23 toolkits to complete responses. An interim report is being presented to the HIS Quality and Performance Committee.
Eight clinical services and two public library services are undertaking tests of change to implement the Being a partner in my care app. This app aims to support patients and the public to become active participants in Realistic Medicine. It has a strong focus on personalised, person-centred care and a library of shared decision aids, as well as simple explanations and videoclips to help the public to understand the aims of Realistic Medicine. The tests of change will inform guidance and an implementation model around wider adoption and spread of the app.
With kind regards
Right Decision Service team
Healthcare Improvement Scotland
Patient has access to CNS team via direct telephone number.
Low risk CPG 1 | PSA <10 and | Gleason 6 | T1 or T2a disease |
Intermediate risk CPG 2 | PSA <20 | Gleason 7 (3+4) | T1/T2a/b |
High risk CPG 2 | PSA <20 and/or | Gleason 6 or 7 (3=4=7) and/or | T2c |
All cases will be reviewed in MDT and agreed if Active Surveillance is an appropriate option.
The CNS will discuss treatment options with patients, ensuring the patient has a good understanding of the principles of Active Surveillance. The nurse will provide written information +/- signpost to validate online support (Prostate Cancer UK). This information can be accessed by the patient and their family. All patients will be provided with contact details for the specialist nursing team.
Year 1 | 4 monthly PSA* | |
Year 2 | 6 monthly PSA* | 12 month MRI scan* |
Year 3-10 | 6 monthly PSA* | Year 4 MRI |
*Assess if active surveillance remains appropriate - consider radical treatment/watchful waiting.
If MRI confirms disease progression +/- a continual rise in PSA. The CNS would request radiology staging investigation as per the local protocol. Following the completion of required investigation the nurse specialist will request for the case to be discussed in the local Urology MDT. A consensus will be sought regarding appropriate further management options. The nurse specialist will update the patient regularly.
All patients will have direct contact details for CNS team should they have any concerns between visits.
Review patient in clinic/telephone at time of developing relapsed disease. Discuss disease status and further treatment options. Consider rescanning and discussion in MDT if the patient has a good performance status and wishing to consider salvage treatment.
If not suitable or the patient does not wish to be considered for salvage treatment the following follow up schedule is advised.
*Consider Discharge if it becomes evident that the patient is unlikely to benefit from regular PSA checks. Example: increased comorbidities where it is evident that hormone therapy would only be considered if the patient is symptomatic - Discharge to GP with advice that hormone therapy could be commenced on basis of symptom progression.
All patients will have direct contact details for CNS team should they have any concerns between visits.
Consider Discharge if it becomes evident that the patient is unlikely to benefit from regular review. Example: increased comorbidities where it is evident that systemic treatment/palliative radiotherapy would only be considered if the patient is symptomatic - Discharge to GP with advice that further treatment could be considered on basis of symptom progression. Provide details for Patient Initiated Review.
All patients will have direct contact details for CNS team should they develop symptoms of concern – Patient Initiated Review.
Consider Discharge if it becomes evident that the patient is unlikely to benefit from regular PSA checks. Example: increased comorbidities where it is evident that systemic treatment/palliative radiotherapy would only be considered if the patient is symptomatic - Discharge to GP with advice that further treatment could be considered on basis of symptom progression. Provide details for Patient Initiated Review
If PSA progression (PSA doubling time <6months) or symptom progression consider CT + Bonescan and arrange discussion in local MDT.
All patient will have direct contact details for CNS team should they have any concerns between visits.
Consider Discharge if it becomes evident that the patient is unlikely to benefit from regular PSA checks. Example: increased comorbidities where it is evident that systemic treatment/palliative radiotherapy would only be considered if the patient is symptomatic - Discharge to GP with advice that further treatment could be considered on basis of symptom progression. Provide details for Patient Initiated Review
If PSA progression (PSA doubling time <6 months) or symptom progression consider CT + Bonescan and arrange discussion in local MDT.
Review in Consultant Oncology clinic / Non Medical Prescribing clinic.
All patients will have direct contact details for CNS team should they have any concerns between visits.