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Heterogeneity in patient diagnostic pathways: an example from contrast-enhanced ultrasound diagnostic scans for focal liver lesions.

Smith AB, Filby A, Carr LM - BMC Res Notes (2014)

Bottom Line: The results from the semi-structured interviews with UK clinicians revealed that there is a great deal of heterogeneity in diagnostic pathways followed by patients with potential liver lesions which differ both within and between hospitals.However, current clinical practice means that patient choice is virtually non-existent.The gradual development of patient choice of modalities may necessitate a change of practice in radiology processes.

View Article: PubMed Central - HTML - PubMed

Affiliation: York Health Economics Consortium Ltd, University of York, Market Square, Heslington York YO10 5NHUK. adam.smith@york.ac.uk.

ABSTRACT

Background: The UK's National Institute for Health and Care Excellence (NICE) has recommended contrast-enhanced ultrasound (CEUS) for the characterisation of focal liver lesions where the results of standard unenhanced ultrasound are inconclusive. A further recommendation is for CEUS to replace other imaging modalities. However, little is currently known about the diagnostic pathways in the National Health Service (NHS) followed by patients with potential liver lesions. The aim of this study was to identify the diagnostic pathways for a number of representative hospital trusts and record the clinicians' views on patient experiences of these processes through a series of semi-structured interviews with UK clinicians (radiologists and sonographers) (N = 7). This study was undertaken in the broader context of a larger research project where the overarching research question is focused on patient preferences for CEUS and other imaging modalities, and how these impact on patient quality of life (QOL).

Results: The results from the semi-structured interviews with UK clinicians revealed that there is a great deal of heterogeneity in diagnostic pathways followed by patients with potential liver lesions which differ both within and between hospitals. In terms of the patient experience, the clinicians believed that a combination of the more patient-friendly ultrasound process, and the fact that scan results are given to patients in 80-90% of cases on the day, as well as the problems inherent to other scan modalities (claustrophobia, anxiety) would lead to patients preferring ultrasound compared with other imaging modalities (CT or MR). However, current clinical practice means that patient choice is virtually non-existent.

Conclusions: The significant variation in diagnostic pathways across the NHS will require further standardisation through local agreements if contrast-enhanced ultrasound is to replace other imaging modalities in characterising focal liver lesions in line with NICE Diagnostics Guidance. The gradual development of patient choice of modalities may necessitate a change of practice in radiology processes.

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Related in: MedlinePlus

Diagnostic pathway for liver imaging with contrast-enhanced ultrasound as a replacement for contrast-enhanced CT/contrast-enhanced MR.
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Figure 1: Diagnostic pathway for liver imaging with contrast-enhanced ultrasound as a replacement for contrast-enhanced CT/contrast-enhanced MR.

Mentions: The NICE guidance suggests that CEUS may be used in the diagnostic pathway to replace contrast-enhanced CT (CECT) and contrast enhanced MR (CEMR). The NICE guidance also suggests that CEUS could be used as a “triage step” in order to minimise the use of these two technologies, however, the available data only allowed CEUS to be included as a replacement for CECT and CEMR. The potential diagnostic pathways for these two options are shown in Figures 1 and 2. However, a scoping search identified that little is currently known about the diagnostic pathways that patients follow when undergoing unenhanced/enhanced imaging for focal liver lesions.


Heterogeneity in patient diagnostic pathways: an example from contrast-enhanced ultrasound diagnostic scans for focal liver lesions.

Smith AB, Filby A, Carr LM - BMC Res Notes (2014)

Diagnostic pathway for liver imaging with contrast-enhanced ultrasound as a replacement for contrast-enhanced CT/contrast-enhanced MR.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230804&req=5

Figure 1: Diagnostic pathway for liver imaging with contrast-enhanced ultrasound as a replacement for contrast-enhanced CT/contrast-enhanced MR.
Mentions: The NICE guidance suggests that CEUS may be used in the diagnostic pathway to replace contrast-enhanced CT (CECT) and contrast enhanced MR (CEMR). The NICE guidance also suggests that CEUS could be used as a “triage step” in order to minimise the use of these two technologies, however, the available data only allowed CEUS to be included as a replacement for CECT and CEMR. The potential diagnostic pathways for these two options are shown in Figures 1 and 2. However, a scoping search identified that little is currently known about the diagnostic pathways that patients follow when undergoing unenhanced/enhanced imaging for focal liver lesions.

Bottom Line: The results from the semi-structured interviews with UK clinicians revealed that there is a great deal of heterogeneity in diagnostic pathways followed by patients with potential liver lesions which differ both within and between hospitals.However, current clinical practice means that patient choice is virtually non-existent.The gradual development of patient choice of modalities may necessitate a change of practice in radiology processes.

View Article: PubMed Central - HTML - PubMed

Affiliation: York Health Economics Consortium Ltd, University of York, Market Square, Heslington York YO10 5NHUK. adam.smith@york.ac.uk.

ABSTRACT

Background: The UK's National Institute for Health and Care Excellence (NICE) has recommended contrast-enhanced ultrasound (CEUS) for the characterisation of focal liver lesions where the results of standard unenhanced ultrasound are inconclusive. A further recommendation is for CEUS to replace other imaging modalities. However, little is currently known about the diagnostic pathways in the National Health Service (NHS) followed by patients with potential liver lesions. The aim of this study was to identify the diagnostic pathways for a number of representative hospital trusts and record the clinicians' views on patient experiences of these processes through a series of semi-structured interviews with UK clinicians (radiologists and sonographers) (N = 7). This study was undertaken in the broader context of a larger research project where the overarching research question is focused on patient preferences for CEUS and other imaging modalities, and how these impact on patient quality of life (QOL).

Results: The results from the semi-structured interviews with UK clinicians revealed that there is a great deal of heterogeneity in diagnostic pathways followed by patients with potential liver lesions which differ both within and between hospitals. In terms of the patient experience, the clinicians believed that a combination of the more patient-friendly ultrasound process, and the fact that scan results are given to patients in 80-90% of cases on the day, as well as the problems inherent to other scan modalities (claustrophobia, anxiety) would lead to patients preferring ultrasound compared with other imaging modalities (CT or MR). However, current clinical practice means that patient choice is virtually non-existent.

Conclusions: The significant variation in diagnostic pathways across the NHS will require further standardisation through local agreements if contrast-enhanced ultrasound is to replace other imaging modalities in characterising focal liver lesions in line with NICE Diagnostics Guidance. The gradual development of patient choice of modalities may necessitate a change of practice in radiology processes.

Show MeSH
Related in: MedlinePlus