Establishment of Nurse-led clinic for early detection of prostate Cancer: NTWC experiences

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Abstract Summary
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Authors (including presenting author) :
WY Yung, ML Li, SM Yuen, LH Wan, LY Wong, GYK Lu, KC Lee, KS Ma, VWM Tang, YK Lee, MTY Chau, CH Cheng, LH Chau, CW Man , SK Chu
Affiliation :
Day Urology Service, Ambulatory Services Centre, Division of Urology, Department of Surgery, Pok Oi Hospital, New Territories West Cluster
Introduction :
Patients with elevated PSA >4.0 undergo long waiting time (~6-12 month) before their first consultation within NTWC
Objectives :
A new Nurse-led Prostate-specific Antigen Care Clinic (PSAC) was developed to extend the roles of urology nurses who provide an initial assessment to patients who suspected prostate cancer or other urological illness.
Methodology :
All urology new case referrals were screened by Urologists. Suitable patients refer to attend PSAC within 4-8 weeks. Urology nurses deliver initial assessment and counselling according to pathway algorithm with support of education materials. A medical appointment will be prescribed by Urologists according to nursing assessment and related investigation findings. 345 patients who attended PSAC from 22 March 2016 to 21 March 2017 were included for analysis retrospectively. Service audit was conducted annually (2016 & 2017) for evaluation of its effectiveness and level of patients’ satisfaction towards service provided.
Result & Outcome :
Mean (range) age of population was 68 (39-90). Average waiting time for initial assessment was 55 (3-267) days. PSA level on referrals were ranged from 4-99 ug/L (mean 9 ug/L) while PSA taken 2 days after PSAC ranged from 0.4-127ug/L (mean 8.49 ug/L). 155 patients repeated PSA before Urologist FU with mean PSA 6.71 (0.1-22.6ug/L). Mean (range) prostatic size was 56.6ml (14.3-258.3ml). 8 of population undergone TURP. 226 patients referred to Prostate clinic for FU after attending PSAC; 103 referred to ACC for Urology FU; 3 referred to Uro-oncology; 2 referred to stone clinic; 5 arranged flexible cystoscopy; 3 referred to GOPD; 2 referred Geriatric specialty; 1 referred Pre-operative assessment for TURP. 67 of 345 patients had undergone TRUS biopsy. 52/345 (15%) of them confirmed prostate cancer Patients expressed that their overall urinary symptoms had been improved after education and interventions provided during first visit by Urology nurses. Mean score of IPSS during their first PSAC visit 14.7 QOL 3.2 while IPSS 13.5 QOL 2.9 during second visit. Service audit was conducted annually (2016 & 2017). 96% (2016) and 98% (2017) of population satisfied to our services provided. Conclusion: The establishment of PSAC lead by Urology nurses demonstrates crucial roles which shorten waiting time for patients who suspected prostate cancer. Prompt treatment can be delivered by early detection of Urological cancer/ emergency.

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