Context
The NPCA patient survey is designed to determine patients’ views of their outcomes following treatment ≥ 18 months after diagnosis. The questionnaire includes the Expanded Prostate Cancer
Index Composite 26-item (EPIC-26), a validated instrument that measures prostate cancer related quality of life after radical treatments for prostate cancer on a scale of 0-100 with higher scores representing better functioning. The NPCA compared risk-adjusted EPIC-26 urinary incontinence scores for each of the 56 surgical centres in England and Wales (ranging from 59.0 – 83.8 by
provider).
Stockport NHS Foundation Trust was found to be outside the expected limits for the national mean urinary incontinence EPIC-26 domain score following adjustment for age, comorbidities, cancer risk status and socioeconomic deprivation (60.9 compared with 71.0). As a result, the trust was flagged as a potential outlier and the clinical lead formally notified in keeping with the NPCA Outlier Process.
Evaluation & diagnosis
The clinical lead and trust team were provided with a list of patients within their cohort and provided with patient-level risk adjustment information and procedure date to support their internal investigation. Individual patient response information or individual scores were not provided.
The results represent the start of the robotic programme within the trust and there was a recognised mentoring system in place. However, the trust acknowledged that there was variation
with respect to urinary incontinence outcomes and recognised the need to constantly improve their patient outcomes. Part of the Improving Outcomes Guidance (IOG) compliant network at the time
contained an in-reach element which the trust felt made it more difficult to run a unified service and to keep a close eye on outcomes.
Improvement plan
The IOG compliant network in-reach element has been changed to an out-reach service which is anticipated to improve feedback and patient outcomes.
Next on the improvement journey
The trust highlighted that the first EPIC-26 patient-reported urinary incontinence results from the NPCA provide an invaluable starting point to drive local quality improvement activities, the success of which will be determined by further data collection to provide comparative patient outcomes. The trust plan to report annual results on their website to support patient counselling regarding treatment outcomes following radical treatment for prostate cancer.
Last updated: 9 November 2020, 10:53pm