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Войти в исследования British journal of nursing (Mark Allen Publishing) · 2026
The Integrated Foregut Clinical History: enabling nurse-led, joined-up initiation of suspected-cancer pathways.
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Parkes Robyn, Probert Clare, Baker Stacey, Noon Sarah, McGlashan Julian M, Simons Anthony Cr, Parsons Simon L, Fernandez-Sordo Jacobo Ortiz, Martin Matthew J, Patel Heetan, Nouraei Sa Reza
Аннотация
BACKGROUND: Prompt diagnosis of aerodigestive cancers and other time-sensitive conditions improves survival and reduces morbidity and anxiety. However, early symptoms do not reliably differentiate between different pathologies and, in isolation, seldom localise the disease anatomically.
OBJECTIVES: To disseminate a multidisciplinary foregut (head and neck, oesophagogastric, and respiratory) diagnostic dataset, using patients' integrated clinical histories to initiate diagnostic pathways, reassure patients, and communicate information between stakeholders.
METHODS: 260 patients had their clinical histories taken either by two nurse specialists following training and then supported by a digital proforma (n=81), or by one laryngologist (n=179). The discriminative performance of the clinical history to ascertain specific symptoms was tested against validated Patient-Reported Outcome Measures (PROMs) using Receiver Operating Characteristic Area Under the Curve (ROC AUC) statistics.
RESULTS: There were 103 men and 157 women. Mean age was 58±16 years. All ROC AUCs were significantly greater than 0.5. For dysphagia, against the Eating Assessment Tool, AUC was 0.86±0.02 [0.81-0.90]. For hoarseness, against the 10-item Voice Handicap Index, AUC was 0.82±0.03 [0.77-0.0.86]. There were no significant differences in symptom ROCs between the laryngologist and trained nurse specialists using a digital proforma.
CONCLUSIONS: The Integrated Foregut Clinical History implements the clinical history as diagnostic technology to guide clinical pathways. It performs well against validated PROMs and can form the basis of nurse-led pre-visit planning to support head and neck and upper gastrointestinal timed diagnostic pathways.
OBJECTIVES: To disseminate a multidisciplinary foregut (head and neck, oesophagogastric, and respiratory) diagnostic dataset, using patients' integrated clinical histories to initiate diagnostic pathways, reassure patients, and communicate information between stakeholders.
METHODS: 260 patients had their clinical histories taken either by two nurse specialists following training and then supported by a digital proforma (n=81), or by one laryngologist (n=179). The discriminative performance of the clinical history to ascertain specific symptoms was tested against validated Patient-Reported Outcome Measures (PROMs) using Receiver Operating Characteristic Area Under the Curve (ROC AUC) statistics.
RESULTS: There were 103 men and 157 women. Mean age was 58±16 years. All ROC AUCs were significantly greater than 0.5. For dysphagia, against the Eating Assessment Tool, AUC was 0.86±0.02 [0.81-0.90]. For hoarseness, against the 10-item Voice Handicap Index, AUC was 0.82±0.03 [0.77-0.0.86]. There were no significant differences in symptom ROCs between the laryngologist and trained nurse specialists using a digital proforma.
CONCLUSIONS: The Integrated Foregut Clinical History implements the clinical history as diagnostic technology to guide clinical pathways. It performs well against validated PROMs and can form the basis of nurse-led pre-visit planning to support head and neck and upper gastrointestinal timed diagnostic pathways.