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The role of the Head and Neck cancer-specific Patient Concerns Inventory (PCI-HN) in telephone consultations during the COVID-19 pandemic

  • A. Kanatas
    Correspondence
    Corresponding author: Anastasios Kanatas, BSc (Hons), BDS, MBChB (Hons), MFDSRCS, MRCSRCS, FRCS (OMFS), MD, PGC, FHEA. Consultant Surgeon / Professor, Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, LS1 3EX. Tel.: 00447956603118.
    Affiliations
    Professor Anastasios Kanatas, MFDSRCS, FRCS (OMFS), MD, PGC, FHEA. Consultant Surgeon / Professor, Leeds Teaching Hospitals and St James Institute of Oncology and Leeds Dental Institute
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  • S.N. Rogers
    Affiliations
    Professor Simon N Rogers, BDS, MBChB(hons), FDSRCS(Eng), FRCS(Eng), FRCS(max), MD, Consultant Surgeon / Professor, University Hospital Aintree and University of Liverpool
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      At the end of 2019, a novel severe acute respiratory syndrome (SARS) coronavirus (CoV), named SARS-CoV-2, was identified. Since then, the spread of coronavirus disease 2019 (COVID-19) has progressively involved countries worldwide, with the World Health Organization (WHO) stating that it had reached pandemic status.
      • Zhu N.
      • Zhang D.
      • Wang W.
      • et al.
      A novel coronavirus from patients with pneumonia in China, 2019.

      https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19-11-march-2020 Google Scholar.

      Older adults and patients with pre-existing comorbidities including cancer, particularly those on treatments that cause immunosuppression, have a higher risk of life-threatening consequences.
      • Murthy S.
      • Gomersall C.D.
      • Fowler R.A.
      Care for critically ill patients with COVID-19.
      • Wu Z.
      • McGoogan J.M.
      Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention.
      Clinicians involved in the management of patients with head and neck cancer (HNC) are having to address for the first time a new challenge related to social distancing and reduced clinical contact. There is a primacy towards risk assessment that minimises the exposure of vulnerable groups to the hospital environment, and this included HNC patients. There is a requirement to rapidly adapt previous established ways of working.
      Due to the COVID-19 crisis emphasis has been placed on delivering remote consultations. HNC clinicians and their patients are familiar with face-to-face consultations, but are not very experienced at efficiently raising concerns over the telephone. The telephone consultation could lead to a missed opportunity in exposing critical issues. Effective telephone reviews would need to follow appropriate training and monitoring, but the COVD-19 crisis has forced a rapid change in practice. The follow-up consultation is an essential component of care
      • Kanatas A.
      • Bala N.
      • Lowe D.
      • Rogers S.N.
      Outpatient follow-up appointments for patients having curative treatment for cancer of the head and neck: are the current arrangements in need of change?.
      • Nguyen N.A.
      • Ringash J.
      Head and Neck Cancer Survivorship Care: A Review of the Current Guidelines and Remaining Unmet Needs.
      but during the crisis it is even more critical as there is likely to be increased levels of isolation, anxiety and difficulty accessing support services for the affected patients.
      The PCI-HN is a 56-item prompt list and has been used in clinics as means of facilitating patients to raise concerns that might otherwise be missed.
      • Rogers S.N.
      • El-Sheikha J.
      • Lowe D.
      The development of a Patients Concerns Inventory (PCI) to help reveal patients concerns in the head and neck clinic.
      • Rogers S.N.
      • Thomson F.
      • Lowe D.
      The Patient Concerns Inventory integrated as part of routine head and neck cancer follow-up consultations: frequency, case-mix, and items initiated by the patient.
      A recent systematic review and content comparison of unmet needs self-report measures used in patients with head and neck cancer favoured the PCI compared to 13 other tools.
      • Shunmugasundaram C.
      • Rutherford C.
      • Butow P.N.
      • Sundaresan P.
      • Dhillon H.M.
      Content comparison of unmet needs self-report measures used in patients with head and neck cancer: A systematic review.
      Although designed to be used in electronic format
      • Rogers S.N.
      • Lowe D.
      • Lowies C.
      • Yeo S.T.
      • Allmark C.
      • Mcavery D.
      • et al.
      Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: a cluster preference randomized controlled trial.
      it has been used as a one sheet paper version and the responses using this method are reported in a 19-unit international study.
      • Rogers S.N.
      • Alvear A.
      • Anesi A.
      • Babin E.
      • Balik A.
      • Batstone M.
      • et al.
      Variations in concerns reported on the patient concerns inventory in patients with head and neck cancer from different health settings across the world.
      During this crisis there is potential merit for members of the head and neck team in using the PCI-HN (Appendix-1) as part of a telephone review consultation. This would serve to help standardise and guide the consultation, aid multi-professional communication, and avoid missing key issues. Preliminary use of this tool by the authors indicated a series of advantages. These included the reduced face to face consultations so as to limit the spread of COVID-19 and protect the patients and the clinical teams. Additionally, it would save patients’ travel to hospital and support providers to focus in a particular locality. The consultations may be completed by less experienced members of the team including utilisation in the nurse-led clinics. Consequently, experienced staff would become free in order to aid clinical and workforce planning in other pressure points. The use of the PCI-HN allows clinicians to continue to work from home and have a record (maybe of medicolegal significance) of the structured consultation.
      There are several reports that cancer patients are feeling anxious
      • Porzio G.
      • Cortellini A.
      • Bruera E.
      • Verna L.
      • Ravoni G.
      • Peris F.
      • et al.
      Home care for cancer patients during COVID-19 pandemic: the "double triage" protocol.
      and somewhat neglected during this crisis which is likely that add to their concerns. A structured telephone consultation may help to alleviate those fears. There is evidence to support efficacy for the use of question prompt-list approach in oncology,
      • Miller N.
      • Rogers S.N.
      A review of question prompt lists used in the oncology setting with comparison to the Patient Concerns Inventory.
      however the PCI-HN is even simpler as it is an item prompt list rather than questions. It lends itself to a single sheet of paper format which patients find easy to complete. This approach can be rapidly deployed and does not require advances in IT. During this pandemic, this strategy is suitable across many different healthcare settings and use by international colleagues.
      Our preliminary experience is that the PCI-HN may provide a very useful tool to aid remote consultations, but more clinical evidence is needed in order to ensure that such consultations are optimal for our head and neck patients.

      Conflict of interest

      We have no conflicts of interest.

      Appendix 1

      The first page of the PCI HaNC-PT as used in telephone follow-up consultations

      Figure thumbnail fx1

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