Print this pageStructured Pathology Reporting
Review of Protocols
Your feedback is invited about the content and format of the draft cancer protocols. Click here to review these protocols.
Background
The NSW Oncology Group has identified Structured Pathology Reporting as a high priority for improving clinical decision support. Unlike the United Kingdom or the United States, there is no structure for development and dissemination of structured (or synoptic) pathology reports against a national standard for cancer in Australia. There is limited evidence or research to demonstrate that structured pathology reports are beneficial to clinical treatment, clinical decision making or that they reduce workload. However, clinicians agree that it is good practice to have guidelines, standard report formats and minimum data items.
A Round Table on the 28th June 2007 was convened by the Cancer Institute NSW, in conjunction with The Royal College of Pathologists of Australasia (RCPA) and Cancer Australia. The subject was the use of structured pathology reports in cancer, and the aims of the Round Table were to discuss clinical drivers for structured requests and reporting; identify current projects and practices in each state, and to identify a national pathway for the development, review and publication of agreed voluntary standards for structured pathology reports for each type of cancer.
All who were present at The Round Table agreed that structured reporting of cancer cases in anatomical pathology and haematology is likely to contribute to better cancer control through improvements in:
- Clinical management and treatment planning
- Cancer notification, registration and aggregated analyses
- Research.
It was agreed that currently available knowledge and clinical engagement should be built on and a project should be resourced and undertaken without delay. A full report, including details of the organisations participating and the Consensus Statement, is available by clicking here. 
The Cancer Institute NSW secured funding in February 2008 from the Dept of Health & Ageing (Quality Use of Pathology Programs) to work with the RCPA and Cancer Australia to develop 6 reporting protocols (lung, melanoma, breast, colorectal, lymphoma and prostate) and a toolkit in partnership with national clinician and pathologist organisations.
TopGovernance
The National Round Table for Structured Pathology Reporting of Cancer project is a partnership between the Royal College of Pathologists of Australasia (RCPA), Cancer Australia and the Cancer Institute NSW. To ensure the project is managed effectively between the three organisations and that roles are clearly delineated, a Memorandum of Understanding (MOU) has been developed.
The Colorectal Cancer Research Consortium (CCRC) is undertaking a project that is in part concerned with the development of standards for structured pathology reporting of colorectal cancer. Due to the potential overlap between the two projects, a collaboration plan has been jointly prepared between CCRC and the Cancer Institute NSW to ensure duplication is kept to a minimum.
Two committees will be responsible for governing the affairs of the National Round Table for Structured Pathology Reporting of Cancer. The Working Party, whose inaugural meeting took place on 25 October 2007, will provide strategic direction, expert advice and review. The Project Group will meet more regularly and will be responsible for maintaining transparency with the broader group, tracking the project against the plan and resolving or escalating issues that threaten the project’s momentum and successful execution.
Six expert subgroups of the RCPA Cancer Services Advisory Committee will be convened to develop the structured reporting protocols for the six cancers (lung, melanoma, breast, colorectal, lymphoma and prostate). The subgroups will utilise the RCPA committee structure to approve the guidelines and will also report to the Project Group. Where significant, national collaboration has already taken place for a reporting standard, the RCPA subgroup will re-convene the same members. This includes current work on both breast cancer (NBOCC) and Melanoma (ACN/NHMRC) reporting guidelines.
To see a diagram of the Governance Structure, including a list of members of the Working Party, Project Group and the Expert Subgroups please click here. 
Project Aims / Deliverables
The aim of the Project is to lead the development of an agreed method and structure for developing, disseminating and maintaining guidelines for structured pathology reporting of cancer.
Objectives
The objectives of the Project are to:
- improve the usability of pathology reports by clinicians, registries and researchers;
- improve decision support for cancer treatment;
- improve the feedback of pathology results to cancer patients during consultation;
- ensure best practice by Pathologists by reporting to a minimum data set but not limited to the data set;
- standardise cancer-specific pathology request and report formats, and their terms and contents through the development of guidelines;
- facilitate reporting skills and use of terms for trainee pathologists or new pathologists; and
- provide structured reports that will enable data items to be easily extracted for electronic health records, clinical information systems, clinical audits and research.
Project Deliverables
- jointly prepare a collaboration plan with the Colorectal Cancer Consortium of the University of New South Wales to provide guidance on issues of potential overlap or connection;
- establish governance for a national structured pathology report for cancer in the form of a Memorandum of understanding (MoU) between the Cancer Institute NSW, the Royal College of Pathologists of Australasia (RCPA) and Cancer Australia;
- develop a toolkit and a template with guidelines for structured pathology reporting for cancer in breast, colorectal, melanoma, lung and prostate cancer and lymphoma;
- establish an authoritative site for the publication of the Guidelines and reports;
- establish a framework for the evaluation of standards and reports (for future revisions according to best practice);
- develop HL7 message standards for secure transmission of structured laboratory reports for from laboratories to desktop and hospital clinical systems AND to state cancer registries (for six cancers);
- conduct a detailed study in which clinicians are asked to compare a cohort of unstructured pathology reports against a matched cohort of structured reports and indicate exactly which provide more clinical information against a series of decision support and risk profiling clinical questions;
- survey pathologists to assess the impact of the transition to structured reporting with a particular emphasis on time to report and follow up clarification;
- survey referring doctors (surgeons, oncologists, haematologists and geneticists) and multi-disciplinary teams to assess the impact of structured reporting on care planning and research;
- develop the structured pathology reporting standards for cancer for consideration as laboratory accreditation standards by the National Pathology Accreditation Advisory Council (NPAAC);
- develop the structured pathology reporting standards for cancer for consideration for prospective application of structured pathology messaging standards in cancer by National E-Health Transition Authority (NEHTA); and
- report to the National Round Table on Structured Pathology Reporting for Cancer in 2009.
To see a diagram of the project's deliverables and benefits, please click here.
Recent Activities
FRAMEWORK FOR DEVELOPING PROTOCOLS
The purpose of the Framework for Developing Protocols is to guide the 6 cancer-specific protocols produced during the project. This document is also intended for use by other cancer groups as a template and resource for creating protocols of a consistently high standard.
For the Framework to be a high quality document in needs to advise about both structure and content, an original concept in relation to structured reporting that is being pioneered in Australia. This piece of work has proved more complex and challenging than was initially envisioned and has therefore taken longer to complete than was planned.
Work on the Framework has been undertaken by the Framework Committee which comprises of a team of pathologists, Michael Legg (President of the Health Informatics Society of Australia - HISA), and the project manager. A review of all protocols and the Framework was undertaken in February 2009 which showed that further work was needed to develop the Framework into a high quality, user friendly document. Following this the Framework Committee have worked closely with a team of medical writers, Biotext, to improve the content and format of the document.
The Framework consists of a word template and a general guideline document. In May 2009 it was deemed advanced enough to be used as a template against which to edit the 6 cancer specific protocols. This document will be sent for review by the Cancer Services Advisory Committee (CanSAC) at the Royal College of Pathologists of Australasia (RCPA) in June 2009 together with the first protocol to be finalised. Once all the protocols are edited it is expected that some minor amendments may need to be made to the Framework. This document will therefore not be finalised until the end of the project in October 2009.
CANCER SPECIFIC PROTOCOLS
The melanoma, prostate, lung, colorectal and lymphoma protocols have been developed to final draft stage. The development process is specified in detail in the Framework guideline document and has involved a series of meetings, teleconferences and document review via email. Melanoma has been professional edited and the rest of the protocols have been sent to be edited. The first round of editing for all protocols is expected by 31st July 2009. As each protocol is edited there will be a period of open consultation for stakeholder review and feedback.
Click here to review these protocols.
Breast Protocol
The National Breast and Ovarian Cancer Consortium (NBOCC) have decided to reformat their guidelines in the project format. It is planned that the medical writer responsible for the NBOCC guidelines will reformat as per the Framework. The benefits of using the original medical writer are two fold; firstly their obvious experience and expertise in writing guidelines about breast cancer pathology reporting; secondly it will act as an independent test of the Framework by someone who has not been involved in its development.
EVALUATION OF PROTOCOLS
The RCPA have set-up a new committee called CanSAC which is responsible for coordinating the review of the Framework and the protocols. This committee will also be responsible for any further protocols that are developed outside of this project and will co-ordinate the revision of protocols in the future.
HL7 Messaging and Archetypes
Work is underway to develop HL7 messaging standards and archetypes in conjunction with the National E-Health Transition Authority (NEHTA). Draft archetypes have been developed for all cancers by Ocean Informatics. Review of these archetypes will be undertaken over the next two months.
Protocol Development
Click here for an overview of the Protocol Development Process.
Contact
Megan Judge
Project Manager
Structured Pathology Reporting for Cancer
Tel: 02 8374 5757
Fax: 02 8374 5700
Email: megan.judge@cancerinstitute.org.au