Structured Pathology Reporting

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.

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Governance

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 Anatomical Pathology 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.

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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.

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Recent Activities

Framework for Developing Protocols (formerly the Toolkit)

The Framework for Developing Protocols will be the basis for the six cancer-specific protocols produced in the course of this project. This document will also be used by other cancer groups as a template and resource for creating protocols of a consistently high standard.

A workshop took place in May 2008. Attendees included anatomical pathologists, experts in medical software and health informatics and project managers who have implemented structured pathology guidelines. The objectives of the workshop were achieved in that a comprehensive outline for the Framework for Developing Protocols was developed.

Work has been undertaken following a meeting with the Chairman of the National Pathology Accreditation Advisory Council (NPAAC), Leslie Burnett to create a draft Framework utilising the NPAAC style guide. It is hoped that using the NPAAC format will make the Framework for Developing Protocols (and the Protocols themselves) more accessible to pathologists and also will facilitate incorporation into NPAAC standards in the long term.

Help with the content of the Framework for Developing Protocols continues to be provided by David Ellis (RCPA) and Claire Cooke-Yarborough (RCPA and Cancer Institute NSW).

This document will need the input of a medical writer/editor before it is ready for review by the RCPA. Two medical writing companies have been approached to provide quotations for this work. Quotations are expected by 4th August 2008.

Cancer Specific Protocol Development

The inaugural meetings of the expert groups for Lymphoma, Melanoma, Prostate, Lung and Colorectal have been held. For a breakdown of the members of these groups, please visit the Governance section.

As a basis for the meetings, existing guidelines were updated as per the project format:

The Lymphoma, Melanoma and Lung Protocols are based on NHMRC/ACN guidelines.
The Prostate Protocol is based on James Kench and Warick Delprado’s dataset.
The Colorectal Protocol is based on the Colorectal Cancer Consortium’s Minimum Dataset.

The meetings have centred on discussion about the draft protocol, with debate about additional items, deletions and whether items should be classified as mandatory or non-mandatory (best practice). Each of the protocols has been updated since the 1st meeting and the chair of each group is currently coordinating extra work to provide detail and definitions for the items within the protocol. 2nd meetings are currently being finalised for all groups to discuss the next draft of the protocol.

Currently the groups look on target to deliver draft protocols for review by the RCPA within 4 months of the 1st meeting date.

The medical writer who is contracted to assist with the Framework for Developing Protocols will also be involved in assisting the expert groups with writing up the protocols.

Breast: The National Breast and Ovarian Cancer Centre (NBOCC) has published “The pathology reporting of breast cancer: a guide for pathologists, surgeons, radiologists and oncologists”. This comprehensive guide fulfils the criteria for the project as specified in the funding agreement with DOHA i.e. provides guidance on structured reporting of Breast Cancer and has been developed by a national team of experts with considerable stakeholder involvement and endorsement (including the RCPA). Following discussion with Michael Bilous (Chair of Breast Group), Caroline Nehill (NBOCC) and David Ellis (RCPA) it was decided that the guide should not at present be re-formatted as per the other protocols. When the next edition of the Guide is produced, formatting will be reassessed.

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Key Decisions Made

Discussions are being held with the RCPA to enable hosting of the guidelines, toolkit and detailed information about expert groups on their website.

Dr Debra Graves and Dr David Ellis at RCPA will form the expert groups as sub-groups of the Anatomical Pathology Committee. This means that the College’s committee structure will be used to approve the guidelines.

The Colorectal Cancer Research Consortium agreed that their guidelines can be used as the basis for the national colorectal guidelines.

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Request for Feedback

Should you wish to provide suggestions about relevant cancer stakeholder groups, please email anna.burnham@cancerinstitute.org.au with your suggestions. The cancers for which protocols are being developed are breast, colorectal, lung, lymphoma, melanoma and prostate.

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Protocol Development

Click here for an overview of the Protocol Development Process.

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Contact

Anna Burnham
Project Manager
Structured Pathology Reporting for Cancer
Tel: 02 8374 3532
Fax: 02 8374 5700
Mob: 0431 867 756
Email: anna.burnham@cancerinstitute.org.au

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