National audit of patient reported experience of radical cystectomy for bladder cancer pathways

Abstract

Objective: The objective of this study was to measure and describe the national patient experience of radical cystectomy (RC) pathways in the UK using the validated Cystectomy-Pathway Assessment Tool (C-PAT).

Patients and methods: A cohort of 1081 patients who underwent RC for bladder cancer, between 1 January 2021 and 31 July 2022 at 33 UK cystectomy centres, returned completed C-PAT responses. SPSS was employed for data summary statistics, including median, interquartile range, Mann Whitney U test or Chi-square test with a 95% confidence interval to assess statistical significance between potentially associated variables. Open-text responses in the C-PAT tool were analysed and coded using NVivo software.

Results: In this cohort, the greatest perceived delay in the RC pathway, reported by 19% of patients (n = 208), was at the GP consultation to first hospital referral stage with suspected bladder cancer. Around 10% of patients perceived delays at each of the other stages in their pathway. Cancer nurse specialist (CNS) contact was strongly associated with an improved patient experience (p < 0.001); however, 9.5% of patients reported that they were not assigned a cancer nurse specialist in their pathway. Overall, 96% (n = 1028) reported their experience of RC pathway care to be good or excellent. There were no significant differences in reported patient experience found between cystectomy centres.

Conclusion: This audit demonstrates the feasibility of measuring patient experience of RC pathways at scale. The C-PAT tool demonstrated utility in identifying specific pathway areas for quality improvement. Overall UK patients report a high quality pathway experience. A focus on improving the referral pathway between primary and secondary care is necessary.

Keywords: PREM; PROM; bladder cancer; cystectomy; multicentre outcome audit.

FIGURE 1

Flow diagram of the study process for each centre.