Brennan Paul, Claber Oonagh, Shaw Tracey
Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Fam Cancer. 2007;6(2):181-7. doi: 10.1007/s10689-007-9125-0. Epub 2007 May 17.
The Teesside project took the underlying principle of the Kenilworth model--that people with a family history of cancer should be 'triaged' and signposted to appropriate clinical services--and applied it to a whole clinical cancer network in which inequity was the major driver for change. Unlike the Kenilworth model, the Department of Health/Macmillan Cancer Support-funded pilot project in Teesside embedded genetic risk assessment at secondary care level. The project took a 'bottom up' approach that engaged a wide variety of stakeholder groups and identified key challenges that formed the basis of a clear strategic plan. A number of specialist cancer nurses across the network had independently developed risk assessment roles over preceding years: these roles needed to be redefined prior to the creation of a small team of genetic risk assessment practitioners ('GRAPs'). This innovation challenged existing nursing roles on a local and national level. In turn, however, we were able to introduce a simple, single network-wide referral pathway, reducing workload on both primary care and tumour-specific services; to adopt a standardised genetic risk assessment pathway; and to incorporate risk assessment as a key step in the decision to enroll an individual in a clinical screening programme. Collaborative audit proved to be a useful way of engaging stakeholders and holding their attention throughout the three-year project, proving the value of the project in their terms, and embedding the changes we had made. The keys to success in this project were inclusiveness, transparency and clear strategic management.
蒂赛德项目采用了凯尼尔沃思模式的基本原则——有癌症家族史的人应接受“分诊”并被引导至适当的临床服务——并将其应用于整个临床癌症网络，在该网络中，不公平是变革的主要推动因素。与凯尼尔沃思模式不同，由英国卫生部/麦克米伦癌症支持组织资助的蒂赛德试点项目将遗传风险评估嵌入二级医疗层面。该项目采用了“自下而上”的方法，让各种各样的利益相关者群体参与进来，并确定了构成明确战略计划基础的关键挑战。在过去几年里，该网络中的一些专科癌症护士独立发展了风险评估职责：在组建一小队遗传风险评估从业者（“GRAPs”）之前，需要重新定义这些职责。这一创新在地方和国家层面挑战了现有的护理职责。然而，反过来，我们能够引入一个简单的、全网络统一的转诊途径，减轻初级保健和肿瘤专科服务的工作量；采用标准化的遗传风险评估途径；并将风险评估纳入决定个人是否参加临床筛查项目的关键步骤。协作式审计被证明是在整个三年项目中让利益相关者参与并吸引他们注意力的有效方式，从他们的角度证明了项目的价值，并使我们所做的变革得以落实。该项目成功的关键在于包容性、透明度和清晰的战略管理。
