Influences on and the impact of decisionmaking strategies for the management and surveillance of complex colonic polyps on patient outcomes

Parker, Jody 2024. Influences on and the impact of decisionmaking strategies for the management and surveillance of complex colonic polyps on patient outcomes. MD Thesis, Cardiff University. Item availability restricted.

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Abstract

Background and aims There is increasing awareness and recognition of complex colonic polyps and management across the UK is variable. Endoscopic treatments avoid the risks of surgery but require timely surveillance afterwards. There is a gap in evidence supporting team decision-making strategies introduced across the UK and surveillance guidelines have been recently updated. The aim of this thesis was to understand influences on decision-making, assess the potential impact of team strategies and identify areas to improve surveillance after treatment. Materials and methods A systematic review and focussed interviews were performed to assess the impact of and influences on decision-making. An observational study of patients managed through a multi-disciplinary team approach including a separate analysis of a novel technique, described their impact on clinical outcomes. A systematic review of surveillance guidance led to a linked data cohort study to assess the impact of colonoscopy quality on future risk of colorectal neoplasia. Results Systematic review of the literature suggested optimal decision-making strategies could reduce surgery for complex polyps. Positive experiences of team approaches were identified during clinician interviews. Increasing use of multi-disciplinary teams were identified with organ preservation achieved in 91.9% of patients. Colonic resections decreased and introduction of a novel technique avoided surgery in a further 80% of selected patients. Review of surveillance guidelines identified limited evidence regarding the impact of colonoscopy quality. In bowel screening colonoscopists, colorectal cancers were diagnosed in 0.9% after index examination, but limited impact was demonstrated above a threshold of stricter performance indicators on this risk. Discussion This thesis has demonstrated team decision-making strategies of complex polyps is effective, reduces unnecessary surgery and is endorsed by clinicians. Current surveillance guidelines can be safely utilised as decision-making tools. Quality standards set within a screening programme may be of importance in future surveillance recommendations and when comparing current diagnostic standards with new and emerging technology.

Item Type:	Thesis (MD)
Date Type:	Completion
Status:	Unpublished
Schools:	Medicine
Date of First Compliant Deposit:	6 February 2025
Last Modified:	06 Feb 2025 14:29
URI:	https://orca.cardiff.ac.uk/id/eprint/175989

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