The National Mastectomy

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The National Mastectomy Breast Reconstruction
Audit
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The Audit in context

• A national audit of provision and outcomes of
  mastectomy and breast reconstruction surgery for
  women in England and Wales

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What are the Audits aims?

• The Audit will
• describe provision of and access to breast
  reconstruction in England and Wales
• evaluate current clinical practice in mastectomy
  and breast reconstruction
• measure outcomes following mastectomy with or
  without reconstruction
• assess the quality of information provided to
  women undergoing mastectomy and their
  satisfaction with the reconstructive choices made

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Who is carrying out the Audit?

• A team of specialist clinicians and audit experts
  from
• the Association of Breast Surgery at the British
  Association of Surgical Oncology
• the British Association of Plastic,
  Reconstructive Aesthetic Surgeons
• the Royal College of Nursing
• the National Clinical Audit Support Programme of
  the Information Centre for Health and Social Care
  
• the Clinical Effectiveness Unit of The Royal
  College of Surgeons of England

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Its multi-method audit approach

• Pre-audit qualitative interviews to inform audit
  design
• Organisational survey
• Retrospective outcomes analysis using existing
  datasets
• Prospective study (in-patient data only)
• Patient-reported outcomes study (post-discharge)
• Post-audit qualitative interviews to inform
  recommendations
• ONLY THE PROSPECTIVE STUDY ASKS FOR SIGNIFICANT
  INPUT FROM THE CLINICAL TEAM

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Inclusion criteria

• All women undergoing unilateral mastectomy for
  breast cancer (with or without immediate
  reconstruction)
• All women undergoing delayed reconstruction after
  unilateral mastectomy for breast cancer
• England Wales
• The NHS the Private Sector

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Prospective data items

• Available at pre-admission/admission
• Registration data (6)
• Previous treatment (4) and co-morbidity (5) data
• Patient-reported outcomes consent status (2)
• Available at time of surgery
• Operative data (5-8)
• Decision making data (0-5)
• Available at time of discharge / discharge
  summary
• Peri-operative (in-patient only) morbidity data
  (8)
• Pathology data (6)
• Of a maximum of 44 data items, 22 are standard
  NHS Data Dictionary / National Cancer Dataset
  items (often already collected by units)

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Prospective data collection

• Paper datasheets for distinct patient pathways
• exactly matched to the web-based server
• available in a locally modifiable form
• Data may also be
• entered directly into the web-based server
• uploaded from existing data systems

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Prospective piloting

• Piloted at 8 Units of varying size, clinical
  activity and location (Breast, Plastics, Private)
• November to December 2007
• Produced guidelines/recommendations
• Feedback on optimal local data collection
  solutions

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Patient-reported outcomes

• Key component of the Audit
• All post-discharge follow-up direct with patients
• Emphasis on
• the patients experience of the care pathway
• the patients assessment of their outcomes
• All those consented will receive questionnaires
  three and eighteen months after surgery
  investigating these domains (distributed
  centrally by the Audit team)

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Patient-reported outcomes consent

• A specially designed information leaflet and
  consent form will be provided to all Units
• The consent allows us to verify the current
  address and mortality status of patients before
  sending questionnaires directly to them
• Consent is not required for prospective data
  collection this has full PIAG approval as part
  of a National Cancer Audit being conducted for
  the Healthcare Commission

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How can you help the Audit?

• By encouraging uptake of the Audit within your
  Unit
• By clinicians
• By patients especially with respect to PRO
  consent
• By helping to ensure full case ascertainment and
  data completeness
• By helping to pass on the results of the Audit to
  your patients in future

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How will the Audit help you?

• By providing live feedback of Unit-level data
  with regional and national comparisons
• By allowing you to utilise all data collected and
  entered at a local level as you wish
• By contributing to the evidence base in
  mastectomy and reconstruction surgery
• By informing future national guidelines in this
  area
• By enabling you to provide women with accurate,
  up to date and comparative information about
  different treatment options and their outcomes

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Thank you.If you have any questions, go
towww.ic.nhs.uk/mbr or contact The Project
team atrmbr_at_ic.nhs.uk