Multidisciplinary Diagnostic Centres (MDCs)
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Wave 2 of the ACE Programme comprises five projects piloting Multidisciplinary Diagnostic Centre (MDC) based pathways. This pathway is for patients with non-specific but concerning symptoms that could be indicative of several cancers, where a clear referral route does not currently exist. Wave 2 delivers recommendation 21 of the Independent Cancer Taskforce report to explore new pathway models that speed up diagnosis.
The ACE Programme plans to pilot a new diagnostic pathway for patients with ‘non-specific but concerning symptoms’ – a pathway which incorporates a Multidisciplinary Diagnostic Centre (MDC).
Patients who display symptoms or a combination of ‘non-specific’ symptoms that indicate several different cancers currently don’t have an effective referral pathway. So, as a result, go back and forth between primary and secondary care, present to emergency services or fall through the gap – which leads to delays to diagnosis and subsequently poor outcomes.
The Independent Cancer Taskforce’s strategy (July 2015) recommends MDCs as an effective way to address this current weakness in the NHS. ACE aims to action this recommendation by testing how feasible this referral route will be for the NHS in England. This pioneering pathway can include several NHS provider organisations involving primary and secondary care.
Pilots form 'Wave 2' of the programme, which aims to test how feasible this referral route will be for the NHS in England - a recommendation outlined in The Independent Cancer Taskforce's strategy (July 2015).
ACE wants to assess how clinically and economically effective an Multidisciplinary Diagnostic Centre (MDC) model would be for England.
With the Wave 2 pilots, ACE will assess MDC’s effectiveness to;
- shift from late to early cancer diagnosis at stages I & II
- reduce the number of emergency presentation diagnoses
- improve patient experience
The Multidisciplinary Diagnostic Centre (MDC) concept comes from Denmark where a patient can undergo several diagnostic tests in one location, at the same time, leading to a faster diagnosis. An MDC doesn’t have to be a new ‘centre’, but can be set up within an existing hospital or community setting and would supplement cancer specific diagnostic pathways.
MDCs can potentially be an effective way to support patients with non-specific symptoms who tend to present late, and support GPs whom are unsure of the appropriate referral pathway.
London Cancer are trialling the concept across five sites, with an MDC-based pathway for a wide range of abdominal and respiratory symptoms. Referral criteria includes patients who cannot wait for a 2WW referral and aims to broaden access to the pathway over time to include self and pharmacy referral.
Two MDCs – physician-led and radiology-led – are being piloted for patients with symptoms including fatigue, weight loss and abdominal pain. Referrals are from GPs only.
A virtual MDC within shared hospital diagnostic resources. The MDC-based pathway is for symptoms including weight loss, anaemia and abdominal symptoms. Possible broadening of pathway to include self-referral.
An MDC-based pathway for symptoms including weight loss, fatigue, appetite-loss and thrombocytopenia. Whole-body CT is the discriminating investigation through primary care triage. Referral is made via GP, Consultant and A&E with a view to expand to self-referral.
Airedale Wharfedale and Craven
An MDC-based pathway for symptoms including recurring abdominal pain and a GP suspicion of cancer with no suitable 2WW pathway. The pilot is oncology-led with electronic referral and triage from GP and A&E.
Each of the 5 MDC projects are developing and testing different approaches to Multidisciplinary Diagnostic Centres (MDC), with the shared aim of increasing the evidence-base for these pathways, and evaluating their clinical and economic effectiveness.
As this work progresses, 3 emerging ‘models’ have been identified, in addition to a set of overarching MDC design principles that identify key elements shared by all 5 projects. These models are not intended to reflect any specific ACE project pathway, but instead provide generic information on distinct potential approaches.
These may change to reflect the Programme’s ongoing learning from the pilot sites, but will be useful in supporting decision-making about potential approaches to developing MDC-based pathways.