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.
MDC interim report – May 2018
Latest ACE report
This report provides analysis of activity within the five ACE projects in England, including: symptom presentation, cancer diagnoses, and non-cancer diagnoses. It also describes practical learning from projects and details areas of interest for future evaluation.
The data from this report was up to date in February 2018. A full evaluation of the project is scheduled for the beginning of 2019 and will include quantitative, qualitative and cost analyses.
An approach to building the local case for MDCs
A planning guide for MDCs
The following article sets out a potential approach to planning and developing MDCs. It may be helpful to local commissioners and policy makers interested in implementing MDC-based pathways in their areas.
Early project learning leaflet
Key learning from the five projects
This material is based on feedback from the five ACE projects and describes the key learning points from their early experiences. The information focuses specifically on aspects of planning and development for a cancer diagnostic pathway for non-specific but concerning symptoms.
The five areas covered in this leaflet are: timing, essentials to developing MDC plans, working with primary care, key data elements and operational challenges. The findings from the qualitative, theory-based analysis of implementation research, will be available from the end of 2018.
MDC patient experience survey report
An evaluation by Newcastle University
To measure patient experience of the MDC pathway, a 21-item survey was developed specifically for the ACE Programme by Newcastle University. This report provides final results from the survey and indicates a positive patient experience across a range of key pathway areas.
Video based on views across the MDC pathway
Our animated video looks at the benefits of the MDC pathway from six different perspectives. It features the views of ACE team members who are assessing the effectiveness of MDCs and clinicians who are working on the pathway, supporting patients with non-specific but concerning symptoms.
Please reference the video as: The ACE Programme: MDC animation (October 2018)
MDC design principles
We have identified three emerging ‘models’ as well as a set of overarching MDC design principles that are 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.
Each ‘model’ includes the approach, diagnostics and leadership required. The design principles should be read in conjunction with the MDC resource pack.
MDC core data items
Data items for evaluation
This document lists the data items to be collected as part of the MDC evaluation. Similar data items should be recorded whenever possible for the MDC and comparator groups. A data item called ‘Control pathway or MDC case’ has been added to be used as a filter – the comparators are referred as ‘control’ or ‘control pathway’ across the document.
A full data items list is available on request, please email: firstname.lastname@example.org
How MDCs could improve early cancer diagnosis.
Please use the following reference when using this image ‘How MDCs could improve early cancer diagnosis’ infographic. Source: Cancer Research UK’.
Clinical perspectives on MDCs
Views from primary and secondary care MDC clinicians
MDC resource pack [on request]
Resources for setting up an MDC
This pack provides a set of resource materials as used by the MDC pilot sites.
Areas covered include: components of an MDC, patient pathways and information, MDC diagnostics, examples of referral forms, advice for GPs, evaluation metrics and the patient experience survey.
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.