Metastatic spinal cord compression (MSCC) affects up to 10% of patients with disseminated malignancies, and early diagnosis correlates with improved clinical outcomes. Up to 85% of patients who present with MSCC already have motor deficit by the time of presentation. We investigated our Trust’s compliance with national guidelines on providing at-risk patients with written information on the signs and symptoms of MSCC. Following a period of educational intervention we re-audited our practice.
All Oncology doctors and Specialist Nurses at the Royal Free Hospital were completed an online survey on their knowledge of national guidelines and their clinical practice. We delivered an educational intervention (including formal teaching and presentation at Departmental meetings, case discussions and providing patient information leaflets to clinicians) and re-audited our practice after 3 months.
There were 29 and 20 respondents to the baseline and repeat surveys respectively. 57% vs 84% reported being moderately or very familiar with the MSCC guidelines; 32% vs 47% reported knowing where the information leaflets were kept; 3% vs 15% reported providing written information on MSCC to at risk patients at least every month. (baseline and repeat surveys, respectively)
There was a consensus amongst the clinicians that patients with spinal metastases should be considered at “highest risk”, and verbal information about the risks of MSCC was most commonly given to this group. There was a 42% increase in the proportion of respondents who provided written information on the risk of MSCC to patients with spinal metastases (19 vs 61%) following the intervention.
1) Provision of written patient information leaflets, formal education sessions and case discussions with clinicians resulted in increased knowledge of guidelines on MSCC at 3 months, and positive changes in clinical practice. 2) There was a significant increase in the provision of written information to the highest risk patient groups (19 to 61%). 3) By increasing patient awareness, we can increase the proportion of early self-presentations and diagnosis. This will lead to prompt intervention and improvement of neurological outcomes.
Clinical trial identification
Legal entity responsible for the study
Oncology Department, Royal Free Hospital NHS Foundation Trust
All authors have declared no conflicts of interest.