title: Impact of a dedicated cancer-associated thrombosis service on clinical outcomes: a mixed-methods evaluation of a clinical improvement exercise.
abstract: Cancer-associated thrombosis (CAT) complex condition, which may present to any healthcare professional and at any point during the cancer journey. As such, patients may be managed by a number of specialties, resulting in inconsistent practice and suboptimal care. We describe the development of a dedicated CAT service and its evaluation.
  
  
  
  Specialist cancer centre, district general hospital and primary care.
  
  
  
  Patients with CAT and their referring clinicians.
  
  
  
  A cross specialty team developed a dedicated CAT service , including clear referral pathways, consistent access to medicines, patient's information and a specialist clinic.
  
  
  
  The service was evaluated using a mixed-methods evaluation , including audits of clinical practice, clinical outcomes, staff surveys and qualitative interviewing of patients and healthcare professionals.
  
  
  
  Data from 457 consecutive referrals over an 18-month period were evaluated. The CAT service has led to an 88% increase in safe and consistent community prescribing of low-molecular-weight heparin, with improved access to specialist advice and information. Patients reported improved understanding of their condition, enabling better self-management as well as better access to support and information. Referring clinicians reported better care standards for their patients with improved access to expertise and appropriate management.
  
  
  
  A dedicated CAT service improves overall standards of care and is viewed positively by patients and clinicians alike. Further health economic evaluation would enhance the case for establishing this as the standard model of care.
authors.affiliation: Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Noble
authors.affiliation: Velindre Cancer Centre, Cardiff, UK.
authors.forename: Nikki
authors.initials: N
authors.lastname: Pease
authors.affiliation: Trinity College, Dublin, Ireland.
authors.forename: Jessica
authors.initials: J
authors.lastname: Sui
authors.affiliation: Marie Curie Hospice, Penarth, UK.
authors.forename: James
authors.initials: J
authors.lastname: Davies
authors.affiliation: Department of Haematology, Neville Hall Hospital, Abergavenny, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lewis
authors.affiliation: Velindre Cancer Centre, Cardiff, UK.
authors.forename: Usman
authors.initials: U
authors.lastname: Malik
authors.affiliation: Haemophilia and Thrombosis Centre, University Hospital of Wales, Cardiff, UK.
authors.forename: Raza
authors.initials: R
authors.lastname: Alikhan
authors.affiliation: Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK.
authors.forename: Hayley
authors.initials: H
authors.lastname: Prout
authors.affiliation: Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK.
authors.forename: Annmarie
authors.initials: A
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D001290:Attitude; D001291:Attitude of Health Personnel; D005260:Female; D006296:Health Services; D006297:Health Services Accessibility; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010348:Patient Care Team; D017060:Patient Satisfaction; D011320:Primary Health Care; D058996:Quality Improvement; D012017:Referral and Consultation; D012648:Self Care; D013038:Specialization; D011795:Surveys and Questionnaires; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D006493:Heparin
keywords: cancer associated thrombosis; mixed methods; patient journey; quality of life; service improvement