Abstract: PD42-11
Sources of Funding: Cancer Center Without Walls

Introduction

Urology workforce shortages in rural areas limit access to surveillance cystoscopy for patients with bladder cancer. With expansion of the role of urologic allied health professionals (AHP), we developed a tele-cystoscopy model in which AHPs perform cystoscopies that are interpreted and directed in real-time by board-certified urologists at a remote location. The conceptual model is comprised of three pillars: 1) development of the technical infrastructure, 2) creation of AHP cystoscopy training curriculum and skill assessment, and 3) evaluating outcomes. The purpose of this phase of the study was to assess the learning curve for an AHP and patient satisfaction with a tele-cystoscopy program.

Methods

Our prior work evaluated eight combinations of equipment variables - cystoscope type, compressor-decompressor (codec) version, and wireless internet speed to determine the optimal clarity. Crowd sourcing and experts agreed on the best system. Our training program includes background reading, hands-on-training, and proficiency testing. A diagnostic cystoscopy checklist was modified from gynecology literature to determine proficiency; a score of 27/35 to demonstrates competence. Patient satisfaction was measured with the Client Satisfaction Questionnaire (CSQ-8). A score of 32 indicates the highest satisfaction with care.

Results

We trained one nurse practitioner to perform flexible cystoscopy and quantitatively captured improvement in her competency with increasing number of cystoscopy performed using the scored diagnostic cystoscopy checklist (Figure 1). We found that 30 cystoscopies appear to be necessary to attain minimal competence but regular repetition is necessary to maintain the skill. Eighteen patients have completed the CSQ-8. Patients were almost universally satisfied with a mean score of 31/32 (std. dev. 1.09).

Conclusions

We have operationalized the technical infrastructure for tele-cystoscopy and demonstrated the ability to train an AHP. The high satisfaction rates suggest that tele-cystoscopy is a feasible model to project urologic manpower to underserved areas.

Funding

Cancer Center Without Walls