{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:16:19Z","timestamp":1789992979893,"version":"4.0.1"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rising outpatient demand has accelerated adoption of patient-initiated follow-up in surgical practice. This review evaluated whether patient-initiated follow-up safely reduces clinic burden while maintaining patient outcomes across specialties.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>MEDLINE, Embase, and CENTRAL were searched (2014\u20132025) for studies of patient-initiated follow-up, defined as a model enabling clinically stable patients to self-initiate follow-up when new or concerning symptoms arise, rather than attending prearranged appointments. Primary outcomes included outpatient appointment volume and patient-reported quality of life. Where studies reported single-arm utilization data, a random-effects meta-analysis of proportions was undertaken. Exploratory meta-regression examined pathway-level factors associated with utilization. Randomized clinical trials (RCTs) were assessed using the revised Cochrane risk-of-bias 2 tool, observational cohort studies using the Newcastle\u2013Ottawa Scale, and qualitative studies using the Critical Appraisal Skills Programme checklist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1776 manuscripts identified, 34 studies across 6 surgical specialties (breast, colorectal, otorhinolaryngology, orthopaedics, plastics, and urology) were included: 4 RCTs, 17 observational cohort studies, 11 qualitative studies, and 2 mixed-methods studies. Observational studies consistently reported reductions in routine outpatient attendance\u2014including a reduction from 45\u00b70% to 6\u00b70% in first specialist appointments in patient-initiated follow-up in colorectal surgery (P &amp;lt; 0\u00b7001) and 52\u00b75% of patients with high-risk cutaneous squamous cell carcinoma not recontacting the clinic\u2014without evidence of increased adverse outcomes. RCTs demonstrated non-inferior patient-reported quality-of-life outcomes with patient-initiated versus standard follow-up, alongside reductions in physician contact, including a 50% reduction in planned consultations in breast cancer (1\u00b79 versus 3\u00b78 per patient; P &amp;lt; 0\u00b7001) and a reduction in specialist contacts from 42\u00b70% to 23\u00b70% in rectal cancer. In a meta-analysis (1806 participants), the pooled patient-initiated follow-up utilization proportion was 0\u00b719 (95% confidence interval 0\u00b709 to 0\u00b736; I2 = 95%), indicating substantial context-dependent variation. In oncological settings\u2014particularly breast, colorectal, melanoma, and head and neck cancer\u2014structured surveillance and rapid-access systems were identified as critical safety adjuncts to implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patient-initiated follow-up can reduce outpatient burden in selected surgical populations without compromising patient-reported outcomes; however, its effects are dependent on the clinical context and pathway design. Risk-stratified and hybrid models may be the most appropriate, particularly in oncology. Further high-quality trials and robust economic evaluations are required to define optimal implementation strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag147","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:13:39Z","timestamp":1786101219000},"source":"Crossref","is-referenced-by-count":0,"title":["Patient-initiated follow-up in surgical specialties: meta-analysis and meta-regression"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8004-6716","authenticated-orcid":false,"given":"Renato","family":"Pitesa","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Auckland , Auckland ,","place":["New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Moody","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Middlemore Hospital , Auckland ,","place":["New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8672-6379","authenticated-orcid":false,"given":"Andrew G","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Auckland , Auckland ,","place":["New Zealand"]},{"name":"Department of General Surgery, Middlemore Hospital , Auckland ,","place":["New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"2026092106254792900_zrag147-B1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/VGQD4611","article-title":"Investigating innovations in outpatient services: a mixed-methods rapid evaluation","volume":"12","author":"Sherlaw-Johnson","year":"2024","journal-title":"Health Soc Care Deliv Res"},{"key":"2026092106254792900_zrag147-B2","doi-asserted-by":"crossref","first-page":"255","DOI":"10.7861\/fhj.2021-0150","article-title":"The Royal Berkshire NHS Foundation Trust outpatient services transformation programme to improve quality and effectiveness of patient care","volume":"9","author":"Chan","year":"2022","journal-title":"Future Healthc J"},{"key":"2026092106254792900_zrag147-B3","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1111\/imj.15741","article-title":"Patient-initiated follow up as a means of reducing pressures in secondary care","volume":"52","author":"Chhatwal","year":"2022","journal-title":"Intern Med J"},{"key":"2026092106254792900_zrag147-B4","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD010763.pub2","article-title":"Patient-initiated appointment systems for adults with chronic conditions in secondary care","author":"Whear","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"2026092106254792900_zrag147-B5","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2022.954854","article-title":"Patient initiated follow-up in cancer patients: a systematic review","volume":"12","author":"Newton","year":"2022","journal-title":"Front Oncol"},{"key":"2026092106254792900_zrag147-B6","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijsu.2021.105906","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"88","author":"Page","year":"2021","journal-title":"Int J Surg"},{"key":"2026092106254792900_zrag147-B7","author":"Pitesa"},{"key":"2026092106254792900_zrag147-B8","article-title":"Rob 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"2026092106254792900_zrag147-B9","author":"Wells"},{"key":"2026092106254792900_zrag147-B10","author":"CASP UK"},{"key":"2026092106254792900_zrag147-B11","doi-asserted-by":"crossref","first-page":"S72","DOI":"10.1016\/j.ejso.2014.08.159","article-title":"Open access follow up for breast cancer patients at East Surrey hospital: the way forward for breast cancer care","volume":"40","author":"Chadha","year":"2014","journal-title":"Eur J Surg Oncol"},{"key":"2026092106254792900_zrag147-B12","doi-asserted-by":"crossref","first-page":"S63","DOI":"10.1016\/j.ejso.2015.03.168","article-title":"P129. If patient initiated follow-up and 5-year mammograms are in place, is routine annual follow-up also necessary for breast cancer patients after completing treatment?","volume":"41","author":"Li","year":"2015","journal-title":"Eur J Surg Oncol"},{"key":"2026092106254792900_zrag147-B13","first-page":"2063","article-title":"Follow-up after curative treatment for colorectal cancer: longitudinal evaluation of patient initiated follow-up in the first 12","volume":"25","author":"Batehup","year":"2017","journal-title":"Support Care Cancer"},{"key":"2026092106254792900_zrag147-B14","article-title":"Open access follow-up care for early breast cancer: a randomised controlled quality of life analysis","volume":"26","author":"Kirshbaum","year":"2017","journal-title":"Eur J Cancer Care (Engl)"},{"key":"2026092106254792900_zrag147-B15","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1186\/s12885-019-5561-0","article-title":"Follow-up care after treatment for prostate cancer: evaluation of a supported self-management and remote surveillance programme","volume":"19","author":"Frankland","year":"2019","journal-title":"BMC Cancer"},{"key":"2026092106254792900_zrag147-B16","first-page":"81","article-title":"Patient-led trial without catheter (TWOC)\u2014is it feasible?","volume":"124","author":"Hatem","year":"2019","journal-title":"Br J Urol"},{"key":"2026092106254792900_zrag147-B17","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1080\/0284186X.2019.1581948","article-title":"Differences in baseline characteristics and 1-year psychological factors between participants and non-participants in the randomized, controlled trial regarding patient-led follow-up after rectal cancer (FURCA)","volume":"58","author":"Hovdenak Jakobsen","year":"2019","journal-title":"Acta Oncol"},{"key":"2026092106254792900_zrag147-B18","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.22374\/jeleu.v2i4.69","article-title":"Self-administered intravesical hyaluronic acid improves symptoms and quality of life in a patient-centred approach to bladder pain syndrome management","volume":"2","author":"Kitchen","year":"2019","journal-title":"J Endoluminal Endourol"},{"key":"2026092106254792900_zrag147-B19","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1016\/j.ejso.2020.03.192","article-title":"P153: evaluating patient attitudes to patient-led follow-up following breast cancer","volume":"46","author":"Walder","year":"2020","journal-title":"Eur J Surg Oncol"},{"key":"2026092106254792900_zrag147-B20","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s11764-020-00942-3","article-title":"ePRO-based individual follow-up care for women treated for early breast cancer: impact on service use and workflows","volume":"15","author":"Riis","year":"2021","journal-title":"J Cancer Surviv"},{"key":"2026092106254792900_zrag147-B21","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1080\/0284186X.2021.1950924","article-title":"Patient-led follow-up reduces outpatient doctor visits and improves patient satisfaction. One-year analysis of secondary outcomes in the randomised trial Follow-Up after Rectal CAncer (FURCA)","volume":"60","author":"Jakobsen","year":"2021","journal-title":"Acta Oncol"},{"key":"2026092106254792900_zrag147-B22","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1001\/jamadermatol.2021.4704","article-title":"Assessing the potential for patient-led surveillance after treatment of localized melanoma (MEL-SELF): a pilot randomized clinical trial","volume":"158","author":"Ackermann","year":"2022","journal-title":"JAMA Dermatol"},{"key":"2026092106254792900_zrag147-B23","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1111\/ans.17676","article-title":"Changing the routine: a move to patient initiated follow up to improve surgical outpatient clinic","volume":"92","author":"Balhorn","year":"2022","journal-title":"ANZ J Surg"},{"key":"2026092106254792900_zrag147-B24","article-title":"Experiences of patient-led surveillance, including patient-performed teledermoscopy, in the MEL-SELF pilot randomized controlled trial: qualitative interview study","volume":"5","author":"Drabarek","year":"2022","journal-title":"JMIR Dermatol"},{"key":"2026092106254792900_zrag147-B25","article-title":"Perspectives and experiences of patient-led melanoma surveillance using digital technologies from clinicians involved in the MEL-SELF pilot randomized controlled trial: qualitative interview study","volume":"5","author":"Drabarek","year":"2022","journal-title":"JMIR Dermatol"},{"key":"2026092106254792900_zrag147-B26","doi-asserted-by":"crossref","DOI":"10.1093\/bjs\/znac269.302","article-title":"305\u2014Improving clinic DNA rates with a patient initiated follow up pathway: a cohort study","volume":"109","author":"Katsura","year":"2022","journal-title":"Br J Surg"},{"key":"2026092106254792900_zrag147-B27","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.clon.2021.11.010","article-title":"Clinicians\u2019 views of patient-initiated follow-up in head and neck cancer: a qualitative study to inform the PETNECK2 trial","volume":"34","author":"Lorenc","year":"2022","journal-title":"Clin Oncol"},{"key":"2026092106254792900_zrag147-B28","article-title":"Exploring the views of patients\u2019 and their family about patient-initiated follow-up in head and neck cancer: a mixed methods study","volume":"31","author":"Lorenc","year":"2022","journal-title":"Eur J Cancer Care (Engl)"},{"key":"2026092106254792900_zrag147-B29","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejon.2022.102183","article-title":"Optimising patient-initiated follow-up care\u2014a qualitative analysis of women with breast cancer in the UK","volume":"60","author":"Moore","year":"2022","journal-title":"Eur J Oncol Nurs"},{"key":"2026092106254792900_zrag147-B30","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1302\/0301-620X.104B6.BJJ-2021-1464.R2","article-title":"Virtual management of clinically suspected scaphoid fractures","volume":"104-B","author":"Stirling","year":"2022","journal-title":"Bone Joint J"},{"key":"2026092106254792900_zrag147-B31","doi-asserted-by":"crossref","DOI":"10.2196\/45865","article-title":"Acceptability of a hypothetical reduction in routinely scheduled clinic visits among patients with history of a localized melanoma (MEL-SELF): pilot randomized clinical trial","volume":"6","author":"Drabarek","year":"2023","journal-title":"JMIR Dermatol"},{"key":"2026092106254792900_zrag147-B32","doi-asserted-by":"crossref","DOI":"10.1093\/bjs\/znad258.535","article-title":"1038\u2014Introducing a patient-initiated follow up (PIFU) pathway to a district general hospital\u2019s urology department: a two-cycle quality improvement project following the first 100 patients","volume":"110","author":"Hirniak","year":"2023","journal-title":"Br J Surg"},{"key":"2026092106254792900_zrag147-B33","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1007\/s11764-023-01410-4","article-title":"Quality of life and symptom burden after rectal cancer surgery: a randomised controlled trial comparing patient-led versus standard follow-up","volume":"18","author":"Hovdenak","year":"2024","journal-title":"J Cancer Surviv"},{"key":"2026092106254792900_zrag147-B34","first-page":"570","article-title":"Patients\u2019 experiences of a suppoRted self-manAGeMent pAThway In breast Cancer (PRAGMATIC): quality of life and service use results","volume":"31","author":"Jenkins","year":"2023","journal-title":"Support Care Cancer"},{"key":"2026092106254792900_zrag147-B35","first-page":"658","article-title":"Patients\u2019 views and experiences on the supported self-management\/patient-initiated follow up pathway for breast cancer","volume":"31","author":"Jenkins","year":"2023","journal-title":"Support Care Cancer"},{"key":"2026092106254792900_zrag147-B36","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1080\/0284186X.2023.2199128","article-title":"Are education and cohabitation associated with health-related quality of life and self-management during breast cancer follow-up? A longitudinal study","volume":"62","author":"Karlsen","year":"2023","journal-title":"Acta Oncol"},{"key":"2026092106254792900_zrag147-B37","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1093\/ced\/llae160","article-title":"Patient-initiated follow-up for high-risk cutaneous squamous cell carcinoma: how we do it and 2\u2005years of outcome data","volume":"49","author":"Abdul Gafoor","year":"2024","journal-title":"Clin Exp Dermatol"},{"key":"2026092106254792900_zrag147-B38","article-title":"Early discharge and patient-initiated follow-up in hand surgery: a new norm following simple hand surgery?","volume":"16","author":"Abed","year":"2024","journal-title":"Cureus"},{"key":"2026092106254792900_zrag147-B39","doi-asserted-by":"crossref","DOI":"10.2196\/58136","article-title":"Participant motivators and expectations in the MEL-SELF randomized clinical trial of patient-led surveillance for recurrent melanoma: content analysis of survey responses","volume":"7","author":"Ackermann","year":"2024","journal-title":"JMIR Dermatol"},{"key":"2026092106254792900_zrag147-B40","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1302\/2633-1462.52.BJO-2023-0119.R1","article-title":"Patient-directed follow-up for the clinical scaphoid fracture","volume":"5","author":"Chaturvedi","year":"2024","journal-title":"Bone Jt Open"},{"key":"2026092106254792900_zrag147-B41","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-081655","article-title":"Patient experiences with patient-led, home-based follow-up after curative treatment for colorectal cancer: a qualitative study","volume":"14","author":"Swartjes","year":"2024","journal-title":"BMJ Open"},{"key":"2026092106254792900_zrag147-B42","article-title":"Evaluation of patient-initiated follow-up (PIFU) service in a fracture clinic: a comprehensive service evaluation and patient satisfaction audit","volume":"16","author":"Younis","year":"2024","journal-title":"Cureus"},{"key":"2026092106254792900_zrag147-B43","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s00590-025-04193-9","article-title":"Efficient patient-initiated follow-up after orthopaedic injections","volume":"35","author":"Fan","year":"2025","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"2026092106254792900_zrag147-B44","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1308\/rcsann.2025.0073","article-title":"The impact and utilisation of patient-initiated follow-ups (PIFU) in the elective upper-limb clinic at secondary care","author":"Naskar","year":"2025","journal-title":"Ann R Coll Surg Engl"},{"key":"2026092106254792900_zrag147-B45","doi-asserted-by":"crossref","DOI":"10.2196\/35864","article-title":"Enabling rural telehealth for older adults in underserved rural communities: focus group study","volume":"6","author":"Hunter","year":"2022","journal-title":"JMIR Form Res"},{"key":"2026092106254792900_zrag147-B46","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s13304-021-01132-1","article-title":"The role of telemedicine in the postoperative home monitoring after robotic colo-rectal cancer surgery: a preliminary single center experience","volume":"74","author":"Mancini","year":"2022","journal-title":"Updates Surg"},{"key":"2026092106254792900_zrag147-B47","doi-asserted-by":"crossref","first-page":"16531","DOI":"10.1002\/cam4.6243","article-title":"Systematic review of patients\u2019 and healthcare professionals\u2019 views on patient-initiated follow-up in treated cancer patients","volume":"12","author":"Dretzke","year":"2023","journal-title":"Cancer Med"},{"key":"2026092106254792900_zrag147-B48","doi-asserted-by":"crossref","first-page":"5597","DOI":"10.21873\/anticanres.16067","article-title":"Detection of recurrence after primary treatment for oropharyngeal carcinoma","volume":"42","author":"Landstr\u00f6m","year":"2022","journal-title":"Anticancer Res"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/5\/zrag147\/71276291\/zrag147.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/5\/zrag147\/71276291\/zrag147.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:49:05Z","timestamp":1789991345000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zrag147\/8823617"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":48,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9,4]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zrag147","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,9,4]]},"article-number":"zrag147"}}