Endocrine Abstracts

Background: DSD services are evolving across the UK in response to both family, professional and societal pressures but MDT provision and access to specialist DSD services varies. In November 2017, DSD Clinical Standards were published by the BSPED Clinical Committee with the aim to improve and standardise DSD patient care and these were audited in March 2019. 95% of DSD centres responded with 85% listing psychology as part of their MDT.

Aim: 1. To understand in greater depth the current profile of DSD MDTs in the UK, recognise scope for service development and share best practice

2. Review current psychological service in DSD and establish key needs for provision

Method: All clinical leads of DSD MDTs across the UK were invited to participate in a semi-structured telephone interview. This interview targeted the areas of MDT structure, geography and population, referral processes and psychological provision.

Results: Initial results show a wide variety in the structure of the MDT across the UK with a ‘functioning’ MDT taking many forms. The current standards do not distinguish between core members of the MDT vs wider peripheral input, raising questions about whether physical attendance at MDT provides superior service for DSD patients. There is variable provision of integrated psychological care within DSD MDTs. Some tertiary centres are unable to include routine psychological assessment and intervention. Some services have a referral path for arm’s length psychological consultation. Others have a psychologist present and contributing to MDT clinical reviews but with inadequate provision for direct psychological work with parents and children. Few have the resource to involve expert psychological care as part of the acute assessment and diagnostic phase. Many clinicians listed psychology as the most ‘needed’ improvement to their service. There has been innovative use of extended services such as genetic counsellors and patient support groups as alternative sources of psychological support but clinicians do not feel these provide the full range of formal psychological services required for patient needs. Further exploration of what constitutes minimum effective psychological care within a specialist DSD multi-professional service is needed.