Transcript Slide 1

Transforming Cancer Follow Up Programme
Mrs Mary Jo Thompson
Nurse Consultant , Public Health Agency / NICaN
Mrs Rosey Whittle
Breast Care Nurse, South Eastern HSCT
NIPEC Annual Conference
Professional Standards Enhancing Person-Centred Care
The cancer landscape is changing
• 11,000+ patient
diagnosed with cancer
every year
• 69,000+ people living
with a diagnosis of
cancer (diagnosed up to
18 years previously)
• Issues with current
system
• Patient report unmet
needs 40%
Approach
Macmillan offer of
funding
CMO involvement
Professional
Workshop 2010
Patient / Carer
Workshop 2009
Ministerial approval
CE Regional
Board
Director of
Commissioning
TCFU
Programme Lead
Programme aims to.....
• Improve the patient experience and health &
well being
• Make best use of available resources
• Enhance coordination and integration across
boundaries
National Cancer Survivorship Initiative
Breast patient survey n=250
Prostate patient survey n=247
Evaluation pre-programme
• Patients they received the medical support they
needed 82.6% 82.3%
• Patients felt less supported with
–
–
–
–
Physical impact of cancer 59.2% 47.6%
Emotional impact of cancer 44.3% 34.0%
Practical impact of cancer 40.0% 29.9%
Financial impact of cancer 29.5% 17.3%
• Felt supported to make lifestyle changes to
maximise health & well-being (31.3 % 32.6%)
Breast - Self directed aftercare
programme
• Review mammography
• Equipping the patient
to self manage
– Holistic needs
assessment
– Health & wellbeing
events &
– End of treatment
summary record
– Rapid access point
– Survivorship services to
support health & well
being
Prostate Follow-up programme
• 6 regional nurse led follow-up pathways agreed
• Varying degrees of implementation across
Trusts
• Implementation of recovery package
– Health and wellbeing events
– Holistic needs assessment
• Survivorship services to support health & wellbeing
Early wins
• Survivorship website
www.survviorship.cancerni.net
• Health & wellbeing
events
www.survivorship.cancerni.net
Calendar of events
Challenging change process
Change methodologies & tools
SERVICE
IMPROVEMENT
Process Mapping,
Analysis, Redesign,
Measurement for
improvement, PDSA,
Sustainability &
Spread, Involving
patients
PRACTICE
DEVELOPMENT
Shared Vision,
Creativity, Values &
Beliefs, Facilitation,
Person Centredness,
Culture & Context,
Claims Concerns Issues,
Clinical Leadership
LEAN
METHODOLOGY
A3 Project
Planning,
Transformational
Maps, Value
Stream Mapping
etc
Reflecting on the human
dimensions of change
• IT processes (time factors),
• Project plans (realistic
deliverables ,timeframes),
• Funding (longer term),
• Admin support (crucial at
Trust level),
• Measurement (attention to
detail, be sure what is to be
monitored)
• Energy (project team and
health professionals),
• Emotions (understanding
the context and local
relationships),
• Commitment (driver for
change – commissioner
/clinical need, evidence
repository)
You can’t impose anything on anyone and expect them to be committed to it
Edgar Schein
Achievements Breast
• Review mammography implemented for all patients on SDA
pathway
– Timely mammograms, results to patients in timely manner
– Plan to rollout to all Trust
• Rapid access
– Confidence in re-entering system, appt within 2 weeks if required
• Full implementation of the recovery package
– Health and wellbeing events, holistic needs assessment, treatment
summary records
Achievements Breast
• 41% on New SDA pathway (1,095 End Aug 2014
• 30% reduction (1023 dual specialty follow-up)
• 25% reduction (2374) in waiting lists for breast surgical followup across region
• 12% reduction (442) waiting lists for oncology clinics for
breast follow-up
Achievement Prostate
• PSA IT Tracking system
– through Regional Information System for Oncology
and Haematology
– Go live January 2015
• Pre PSA information leaflet
– regionally agreed and available for GPs
Achievement Prostate
• Regional agreement for six nurse led
prostate follow-up pathways
• Implementation of several pathways
across 4 Trusts
• Implementation of recovery package
– holistic needs assessment
– Establishing and provision of health and wellbeing events
Holistic Needs Assessments
Rosey Whittle
Macmillan Breast care Nurse
South Eastern H&SC Trust
NIPEC Annual Conference
Professional Standards Enhancing Person-Centred Care
40% of cancer survivors in Northern Ireland
have been found to have unmet needs following
treatment (Santin 2012).
There is a need to enable people living with and
beyond cancer to have the best possible support
and information to lead as active and normal
lifestyles as possible. (NCSI 2010)
Recovery Package
‘This provides a good
summary of (alert
symptoms & toxicities) in
one letter.’
Breast HNAs - Numbers Completed
Throughout NI utilising this new
approach with concerns checklist
• 800+ completed for new patients on SDA pathway
• 500+ for patients on existing pathways and moved
onto self directed aftercare pathway
SET Audit Results
(Breast, Colorectal, Haematology, Urology)
Main Concerns Identified
Fatigue
42%
Worry, fear or anxiety
Depression
24%
16%
Hot flushes
Insurance & travel
16%
12%
Anger
10%
Housework
Diet & nutrition
8%
6%
Advice & Signposting
Education
• Breast Awareness
• ‘Caring for yourself after Breast Cancer
treatment’ leaflet
– Automated mammography
– Signs & Symptoms
– Rapid access back into system
• Breast Cancer Care Moving Forward Pack
• Copy of Care Plan
Impact of HNA
Help or adapt
Fatigue
Fear
Increase Physical Activity
Depression
100%
80%
75%
75%
Confidence/Information
Effects of Treatment
100%
Signs & Symptoms to look out for 95%
Manage your health
93.3%
‘The CNS and support worker are great listeners,
very understanding and very helpful. I had lost
faith in nursing staff but these two girls
especially the CNS, has got me through some
very rough times.
They are what nursing and caring is all
about.
I wouldn’t be here if it wasn’t for her.’
Conclusion