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Gynaecological Oncology Patient Pathway Cecile Bergzoll Gynaecological Oncologist Wellington Gynaecological Oncology Patient Journey Symptom Tests Diagnosis Tests Review tests results Treatment TTT Plan F/U Gynaecological Oncology treatment resources Surgery Radiation oncology (external) Hawke's Bay Wlgtn HB/Wellington PN Wellington PN/HB HB Tairawhiti Wlgtn HB/Wellington PN Wellington PN/HB 0 Taranaki Wlgtn T/Wellington PN Wellington PN/T 0 Midcentral Wlgtn PN/Wellington PN Wellington PN PN? Wanganui Wlgtn PN/Wellington PN Wellington PN/W 0 Wairarapa Wlgtn Wellington Wellington Wellington Wellington Wellington Hutt Wlgtn Hutt/Wellington Wellington Wellington Wellington Wellington Capital Wlgtn Wellington Wellington Wellington Wellington Wellington DHB of origin MDT Radiation Gynaeoncology Medical oncology oncologist F/U (brachytherapy) Standards agreed Clusters 1.Timely access to services Symptom Tests Diagnosis Tests Review tests results Treatment TTT Plan 28-31 days 14 days 62 days F/U 2.Investigations, staging and diagnosis • Pathology review: structured/synoptic report ? GOAL = < 31 days 2.Investigations, staging and diagnosis • Investigations guidelines: – What test for what patient ? – Get an a timely answer – Regional/National guidelines – Web based tool ? • Radiology protocols review 3.Multidisciplinary care • MDM current issues – Time= 60 to 80 min max 17-19 patients – Triage and referral – Specialist resources attending the MDM: • nb of members • Job sizing – Video conference technology – Partnership with PN – Up to 20% cases deferred = why ? 4. Provision of Gynae cancer treatment 4. Provision of Gynae cancer treatment Gynaecological oncology centres (National Standards document definition) – specialist surgery by a gynaecological oncologist (vulva, ovary, cervix) – hosting the regional multidisciplinary team (MDT) – convening and coordinate multi-disciplinary conferences (MDMs), and ensuring all women in the region have timely access to the MDM – referring patients whose surgical treatment can be appropriately provided at local level back to their local surgeon – providing consultation & liaison services to secondary and sub regional centres – ensuring regional information flows and patient pathways are in place and understood by key stakeholders – Staffing, Fellow position 4. Provision of Gynae cancer treatment • Why centralize care ? Bristow, JCO, 2002 4. Provision of Gynae Cancer treatment Gynaecological oncology units (National Standards document definition) – Providing timely, comprehensive information and referral to the regional multidisciplinary conference (MDM) – Providing 24/7 local gynaecology assessment and treatment services, including surgical treatment of cancers by appropriately credentialed surgeons on advice from the MDM – Providing consultation & liaison services to primary care providers – Ensuring local information flows and patient pathways are in place and understood by key stakeholders. 5.Communication and coordination of care e-referrals Cancer nurses “% of women with gynaecological cancer that receive contact with their care coordinator or CNS within 2/52 of receipt of their diagnosis” “The lead clinicians in gynaecological oncology units and gynaecological oncology tertiary centres should develop a structure for liaison to ensure seamless care coordination “ 6. Supportive care • Ministry of Health travel Policy – Equity – Information – Nurse coordination • Access to extended allied health services • Lymphedema services • OT/dietitian/wound care/social services 7. Follow up, Recurrence and survivorship • National/Regional policies – Location – Frequency – Tests • Survivorship program / low risk patients • Recurrences discussed at MDT – Inclusion in trials – Radical surgery offer 8. Palliative care • Women are offered early access to palliative care services when there are complex symptom control issues or when curative treatment cannot be offered or is declined 9. Clinical performance, monitoring, research • Participation in international trials informs centres as to what is considered international best practice and enables patients and clinicians to access promising new management strategies • Gynaecological cancer centres should have a process for auditing and reporting outcome data – 0.2 FTE datamanager – Access database non updated = registering tool of NHI lists – A national minimum dataset should be agreed upon and a system of outcome reporting agreed and implemented • National discussion for MDM/Database Information System • Conclusion • Working together is the key connectivity standardisation and equity • Availability of current resources sustainability ? New tools ? More staff ? • National Standard Service Provision Audit – Begin implementing ? Working group in CCN Thank you for your attention