Transcript Slide 1

Linking Initiatives which Support
the Patient Experience
Noëline Young
National Cancer Survivorship Initiative
Assessment and Care Planning
Workstream
The vision is to provide answers to
the questions that patients ask
“So what exactly has been done to me?”
“What happens next?”
“Why am I having these appointments?”
“How will this medical / emotional /
financial / practical / spiritual issue be
addressed?”
NCSI Assessment and Care Planning
Workstream
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Assessment and Care Planning
Treatment Record Summary
Cancer Care Review
Transition from Treatment to Follow- up Care
Treatment Record
Summary
Cancer Care
Review
End of Treatment
Risk Assessment
GP
Assessment
and Care
Planning
Individualised
Care
Assessment and Care Planning
Survivorship
• Survivorship can be a sad, lonely and scary
place for people affected by cancer
• But it does not have to be like that
• By learning how to improve the quality of care
survivors receive and communicating more
effectively, patients can be focused, supported
and motivated to become more self caring
Why Assess Patients Needs?
• Patients that currently have a routine followup have reported that their needs are not
being met
• Resources are being wasted by providing
services that are not fit for purpose
• Assessing patients will mean that patients
needs are addressed and resources are used
appropriately
Why Assess Patients Needs?
“I feel like my whole life has been
thrown up into the air,
chopped in a million pieces
and is now on the floor in front of me.
How do I make sense of this?
Where do I start?”
Jane Rankin (2008)
Assessment Process
Self Assessment
Contact Assessment
Specialist MDT Assessment
Specialist Assessment
Why a Care Plan?
“Cancer patients who feel comfortable
communicating with their health care
providers report greater satisfaction with their
care, a stronger sense of confidence in their
abilities to cope with cancer and a better
quality of life than patients who were less
positive about their communication skills”
Michael Feuerstein (2006)
Treatment Record Summary
• Copy of the treatment record summary to be
forwarded to the GP and given to the patient
• Provided by the consultant and/or by
extracting information from the Assessment
and Care Plan
Cancer Care Review
• GPs play a pivotal role in providing care in the
community
• Cancer Care Review is carried out by the GP at
6 months following diagnosis
• This enables the GP to identify the needs of the
patient and their family
• Able to offer information, advice and support.
• QOF points attached to this review
By assessing, care planning
and communicating with
people living with and
beyond cancer we are
identifying individual needs
and planning for the future
whatever their prognosis,
faith, gender, sexual
orientation, age or disability
Health and Wellbeing Clinics
The Story So Far !
Jane Rudge and Fay Scullion
Joint Project Managers - HWBC
9TH March 2010
Background
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What have patients told us
Vision and concept
Volunteers complimenting professionals
Lets focus on living
Part of a bigger picture
• So lets go for it!
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Process so far
• UK wide expressions of interest
– timescales
– shortlists
– Site visits
• Final test sites
• Learn and share events
• Evaluation
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What’s in a name?
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Vocational Rehabilitation
Project
Lyn Bruce – VR Project Manager
Introduction
• How the VR project developed
• Key purpose of the VR project
• - to identify a model of VR that can be
adopted nationally
• Method – to fund pilot sites to test the model
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Four level model of Vocational
Rehabilitation
• Case management
approach
LEVEL 4
Specialist VR services
• Employer involvement
• Four values
LEVEL 3
Self Management programmes
LEVEL 2
121 & signposting
LEVEL 1
Info & support
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Project timelines
January
February
March
April
May
March 2011
May 2011
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- Fifteen proposals received
- Ten proposals shortlisted
- Seven orgs complete case of need
- ITT for project evaluation sent out
- Pilots start
- Evaluation starts
- Pilots end
- Evaluation completes
Some key features of pilots
Employer
Partnerships
CMP foundations
VR Project
Upskilling existing
staff
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Workplace
assessments
Learn &
Share
Learn &
Share
Formative
&
Summative
Evaluation
Learn &
Share
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Learn &
Share
National Cancer Survivorship
Initiative
Supported Self-Management
Workstream
Lynn Batehup
Nicola Davies
Self-Management workstream
9th March, 2010
Self-Management and Cancer
• Having an active role in managing a long-term condition can
empower people to act for themselves – increase their confidence in
their ability to manage problems associated with their condition
(Coulter and Ellins, 2006)
• People generally manage problems associated with their cancer and
its treatment as part of their daily lives, and may want to have an
active role in tackling them.
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Self-Management and Cancer
• “People have different dispositions, supports and resources,
resulting in individual differences in recovery and
restoration of health and well-being, self-management
activity, and the need for self-management support.”
Foster et al. (2009)
Self-management of problems experienced following
primary cancer treatment: an exploratory study.
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Components of Cancer Survivor Self-Management
(Foster et al 2009)
Problems After
Cancer Treatment
Effects of treatment
Sources of Self
Management
Support
Abandonment
Healthcare workers
Lack of information
Families & friends
Lack of support
Accessing information
Emotional difficulties
Networking with other
cancer survivors
Social/relationship
difficulties
Work & finance
Physical/functional
changes
Organised support
External
Resources
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Self Management
Strategies
Psychological problems:
Altered outlook/priorities
Managing emotions
Self resourcefulness
Social problems:
Proactive socialising
Sharing experience
Resisting contact
Managing work/finance
Physical problems:
Simple strategies
Complex strategies
Personal
Resources
Problem
Resolution
LIVE WELL
AFTER
CANCER
Support for Self-Management – what is the Evidence? –
Fundamental Culture Change
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A relationship with health professionals which is based on partnership is
fundamental – both patient and professional are experts from their different
perspectives.(Powell et al 2009; Epstein & Street 2007)
Evidence – Who Benefits?
Personalised
assessment and
care plan (Yates et
al ongoing; Ruland
et al 2007)
Risk stratification
– ‘high risk’ groups
(e.g. Comorbidities; ethnic
minorities)
Tailored
information that
enhances
knowledge –
health
literacy(Jordan&O
sborne 2006)
A partnership
relationship with
their health
professionals
which enables self
management
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Evidence of Benefits
Self-management programmes
which target specific
problems/symptoms, and for
specific cancer types (Cockle-Hearne
and Faithful, 2009; May et al., 2009)
Self-management programmes supporting
adjustment to survivorship:
Based on assessment of need and risk:
- Low support and low self-efficacy
- Lack of preparedness(Stanton et al., 2007)
- Health literacy
Evidence of
some benefit
Having to undertake challenging
lifestyle behaviour change –
obesity; physical activity; smoking
cessation; as part of patienttriggered aftercare
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Referral to organised cancer support
groups – sharing and learning from
the experience of other cancer
survivors
Evidence - What Works?
What Works?
Evidence
Clinician training for supporting self-management during the consultation.
Coulter and Ellins,
2007; Powell et al
2009; Epstein&Street
2007)
‘Intensive’ adjustment-focused self-management programmes targeted at
‘high risk’ survivors.
Cockle-Hearn and
Faithful, 2010).
Design of programmes should include:
-information provision
-instruction
-modelling
-personal goal setting
-practice
-self-monitoring
-reporting back
-goal review
- CBT techniques
- consider length
(Abraham and
Gardner, 2009)
Coulter & Ellins 2007
Lifestyle behaviour change requires ongoing support and coaching.
Coulter & Ellins,
2007;Korstjens 200
Self-help resources such as video/DVDs can be effective/cost-effective if
designed to incorporate self-efficacy
(Mandelblatt et al.,
2008)
Self-management interventions can have cost advantages over conventional
care.
(Mandelblatt et al.,
2008)
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Health care as individual as you
East Surrey CareCall is a service
designed to help you manage your health.
Set up in response to local patient views, CareCall
is a free service offering you:• Your own personal Health Coach who is a specially
trained Registered Nurse.
• Information about health issues that are important
to you.
• Better control of your own healthcare.
• The opportunity to discuss treatment plans and
options.
CareCall works along side your GP practice and
other community services – it does not replace your
contact with them.
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CareCall is part of Surrey Primary Care Trust
How do I access the Service?
Participation in CareCall is your
choice. You can call a Health
Coach between the hours of 7am
and 11pm Monday to Friday and
on Saturday 9am to 1pm through
a freephone number 0800 028
4207.
Outcomes: what are the important ones?
Patient
Clinician
Commissioners
Policy
Personalised care
Patient in partnership
communication skills.
Meeting national
targets.
Establishment of
patient-centred care.
Improved healthcare
utilisation - reduction
in missed
appointments.
Service improvement.
-quality
Reduced costs of
treatment.
Cost-effectiveness.
Secondary
prevention.
Health literacy
Self-efficacy to selfmanage.
Self-management
skills development.
More clinic time.
Earlier diagnosis.
Reduced symptom
burden.
Improved quality of
life.
Satisfaction with
service.
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Multidisciplinary
team work.
Improvements in
cancer care to match
those established in
the best European
countries.