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<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
Post operative support<br />
Michael Evans<br />
Macmillan Clinical Nurse<br />
Specialist Thoracic<br />
Oncology<br />
<strong>Royal</strong> Brompton Hospital<br />
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<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
Lung Cancer pathway<br />
Pre op<br />
Peri-operative<br />
Post-operative<br />
Post discharge from service<br />
Survivorship/wellbeing
<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
Accessing support pre-op<br />
Lung CNS available before initial i i hospital appointment<br />
(usually keyworker)<br />
Lung Cancer Journey Nurse (Hammersmith Hospital)<br />
Majority of Lung CNS’ registered with Roy Castle Lung<br />
Cancer Foundation<br />
Advise on what to expect during OPD and investigations<br />
Information Prescriptions/Holistic needs assessment
<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
Peri - operative<br />
– Link on the ward<br />
– Update on procedure and outcome<br />
– Diagnosis – change in prognosis<br />
– Information Prescriptions/Holistic needs assessment<br />
– Family friends<br />
– Financial
<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
Post operative<br />
– Hospital link until routine follow up OPD<br />
– Survivorship clinic<br />
– Holistic needs assessment<br />
– Structured follow up<br />
– Liaison with GP/Community team<br />
– Referral to community support services
<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
Discharge from service<br />
– Offer Holistic i needs assessment<br />
– Plan for where to seek support<br />
– Disease recurrence – fast track back in to the service
<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
Survivorship/Wellbeing<br />
– Local Support groups<br />
Hillingdon hospital<br />
– Cancer support Centres<br />
e.g. Macmillan Information and Support Centre<br />
RMH/C&W<br />
Maggie’s Cancer Caring Centre (Charing X)<br />
Paul’s Cancer Centre (Battersea High Street)<br />
Self Management<br />
Expert patient Courses<br />
New Perspectives (Macmillan)
<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
When to offer holistic assessment<br />
• Around the time of diagnosis<br />
• Commencement of treatment<br />
• Completion of the primary treatment t t plan<br />
• Each new episode of disease recurrence<br />
• <strong>The</strong> point of recognition of incurability<br />
• <strong>The</strong> beginning of end of life<br />
• <strong>The</strong> point at which dying is diagnosed<br />
• At any other time that the patient may request<br />
• At any other time that a professional carer may judge<br />
necessary
<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
What assessment tools are there<br />
– SPARC<br />
– Distress <strong>The</strong>rmometer<br />
– PEPSI COLA
<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
SPARC<br />
– 45 questions<br />
– Rate each symptom<br />
– Can be done prior to consultation<br />
– Aid to self management
<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
Distress thermometer<br />
– Visual scale<br />
– Checklist of problems<br />
– Priority ranking<br />
– Initial consultation to introduce system to patient<br />
– <strong>The</strong>n can be used as a tool for self assessment
<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
Pepsi Cola<br />
– Aide memoire for healthcare staff<br />
– Physical<br />
– Emotional<br />
– Personal<br />
– Social Support<br />
– Information/Communication<br />
– Control<br />
– Out of hours<br />
– Living with your illness<br />
– Aftercare
<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
Information Prescriptions<br />
– Giving i the right patient, the right information i at the<br />
right time in the right way.<br />
– Aim is to tailor information based on the patients<br />
agenda<br />
Usually in conjunction with a Holistic Needs<br />
– Usually in conjunction with a Holistic Needs<br />
assessment
<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
In Summary<br />
– Patients should have easy clearly l defined d access to<br />
their keyworker at all stages of their journey<br />
– Once diagnosis and initial treatment is complete they<br />
should have a structured followed up that includes a<br />
care plan based on their agenda( derived from an<br />
holistic needs assessment)<br />
– On discharge from follow up they should have<br />
On discharge from follow up they should have<br />
another care plan which includes a clear easily<br />
identifiable route back in to the service
<strong>The</strong> <strong>Royal</strong> <strong>Marsden</strong><br />
– http://www.nice.org.uk/CG121 <strong>The</strong> diagnosis and treatment of Lung<br />
Cancer (update of NICE Clinical Guideline 24)<br />
– http://ncat.nhs.uk/sites/default/files/Excellence%20in%20Cancer%20nhs Care.pdf <strong>The</strong> contribution of the clinical nurse specialist<br />
– http://www.macmillan.org.uk/GetInvolved/Campaigns/Survivorship/<br />
Two_million_reasons.aspx Macmillan Survivorship survey<br />
– http://www.ncat.nhs.uk/our-work/living-with-beyond-cancer/holistic-<br />
nhs work/living with cancer/holistic<br />
needs-assessment<br />
– www.nhs.uk/ipg - Information Prescriptions Site<br />
– http://learnzone.macmillan.org.uk/course/view.phpid=252<br />
– Macmillan e-learning
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