Living with and beyond cancer: The improvement story so far - NHS ...

18 | Living with and beyond cancer: The improvement story so far
Clatterbridge Centre for Oncology
Moving forward (or initially backwards!): setting up a
successful education programme for patients living with
and beyond pelvic cancer
Summary
Clatterbridge Centre for Oncology has
an average of 50 patients treated on
each accelerator every day and over
7,000 new patients registered at the
hospital each year. In the delivery of
services, the Trust works alongside
other hospital trusts within the
Merseyside and Cheshire Cancer
network, both as part of a joint multidisciplinary
team approach to treatment
of patients and in the provision of outpatient
and day care services within
those trusts.
The aim of the project was to educate
patients in a ‘Moving Forward’ group to
live with and beyond cancer. We
completed a baseline case note audit to
establish if patients who have had
treatment for pelvic cancers (colorectal,
prostate and gynaecological) identify
common post treatment side effects
during their medical review in the late
effects clinic. The aim was to establish
the prevalence and management of
symptoms and identify existing primary
care services to which patients are
referred.
Patients were invited to attend the
‘Moving Forward’ group and to
complete a Sheffield Profile for
Assessment and Referral for Care
(SPARC) Holistic Needs Assessment
(HNA) to ascertain whether our
baseline case note data correlated with
patients’ identified needs. This
information then formulated the
content of the sessions and provided
evidence of need.
The problem
The programme was aimed at preempting
some of the problems that
patients regularly encounter living with
and beyond cancer which are identified
at the late effects clinic. We conducted
a baseline case note audit for 45
patients (15 gynaecological, 15
prostate, 15 colorectal) looking for
documented post treatment side effects
e.g. sexual health issues, bowel and
bladder problems, to see whether there
was any documented care plan or
evidence of onward referral to
appropriate agencies. The audit
confirmed the results from the Picker
baseline survey where patients
indicated that they had concerns about
late effects and would have liked more
information regarding these and where
to access help and advice.
What was done
• The baseline audit set the educational
agenda to address the common post
treatment side effects for the first
programme. 67 patients were
invited, 15 phoned to confirm
attendance and returned a
completed SPARC before the course
commenced. Some minor alterations
i.e. dietetic advice were added
following collation of the data from
the returned SPARCs
• During this first session some
signposting was done for identified
level 3 needs as defined in the SPARC
tool i.e. a patient that feels that in
the past month they have been
distressed or bothered by the
problem ‘very much’
• Interestingly, some patients who
declined to attend still sent back the
SPARC and their identified needs
mirrored those of the group
participants. 67 patients invited, 21
attended, six of whom turned up
having not responded but brought
SPARC with them, five returned
completed SPARCs but couldn’t
attend the sessions.
What difference has this testing
work identified
Positives
• Patient needs identified from the
baseline audit and SPARC
assessments showed the same types
of emotional and information issues
being raised
• SPARC responses identified post
treatment side effects e.g.
psychological issues, fatigue, exercise,
getting back to work
• The casenote audit and completed
SPARCs revealed that there were no
consistent onward referrals. This has
resulted in greater awareness within
the Clatterbridge team and clear
onward referrals pathways and
robust partnership working
• Effective cross boundary working and
sharing of expertise.
Negatives
• If additional needs are identified after
the agenda has been set, timescales
can make it difficult to access other
Allied Health Professionals for their
input
• When SPARC is completed
anonymously only general
signposting for further support
services could be done as part of a
group session. A robust policy for the
use of SPARC in this setting is
essential.