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

More documents

Recommendations

Info

26 | Living with and beyond cancer: The improvement story so far Guy’s and St Thomas’ NHS Foundation Trust Surviving cancer living life – a nurse led telephone service for breast and prostate cancer survivors Pfizer Health Solutions Guy’s and St Thomas’ NHS Foundation Trust NHS Summary Surviving Cancer Living Life (SCLL) is a telephone based support service launched by Guy’s and St Thomas’ NHS Foundation Trust (GSTT) in May 2008. This pilot service is offered to people who have recently finished active treatment (surgery, radiotherapy, chemotherapy) for breast or prostate cancer, that received any part of their treatment at these hospitals. SCLL is run by the Trust in partnership with Pfizer Health Solutions (PHS), financially supported by Guy’s and St Thomas’ Charity. By May 2010 over 570 breast and prostate cancer patients have used the service and it has been extremely well received. Two experienced cancer nurses referred to as care managers give personalised telephone-based support. This holistic service uses the concepts of motivational interviewing and health coaching to help people to: • Better understand factors that affect their health • Build confidence and skills to cope with, and overcome, the anxiety of living life after cancer • Acquire the skills, knowledge and habits in order to remain fit and healthy • Follow their treatment programmes correctly • Understand how to engage with, and use, local NHS, social and voluntary services more effectively. Following an initial assessment, the patient and the care manager identify priorities and and develop an individual care plan, focusing on the areas of greatest need. Telephone calls are planned, usually starting fortnightly, before moving to monthly. Patients usually access the service for between six and nine months. The problem • The steering group, formed in the autumn of 2007, consisted of staff from GSTT, PHS and King’s College London (KCL), identified a lack of support for cancer survivors • PHS had already developed a telephone-based support service for people with chronic conditions such as COPD and were interested in developing the model to include cancer patients • It was decided to pilot this telephonebased support service with breast and prostate cancer patients as they are a large patient group of both sexes. What was done Project Scoping In October 2007 the two main parties GSTT and PHS agreed to pilot a telephone service, with Kings College London to evaluate the service. Contracts were signed off. Development phase December 2007 – May 2008 • Steering group set up with representatives from all organisations and the project plan signed off • Evaluation meetings, project working group meetings and meetings with various stakeholders also took place regularly during the development phase • Barriers and challenges at this point included recruiting the care managers (band 7 oncology nurses) and integrating the Trust IT system and a new PHS software system to record patient’s details and care plans • The care managers five week training programme included motivational interviewing, advanced communications, detailed sessions on the role of the care manager and IT system training
Living with and beyond cancer: The improvement story so far | 27 • Development of the documentation for care managers including letters, information prescriptions and patient care books to be sent to patients offered the service. Implementation phase • The service went live with the first patient enrolled on 27 May 2008 as planned • The initial few weeks were chaotic with staff, IT and all the referral processes to and from the service having to work together. Meetings with stakeholders ironed out issues as they arose. Clinical model review • We are currently extending the service to include all Breast cancer patients treated at Kings College Hospital • The service was originally openended lasting as long as the patients needed it. In the review it was decided to implement a six to nine months time-limited service benefitting patients in setting the expectation of the service from the beginning and allowing care managers to structure their care planning accordingly • Care managers became stricter with patients who were unavailable for their planned calls reminding them of the importance of keeping appointments and to reschedule if needed. Levels of unsuccessful calls have since improved • GSTT’s health psychologist reviewed the documentation used and gave advice about ways to improve the uptake of black and minority ethnic groups • The care books are now printed in A5 following feedback from patients and half the original size A4 • Ongoing service evaluation was initiated in Aug 2009. The questionnaire from KCL has been slightly amended. Care managers send these to patients when they first signup and when they ‘graduate’ from the service at approximately six to nine month with a satisfaction survey • Referral into SCLL service: Implementation of ‘End of Treatment Consultations’. Since March 2010 these consultations have been offered to patients that have completed their active treatment in hospital. The SCLL service is one of the follow up support services offered to patients • Monthly meetings between the breast clinical nurse specialists and the care managers have been established. What difference has the testing work made or identified • The service is being evaluated by KCL and PHS to determine the impact on patients’ quality of life, psychosocial and informational unmet needs, their return to work, utilisation of healthcare services and the acceptability of a telephone-based support service • The results from the initial qualitative research were extremely positive and patients felt the service answered a deep felt need for support at a time when they felt particularly vulnerable • The service has helped patients to understand their illness and its treatment better, to improve their morale and face life with new confidence, often to adopt necessary changes in lifestyle and in some cases to develop better relationships with their families and increase their personal confidence when dealing with other health professionals. Learning so far • The private and public collaboration between Guy’s and St Thomas’ and Pfizer Health Solutions has worked well • Earlier and more extensive clinical engagement with breast and prostate cancer teams would have been beneficial in integrating the service with the existing pathway • The SCLL service is not suitable or necessary for all patients and suggests a more tailored approach based on needs may be more appropriate • Enthusiastic steering group members have helped maintain the momentum for the project. Next steps • In the immediate future we are working on how best to integrate Surviving Cancer, Living Life with mainstream cancer services to ensure effective working relationships and maximize potential to enhance patient care following treatment • Quantitative results from the evaluation should be available autumn 2010 • The follow up pathway for breast cancer patients at GSTT has recently been revised, reducing follow up appointments over five years from nine to six visits. Further work to incorporate a supported self management model is being explored • Financial evaluation of the service will take place summer 2010. Contact Jannike Nordlund Project Manager Jannike.nordlund@gstt.nhs.uk
Page 1 and 2: CANCER NHS NHS Improvement DIAGNOST
Page 3 and 4: Living with and beyond cancer: The
Page 23 and 24: How are clients referred to a Villa
Page 25: Living with and beyond cancer: The
Page 60: CANCER DIAGNOSTICS HEART LUNG STROK

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

Create successful ePaper yourself

Delete template?

Save as template?