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

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28 | Living with and beyond cancer: The improvement story so far Three Counties Cancer Network (3CCN) - Herefordshire ‘Life After the Prostate’ group education programme for stable prostate cancer patients Summary Herefordshire is one of the three counties within the 3 Counties Cancer Network (with Gloucestershire and Worcestershire). This rural county has a population of 180,000 people served by Hereford County Hospital. The urology service at the hospital currently sees approximately 200 new cases of prostate cancer each year. An information course consisting of four sessions in a group setting was developed to replace the ongoing yearly clinical follow up for stable patients and ongoing monitoring of PSA at GP surgeries. The issues Members of the clinical urology team believed that some patients with stable prostate cancer were receiving ongoing yearly follow up at the hospital when a ‘non-medical’ intervention may have been more appropriate. It was also felt that some patients were discharged without being fully informed on topics that were of concern to them, and unaware of what, if anything, would ‘happen next’. Current prostate cancer follow up pathway - Herefordshire Timeline Diagnostic treatment pathway Follow up pathway begins Surgical treatment completed Radiotx treatment completed Hormone responsive 6 weeks 6 months Urology follow up with doctor Oncology follow up with doctor /CNS At any point along these pathways, patients with unstable PSA/SI return for reassessment 6 monthly follow up with CNS 6 monthly follow up with CNS 6 monthly follow up with CNS 3 years 5 years Ad infinitum Long-term monitoring plan Long-term monitoring plan Proposed prostate cancer follow up pathway - Herefordshire Timeline NEW PATHWAY Follow up pathway begins CURRENT PATHWAY 6 weeks 6 months Annual community follow up with GP (PSA tested) 6 month Annual 3 years 5 years Ad infinitum What was done • Project steering group was set up in Hereford in April 2009 including representation from users • A half day process mapping event to map out the current patient pathway for patients with stable prostate cancer and design an altered pathway that reflected the proposed change in follow up provision with the introduction of the Life After Prostate information programme Diagnostic treatment pathway Surgical treatment completed Radiotx treatment completed Hormone responsive Urology follow up with doctor Oncology follow up with doctor /CNS Assessment for group programme Assessment for group programme At any point along these pathways, patients with unstable PSA/SI return for reassessment Group programme Current pathway Group programme Current pathway 6 monthly follow up with CNS Group programme (4 weekly sessions) 6 monthly follow up with CNS Long-term monitoring plan 6 month follow up Group sessions Annual community follow up with GP (PSA tested) 6 month Annual
Living with and beyond cancer: The improvement story so far | 29 • Seven Key Performance Indicators (KPI’s), and evaluation methods were agreed across the 3CCN. These were: patient experience, distress, perceived control, financial impact, information needs, quality of life and patient numbers • An outcome questionnaire was developed to evaluate against the KPI’s • Development of a four week group programme containing sessions on clinical, emotional and practical issues which particularly affect those with prostate cancer, delivered by a clinical psychologist, urology clinical nurse specialist and physiotherapist in a community setting. • Information leaflets disseminated widely, to encourage awareness of the group programme and selfreferrals • A referral pathway was set up and patients were referred from the two urology clinical nurse specialists’ clinics at the County Hospital to the project coordinator • Patient holistic assessments were made using the distress thermometer (D/T) by the project coordinator in a community setting to support recruitment to the programme. Course components • Clinical overview of prostate cancer • Physical and psychological impact of prostate cancer on individuals • Exercise and pelvic floor exercises • Fatigue and energy management • Healthy eating • Distress, motivation and relaxation techniques • Pattern for life What difference has the testing work made From January to May 2010, three Life After Prostate groups were held. Eighteen patients attended the groups from a total of 42 referrals. This attendance rate of over 40% (from referral to attendance) was very encouraging when compared with other group programmes nationally. There were 12 completed pre and postgroup outcome questionnaires returned. The questionnaire data revealed: • Lower anxiety and depression scores following attendance at the group programme • No change in perceived control over condition following attendance • No change in quality of life following attendance. Other notable findings from the course: • Patients described how the course came at a time when they were ready for more information ‘On the whole I thought the course was well organised and very informative’ • Some had lived with the diagnosis and after-effects of treatment for a considerable time and had come to terms with certain issues, so felt that they were now in a position to ask more suitable questions • Self-reported understanding of prostate cancer and treatment increased and patients felt that they had more opportunity to ask questions in an open and less timelimited atmosphere than at a formal follow up: ’This course has helped tremendously in enabling me to understand the side effects of radiotherapy and I am very grateful for the chance to attend’ • However, there have been difficulties in getting specialists on board to deliver the programme • Some patients also reported difficulty in completing the outcome questionnaire because of confusion over pre-existing medical conditions (e.g. diabetes) • All of the participants in the second group said they would be interested in forming a support group in the future. Learning so far • Attendance rates at the groups have been exceptionally high (91.66%) with 17 of the 18 men completing the programme. This suggests that the men valued the course but also that there is a real need for this kind of group education programme • Both the staff delivering the programme and patients have recognised how difficult it is for the patients to make fundamental and lasting changes in their lives and how important it is that this should be communicated in the groups • Use of a 3-D anatomical model of the pelvis has been invaluable for group members in being able to understand the prostate in relation to the rest of the body and has also helped the staff deliver their teaching effectively • The financial section has been regarded as the weakest section of the programme by patients but has been seen as beneficial in increasing awareness about where to seek correct information if it were needed
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