Cancer Reform Strategy - NHS Cancer Screening Programmes

76 CANCER REFORM STRATEGY5.32 Commissioners will want to work withproviders to ensure they have robustsystems in place to ensure that patientsexperience good continuity of care.These include:●●●●●Full assessment of an individual patient’sneeds at key stages in the care pathway andthe development of formal care plans suchas for diagnosis; end of treatment; relapse;and as end of life approaches;Care plans should be communicated to allteams / professionals involved in the patient’scare in a timely way;Systems to enable the rapid and securetransfer of information around the system;Rapid communication between sectors at thetime of key events (such as informing a GPof a patient’s diagnosis or of their deathwithin 24 hours of the event); andEnhancing the role of community teams inthe management of cancer patients, as hasbeen done in the Integrated Cancer CareProgramme, through the appointment ofcare trackers and through enhancing theskills of community nurses.Psychological support5.33 Cancer patients and their families andcarers may need psychological care and support.This can be as important as any other aspect oftheir treatment. Good psychological supportservices should be in place to support patientsfrom the point of diagnosis and as they movealong the patient pathway and progress theircancer journey.5.34 There are four key levels of psychologicalsupport:●●Level 1: Effective information giving,compassionate communication and generalpsychological support;Level 2: Psychological interventions, such asanxiety management, problem solving;●●Level 3: Counselling, theoretically drivenpsychological interventions, such as cognitivebehavioural therapy and solution focusedtherapy; andLevel 4: Specialist psychological andpsychiatric interventions.5.35 Providing support for patients experiencingdistress is a key component of the role of theCNS. Yet delivering this effectively will requireappropriate training and support.Commissioners should work collaboratively toensure that this is available.5.36 It is important for all service providers tohave established pathways to enable patients toaccess specialist level three and four support asand when they need it. Commissioners will needto ensure that adequate provision is available sothat all patients, families and carers can accessthe appropriate psychological support for them.This will include establishing service levelagreements with local mental health services formore advanced support.Supportive and palliative care5.37 As discussed earlier in this chapter,implementing NICE guidance will significantlyimprove the quality of supportive and palliativecare available to patients.5.38 The systematic reviews undertaken for thedevelopment of the NICE guidance revealedstrengths and weaknesses in the worldwideevidence base related to supportive andpalliative care. Research into patients’ needs hasbeen quite strong, but research into how bestto meet those needs is lacking. As a result,NCRI set up two supportive and palliative carecollaboratives, based around consortia ofmedical schools, hospitals and hospices. Fivemillion pounds over five years of capacitybuildinggrants has been allocated to thesecollaboratives and work began in 2006. The aimof the collaboratives is to develop the researchinfrastructure capacity for supportive andpalliative care and through this leverage furtherresearch funding leading to the development ofnew, evidence based interventions.