Transforming Cancer Follow Up Programme

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Transforming Cancer Follow Up Programme

• Mrs Mary Jo Thompson
• Nurse Consultant , Public Health Agency / NICaN
• Mrs Rosey Whittle
• Breast Care Nurse, South Eastern HSCT

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The cancer landscape is changing

• 11,000 patient diagnosed with cancer every year
• 69,000 people living with a diagnosis of cancer
  (diagnosed up to 18 years previously)
• Issues with current system
• Patient report unmet needs 40

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Approach
Ministerial approval

Macmillan offer of funding
CE Regional Board
CMO involvement
Director of Commissioning
Professional Workshop 2010
TCFU Programme Lead
Patient / Carer Workshop 2009
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Programme aims to.....

• Improve the patient experience and health well
  being
• Make best use of available resources
• Enhance coordination and integration across
  boundaries

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(No Transcript)
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National Cancer Survivorship Initiative
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Evaluation pre-programme
Breast patient survey n250 Prostate patient
survey n247

• Patients they received the medical support they
  needed 82.6 82.3
• Patients felt less supported with
• Physical impact of cancer 59.2 47.6
• Emotional impact of cancer 44.3 34.0
• Practical impact of cancer 40.0 29.9
• Financial impact of cancer 29.5 17.3
• Felt supported to make lifestyle changes to
  maximise health well-being (31.3 32.6)

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Breast - Self directed aftercare programme

• Review mammography
• Equipping the patient to self manage
• Holistic needs assessment
• Health wellbeing events
• End of treatment summary record
• Rapid access point
• Survivorship services to support health well
  being

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Prostate Follow-up programme

• 6 regional nurse led follow-up pathways agreed
• Varying degrees of implementation across Trusts
• Implementation of recovery package
• Health and wellbeing events
• Holistic needs assessment
• Survivorship services to support health
  well-being

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Early wins

• Survivorship website
• www.survviorship.cancerni.net

• Health wellbeing events

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www.survivorship.cancerni.net
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Calendar of events
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Challenging change process
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Change methodologies tools
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Reflecting on the human dimensions of change

• Anatomy -
• IT processes (time factors),
• Project plans (realistic deliverables
  ,timeframes),
• Funding (longer term),
• Admin support (crucial at Trust level),
• Measurement (attention to detail, be sure what is
  to be monitored)

• Physiology -
• Energy (project team and health professionals),
• Emotions (understanding the context and local
  relationships),
• Commitment (driver for change commissioner
  /clinical need, evidence repository)

You cant impose anything on anyone and expect
them to be committed to it
Edgar Schein
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Achievements Breast

• Review mammography implemented for all patients
  on SDA pathway
• Timely mammograms, results to patients in timely
  manner
• Plan to rollout to all Trust
• Rapid access
• Confidence in re-entering system, appt within 2
  weeks if required
• Full implementation of the recovery package
• Health and wellbeing events, holistic needs
  assessment, treatment summary records

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Achievements Breast

• 41 on New SDA pathway (1,095 End Aug 2014
• 30 reduction (1023 dual specialty follow-up)
• 25 reduction (2374) in waiting lists for breast
  surgical follow-up across region
• 12 reduction (442) waiting lists for oncology
  clinics for breast follow-up

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Achievement Prostate

• PSA IT Tracking system
• through Regional Information System for Oncology
  and Haematology
• Go live January 2015
• Pre PSA information leaflet
• regionally agreed and available for GPs

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Achievement Prostate

• Regional agreement for six nurse led prostate
  follow-up pathways
• Implementation of several pathways across 4
  Trusts
• Implementation of recovery package
• holistic needs assessment
• Establishing and provision of health and well-
  being events

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Holistic Needs Assessments

• Rosey Whittle
• Macmillan Breast care Nurse
• South Eastern HSC Trust

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• 40 of cancer survivors in Northern Ireland have
  been found to have unmet needs following
  treatment (Santin 2012).
• There is a need to enable people living with and
  beyond cancer to have the best possible support
  and information to lead as active and normal
  lifestyles as possible. (NCSI 2010)

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Recovery Package
This provides a good summary of (alert symptoms
toxicities) in one letter.
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(No Transcript)
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Breast HNAs - Numbers Completed

• Throughout NI utilising this new approach with
  concerns checklist
• 800 completed for new patients on SDA pathway
• 500 for patients on existing pathways and moved
  onto self directed aftercare pathway

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SET Audit Results(Breast, Colorectal,
Haematology, Urology)
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Main Concerns Identified Main Concerns Identified
Fatigue 42
Worry, fear or anxiety 24
Depression 16
Hot flushes 16
Insurance travel 12
Anger 10
Housework 8
Diet nutrition 6
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Advice Signposting
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Education

• Breast Awareness
• Caring for yourself after Breast Cancer
  treatment leaflet
• Automated mammography
• Signs Symptoms
• Rapid access back into system
• Breast Cancer Care Moving Forward Pack
• Copy of Care Plan

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Impact of HNA
Help or adapt
Fatigue 100
Fear 80
Increase Physical Activity 75
Depression 75
Confidence/Information
Effects of Treatment 100
Signs Symptoms to look out for 95
Manage your health 93.3
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• The CNS and support worker are great listeners,
  very understanding and very helpful. I had lost
  faith in nursing staff but these two girls
  especially the CNS, has got me through some very
  rough times.
• They are what nursing and caring is all about.
• I wouldnt be here if it wasnt for her.

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Conclusion