SurvivorshipMoving forward project

Veronica Allinson MSc BSc (Hons)RGN

YCN Project lead.Medipex finalist 2012

Moving on project

Survivorship How we changed our service How to manage service changes Results

Survivorship

Macmillan estimate that :

About 2 million people are survivors of cancer. 1:10 people over 65 Are living with a cancer

diagnosis

Need to do something else for follow-up !

Questions… Looked at the value of a clinic

appointments: To monitor for local recurrence, Manage the late effects of treatment Provide information, support and reassurance

for patients. Many patients are willing to take responsibility

for seeking medical attention in the event of symptoms arising (Gulliford et al 1997)

Replace clinics with what?…

What is the problem with clinics? What do patients ask us? What is available now?..BCC courses What can we provide ?

Moving on project

BCC course as baseline Four week educational programme Covering all areas that our patients question Developed pilot study Continuous assessment / evaluations

Audit

69% response rate

84% attended all the course

94% found course beneficial

We liked: Being in a group and hearing from other women.

Also being lead by very well trained facilitators and nice refreshments.

I liked being with other ladies who had been through similar treatments and the speakers who came especially the exercise and diet, plus the Lymphoedema advice.

Very informative and as the breast nurses and experts made the session very revealing. Getting to know other people in the group.

I enjoyed all of it more than I thought I would have done.

I did not like: I would liked the course sessions to be longer.

I enjoyed all the course but at times I found it too involved and a little frightening.

The first part where we did not need to be reminded.

Nothing I found everything refreshing and very helpful

Diet for healthy living

How do you feel now?

N/A6%

NR6%

Satisfied8%

Very Anxious4%

Quite Happy29%

Very Happy31%

A little anxious16%

Who have you contacted?

Breast Care Nurses 16Prosthetic/Bra Services 14GP 12Breast Clinic 8Reconstruction Services 6Genetics Service 5Breast Cancer Care 4The Haven (Leeds) 4Lymphoedema Services 1

Conclusions:

The majority (84%) attended every session on the course. Reasons for the 15% that did not attend were ‘being unwell’.

94% (48) of patients found the course beneficial. In relation to what the patient’s liked most about

the content of the course, the most common themes were – reassurance; sharing experiences and meeting people who have gone through similar experiences.

Conclusions: In relation, to what patients liked the least about the

course content, the most common themes were – Talking about the diagnosis and treatment; diet and healthy living talks; relaxation and psychological skills talk was rushed.

Majority of patients were ‘very happy’ with the fact they have not been required to attend any hospital breast care appointments a year after attending the course.

Majority (69%) of patients have contacted their breast care nurse during the past year for things such as – test results to information about particular concerns they had.

In conclusion

Service was better quality Patients were satisfied No extra calls or appointments Award winning! Transferrable to other specialities

How you can do it ..

Identify the drivers for the project :

a) Survivorship issues and self management policies as suggested by DOH.

b) Providing excellent quality service provisionc) To many patients , to little clinic timed) No proven benefit to follow-up clinicse) Supported by the YCNf) Money savings?

How does it fit within your organisations?

A) Follow-up policiesb) Nurse-led initiatives

Who is supporting the project?

CNS support MD team support Managers support Commissioners support

Leadership:

Project manager on site required to co ordinate project

Key members required: business manager, general manager, contracting

dept. representative, CNS

Supporting documents:

Any available audits of clinic satisfaction Service Specification Patient Pathway Staff/costings: table Template/ chart of processes timetabling

Programme development

Developing the programme. The follow-up programme running at CRH/HRI has been well evaluated.

Our research is based on our programme format so any great deviations from this would not be research based.

Admin support

Recording attendees and DNA’s . Sending out joining information. Patients do not always turn up at the course

and will need to be chased with key information if they are not having hospital appointments.

Volunteers, can support the programme

Other considerations

Venue Speakers

March 2014

May 2014

July 2014

2014 comments

The course was well run and staff were approachable and informative.

The speakers were confident and reassuring. I took away lots of positives, enabling me to move forward and I enjoyed meeting all the other participants.

2014 audit comments 100% of participants strongly agreed they

were satisfied with the quality of the course

All sessions were very useful and interesting. It was lovely to meet people with the same experiences. Excellent course!’

93% of participants felt the course fully met their needs and expectations. 7% felt it met their needs in part.

Conclusion Changing service provision is acceptable if

everyone is in collaboration

Patients accept what you tell them if it is valuable and an acceptable alternative, for you and them.

Having a bad day …

But I think I got away with it……….