Download Living With and Beyond Cancer and Recovery Package

Living With and Beyond Cancer
and Recovery Package
Session 2
Purpose of session
1. Promote wider understanding of Recovery
Package
2. Overview of the elements of Recovery
Package and wider issues in relation to
Living with and Beyond Cancer
The NCSI defined four priorities
1. Recovery package
2. Redesigning follow-up
3. Physical activity
4. Consequences of treatment
What do you think are the benefits of HNA
for:
• People affected by cancer
• Health Care Professionals
• Health Care organisation
Discuss and feedback
Benefits for PABC undertaking HNA
• Provides the opportunity to identify any needs or
concerns they may have
• Person centred i.e enables issues and concerns to be
identified that might not otherwise be addressed in a
HCP led assessment
• Relieves anxiety
Benefits for HCP
• Consistent and structured approach
• Provides a framework so needs are identified from a
PABC perspective( often can be unexpected) e.g
family concerns, work and finance
Benefits for organisation
• Improved patient survey results
• Amalgamation of data can support service
development
• Consistent framework for HNA and Supportive care
Planning
• Recognises the importance of HCP role in supporting
effective HNA and supportive care planning
Quality of care
‘Failing to plan is planning to
fail’ (Earle, 2006)
Why care plan...
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Refocusing on what is important
Regard for patients viewpoint
Ability to prioritise concerns
Individualised care
Patient centred care
Self management
Quality care
Why care plan...
‘Care plan identified as core
component in
survivorship individualised
Holistic Needs Assessments’
(McCabe, 2013)
Assessment alone is not enough
‘ Triage, Referral, Evidence base,
Individualised care, Promote self
management, Recognition of
recurrence, Recognition of
consequences of treatment,
treatment of distress and common
problems’ (Carlson, 2013)
)
Additional Data
Think about what more you can record:
• Unplanned admissions
• Telephone calls
• Crisis management
Which assessment tool?
E.G:
• Concerns check list
• SPARC (Sheffield Profile for Assessment Referral and
Care)
• Distress thermometer
• PCI Patient Concerns Inventory
• PEPSI COLA
Domains of care
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Lifestyle
Physical
Practical
Psychological
Social
Spiritual
What are some of the challenges of introducing
and sustaining HNA and care planning? What are
the potential solutions? Discuss.
What skills do HCP require to undertake effective
supportive care planning? Discuss.
Skills required
You may have identified the following:
• Knowledge of where and how to signpost
• Maintaining safe/effective environment
• Effective communication skills
• Effective time management
• Appropriate clinical knowledge e.g consequences of
treatment
• Motivational interviewing skills to support effective self
management
How do you feel that effective HNA and care
planning has improved your care of people
affected by cancer?
How can HNA and care planning help to
inform health and wellbeing events and
treatment summaries? Discuss and
feedback.
Holistic Needs
Assessment and
Care Planning Film
74 sites (as at end June 2015)
15,945 assessments
12, 252 care plans
•
•Worry, fear or anxiety
•Tired/exhausted or fatigue
•Sleep problems/nightmares
• Pain
• Eating or appetite
eHNA user quotes
What are Health and Wellbeing Events?
•They are education and information events to enable
people living with cancer and their families to take control
and participate in their recovery, giving them necessary
information, and promoting positive lifestyle change.
• Health and Wellbeing Clinics are designed to help
people get support that improves the quality of their lives,
making these as long, healthy and active as possible.
Types of Health and Wellbeing Events
•Generic
•Tumour specific
•Part of Stratification of the Pathway
What are the benefits of Health and
Wellbeing Events for people living with
cancer, their families/carers and the
organisation? Discuss.
How can a Health and Wellbeing Event
benefit PABC and their families?
Evidence from pilots in 2010-2011 has shown that
patients who attended a Health and Wellbeing Clinic
event had:
•Better knowledge of the signs and symptoms of cancer
recurrence and consequences of treatment.
•More confidence to question or challenge information
and make informed decisions about their health.
Benefits to PABC and their families
(continued)
•More confidence to deal with the physical discomfort and
emotional distress associated with cancer and its treatment
from interfering with their everyday life.
•A strong sense of reassurance- even if they don’t need
services at that time, they know what’s available and how to
access it in the future.
How can a HWBE benefit my practice and
organisation?
Help provide better patient outcomes, reduce unplanned
admissions helping meet quality agenda by:
•Providing an effective atmosphere for delivering health
and wellbeing messages in an informal and relaxed
setting.
•Empowering patients by providing knowledge and
boosting confidence, leading to earlier intervention and
improved outcomes.
Health and Well Being Event
Video
•Post-treatment with GP assessment and care planning
•Financial impact of cancer
•Patient awareness of prescription
exemptions
•Possible late effects of cancer and
treatment
•Information needs in primary care
•Referring to other support as
needed
Challenges and Benefits of implementing
the Recovery Package in secondary care
Abigail Orchard
Lead cancer nurse/Advanced
nurse practitioner, Dorset
County Hospital
November 2011.
Overview Dorset County Hospital
• Dorset County Hospital Foundation Trust is the main
provider of acute hospital services to a large rural
population of 230,000 living within Weymouth and
Portland, West Dorset, North Dorset and Purbeck.
• We have above the national average number of older
people.
• We provide diagnostic and treatment interventions for
the majority of cancers, with less common cancers being
treated in other regional hospitals.
Recovery package – why?
• As a trust involved in the national cancer survivorship
initiative, developing a model based on the recovery
package model was essential to enable appropriate
support to patients.
• This was a key driver, however, rather than focus just on
patients being managed as part of the survivorship
initiative, we opened it up to all patient groups.
Benefits of (electronic) holistic needs
assessments
• Patient
– Rates the problems
– Highlights concerns in
a timely fashion
– Promotes discussion
about emotive issues
– They feel listened
to/cared for
– Centres the care
around the patient as
directed by patient
– Increased sense of
control/empowerment
• Staff
– Identifies patient
concerns
– Often different than
perceived by staff
– Informs
discussion/consultatio
n
– Promotes efficiency
and productivity of
consultation
– Repeated HNA allows
comparison
Challenges of (electronic) holistic needs
assessments
• Logistical issues relating
to process/embedding in
practice
• When to do it- which key
points of the cancer
journey
• Frequency of HNA
• Felt by CNS’s not to be
appropriate at diagnosis
• Never the right time!
• Never enough time!
• Seen as something else
• Who gives the EHNA to the
patient/ instructs/ helps
them?
• Where to do it - privacy
• When to go through HNA
results with patient?
• Paper v electronic
• Postage costs
• Patients forgetting to return
/refusing to complete
• Sharing HNA with MDT
• Storage of results – where?
Benefits of care planning
• Owned by the patient/ empowers /promotes self
management
• Allows tailored information/support to be given on
management of concerns
• Signposting to relevant groups/services
• Care plan can be shared with other health care
professionals to promote continuity of care
• Reduces ad hoc calls regarding concerns
Challenges of care planning
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Making time to write it
Keeping it up to date
How often?
Logistics of doing it with the patient/sharing it with the
patient
• Making it individualised
• Without “my care plan”, very labour intensive
• How to improve discussion of difficult topics – sexual
health
Benefits of treatment summary
• GP and patient have a succinct record of cancer
diagnosis and treatment to date.
• Written in language suitable for patient and GP –
remember GP is not a cancer expert!
• Helps ensure consistent information is given to patient
by both GP and cancer clinicians. Reduces risk of
conflicting advice.
• Highlights signs of cancer recurrence as well as short
and long term side effects.
• Provides information on how to quickly refer back to
hospital in event of recurrence.
Challenges of treatment summary
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Agreeing the content of the document
Getting buy-in from all staff involved
When in the pathway? How often?
How and when does it get triggered?
Who produces it?
Making time within established workplan
Paper/electronic
Big bang or stepped approach to implementation
Patient and GP experience of summary
Benefits of health and wellbeing events
• Delivered by experts in a comfortable, supportive
environment.
• Allows up to 20 patients to be “educated” at one time so
efficient methodology.
• Reassuring to patient to be able to bring family or friend
along.
• Covers core subjects areas – exercise, diet,
psychological health, complementary therapy, finance
and benefits advice. Enables all cancer sites to be
managed in one session – more efficient
Challenges of health and wellbeing events
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Getting the format right to suit the majority
When in the cancer pathway?
How to contact/inform/invite patients
How to promote the service
Funding the service
Where to hold it – on site or off site?
Getting buy-in from staff
How to measure success?
Non-site specific, generic sessions – they do not cover
site specific issues – e.g. lymphoedema for breast
cancer, incontinence for urology
Overcoming the challenges
• Engage with patients and
family/friends
• Engage with staff
• Good leadership - vital
• Be realistic about
implementation – how,
when, who, where.
• Pilot in right team!
• Sell the idea of benefits to
staff and patients
• Funding opportunities
• Work with outside
agencies/voluntary
sector/existing cancer
services staff
• Evaluate – audit/patient
experience
• Keep the momentum up –
keep on key agenda’s
• Challenge current
practice and be brave to
make change!
Commissioning /Funding Experience
• Collaborate with CCG so they know what is being
delivered.
• The sessions must be recognised as a way of reducing
traditional follow-up and so be funded properly.
• Macmillan provided grant to help cover set up costs.
• The set up and running costs can actually be minimal
with good planning and use of existing
resources/voluntary help/local experts.