Download Enhanced Cancer Recovery Program Rebuilding and Reshaping

Storyboard Entry Form 2014
Main author: Wendy Wilkinson
Email: [email protected]
Telephone: (01792) 530838
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1. Storyboard title: a clear concise title which describes the work
Enhanced Cancer Recovery Program: Rebuilding and Reshaping Lives for People
Affected by Cancer
2. Brief outline of context: where this improvement work was done;
what sort of unit/department; what staff/client groups were involved
Abertawe Bro Morgannwg University Health Board (ABMUHB) is responsible for
Swansea, Neath Port Talbot and Bridgend.
The Macmillan Therapy Team resulted from developmental investment in ABMUHB.
An Occupational Therapist (OT) and Physiotherapist (PT) were recruited in 2008 to
design and implement rehabilitation opportunities for people affected by cancer
(PABC). The team has following investment from ABMUHB and Macmillan.
The Macmillan Therapy Team provides a range of group and individual rehabilitation
sessions to adults affected by cancer. These are delivered to patients on ward 12, as
outpatients, and at leisure centres in Swansea and Bridgend.
3. Brief outline of problem: statement of problem; how you set out to
tackle it; how it affected patient/client care
ABMUHB is responsible for 500,000 people (ABM, 2013). Local incidence of 2000
cancer diagnoses each year is projected. Up to 1000 of these individuals will reach
five year survival. More than 40% of cancers are linked to lifestyle including tobacco,
alcohol, poor diet, being overweight and inactive (CRUK, 2013). Rehabilitation,
promoting a healthy active lifestyle is essential.
The National Cancer Survivorship Initiative (2010) scoped the impact of cancer on
daily life. Their respondents reported:
 Up to 84% with physical difficulties.
 70% experienced fatigue.
 Up to 80% with relationship or sexual dysfunction.
 Despite receiving written information about cancer, 27% wanted more
information regarding physical aspects of living with or beyond cancer.
 50% serious issues related to emotional wellbeing.
 91% of households experienced a loss of income or increase in costs
associated with cancer.
 1.4 times more unemployment than people not affected by cancer.
Cancer patients need rehabilitation because cancer has become a long term
condition, with long term effects including those listed above. Rehabilitation is the
only mechanism by which people with cancer will be able to re-engage in their usual
daily activities, return to work and reduce reliance on social care and benefits.
Rehabilitation is the first step towards building sustainable lifestyle changes, such as
regular physical activity, healthy eating and stress management.
Before 2009 there were no designated cancer rehabilitation services within
ABMUHB. We scoped cancer and non-cancer services, and decided The Macmillan
Therapy Team was perfectly placed to deliver an Enhanced Cancer Recovery
program, a stepping stone between healthcare and sustained engagement in a
healthy active lifestyle.
In addition, we set out to design, implement and evaluate cancer rehabilitation as
recommended by:
 Welsh Government National Cancer Rehabilitation Standards (2010).
 The National Comprehensive Cancer Network’s (2013) eight domains of care,
including informational; practical; physical; emotional; nutritional; financial;
social and spiritual support.
4. Assessment of problem and analysis of its causes: quantified
problem; staff involvement; assessment of the cause of problem;
solutions/changes needed to make improvements
To design a comprehensive rehabilitation program, accessible to people between
diagnosis and end of life care was required within ABMUHB. This program needed
to:
 Meet the eight domains of care,
 Focus on self-management techniques,
 Link with a community network of agencies to support PABC.
We shaped rehabilitation services by:
 Transfer of a long term conditions (LTC) model as seen in cardiac and
pulmonary settings.
 Offering more flexibility.
 Piloting evidence-based interventions.
 Requests from Clinical Nurse Specialist (CNS) for intervention for men with
weight management difficulties due to hormone treatment for prostate
cancer.
 Regularly updates following participant feedback.
These remain core components of the Enhanced Cancer Recovery (ECR) program.
We introduced a Health and Wellbeing Assessment (H&WA), to enable cancer
patients to:
 Set their own rehabilitation agenda,
 Raise daily life concerns not addressed elsewhere,
 Signpost to community/voluntary services for additional support.
 Be at the core of decision making and rehabilitation.
5. Strategy for change: how the proposed change was implemented;
clear client or staff group described; explain how you disseminated the
results of the analysis and plans for change to the groups involved
with/affected by the planned change; include a timetable for change
The Macmillan Therapists scoped rehabilitation services for all adult cancer patients
across ABMUHB, then created:
 Self-referrals from the Chemotherapy Day Unit, accounting for 15% of all
referrals.
 Cancer Rehabilitation at the Swansea University Sports Centre allowing
access to expert professionals for information, initially two block programs
per year, now a rolling program.
 Successful cancer rehabilitation in Bridgend Recreation Centre, increasing
capacity by 100 places annually.
 Hydrotherapy one session per week, now three sessions per week in
response to demand, has increased capacity by 100 places annually.
 Collaboration with National Exercise Referral Scheme (NERS) following pilot
in Macmillan’s Physical Activity Project in 2012/13. This showcased the ECR
model’s potential transferability across Wales.
 Instigation of H&WA to ensure lifestyle factors considered within a network
of support agencies.
To date, the impact of the ECR program has been presented:
 Locally at ABMUHB events and Cancer Rehabilitation Roadshow;
 Regionally via South Wales Cancer Network (SWCN) and Macmillan events;
 Nationally at the College of Occupational Therapy Conference.
6. Measurement of improvement: details of how the effects of the
planned changes were measured
Since 2009:
 5400 people with cancer received specialist assessment and intervention as
part of the Enhanced Cancer recovery program.
 Average inpatient length of stay reduced by 3.7 days.
 89% of participants improved quality of life as measured by the EQ-5D-5L
standardised tool (EuroQol, 2009).
 74% of participants improved physical condition on ‘Timed Up and Go’
(Podsiadlo & Richardson, 1991), a measure of functional balance and
mobility.
 600% increase in rehabilitation sessions provided over five years in Swansea
and Bridgend.
 93% of participants reported ECR schemes met ‘most’ or ‘all’ of their needs.
 Strong referral links with 7/12 tumour site Multidisciplinary Teams (MDTs)
including those responsible for Lung, Breast, Brain, Metastatic Spinal Cord
Compression, Upper Gastro-Intestinal, Urology, and Sarcoma.
7. Effects of changes: statement of the effects of the change; how far
these changes resolve the problem that triggered the work; how this
improved patient/client care; the problems encountered with the process
of changes or with the changes
Now, ECR is responsible for / has contributed towards:
 Patient-reported increased confidence to self-manage long term conditions.
 Patient-reported reduced reliance on primary and social care and
medications including antidepressants.
 Reduction in emergency admissions to the oncology ward.
 Reduction in length of stay on oncology ward from 11.1 to 7.4 days
 Inclusion of rehabilitation in cancer treatment pathways – especially brain
and lung cancers.
Future plans for development and dissemination of results include:
 Additional rehabilitation options in Neath/Port Talbot, collaborating with
community stakeholders.
 Primary Care Protected Time For Learning (PT4L) events in 2014.
 Cancer Rehabilitation Roadshow in Bridgend in February 2014.
 Public information leaflets.
 Consultation with and promotion to tumour site MDTs
8. Lessons learnt: statement of lessons learnt from the work; what
would be done differently next time
The Macmillan Therapists designed the ECR Program:
 Responsive to need
 As recommended by key political and clinical drivers
 Meeting eight domains of care
 Creating cohesive networks between rehabilitation professionals, NERS, and
the voluntary sector
 In collaboration with stakeholders for sustainability
 To transition from health to leisure
 Any time after diagnosis through to meet late onset needs
 65% attendance, transport and conflicting hospital appointments are the two
most common reasons for non-attendance
9. Message for others: statement of the main message you would like
to convey to others, based on the experience described
Services should be responsive to the changing healthcare landscape.
Shared models of care prevent ‘reinvention of the wheel’.
Collaboration offers rounded experiences, and reduces duplication of services.
The NHS Wales Awards are organised by the 1000
Lives Improvement Service in Public Health Wales.
www.1000livesi.wales.nhs.uk