Download Overview of roles as tumour stream nurses

Cancer Clinical Nurse
Specialist experience of
clinical pathways.
Cheryl MacDonald.
Clinical Nurse Specialist – Lead: Breast Care
Maria Stapleton.
Clinical Nurse Specialist – Lead:
Gastrointestinal Cancer Care
MidCentral District Health Board
Palmerston North
New Zealand
The Cancer Continuum
Ours roles were set up to cover the
whole continuum of care
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Prevention
Early detection and cancer screening
Diagnosis and treatment
Support and rehabilitation
Palliative care
Research
Surveillance
The New Zealand Cancer Control Strategy 2002
Faster Cancer Treatment
The new cancer coordination roles are to assist
the achievement of the faster cancer treatment times
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62 day indicator: all patients referred urgently with a highsuspicion of cancer receive their first treatment (or other
management) within 62 days of the referral being received by
the hospital.
14 day indicator: all patients referred urgently with a highsuspicion of cancer have their first specialist assessment within
14 days of the referral being received by the hospital.
31 day indicator: all patients with a confirmed diagnosis of
cancer receive their first cancer treatment (or other
management) within 31 days of a decision-to-treat.
Roles and responsibilities
Both roles
 Advanced nursing roles.
 Single point of contact to support patients and
their families to facilitate their journey through
the cancer continuum-patient focused at all
times.
 Works within evidence based and best practice
guidelines.
 Works collaboratively and in partnership within
the multi-disciplinary framework.
 Works within the Treaty of Waitangi principles.
 Enhances consistency and continuity of care /
managing the ‘systems’.
The complexity of the cancer journey
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For many - first time engagement with the
secondary health system.
Waiting to hear about appointments can be
stressful – the unknown is even worse
Health is compromised, loss of sleep/
weight/appetite.
Multiple appointments, often on different days
and times.
Financial burden, time off work for both person
with cancer and support person/persons, travel
costs.
Concern at how the family will react and cope.
The complexity of the cancer journey
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Impending threat of change to body image.
Psychological stress of cancer diagnosis, and the
uncertainties it brings.
Complex medical terms and abbreviations.
Information overload – often given verbally.
Multiple clinicians and differing roles.
Multiple hand outs and instructions.
Clinical Nurse Specialist - Cancer Care
‘Know how’ about the about health care and
hospital systems is important to family/whanau,
this has to do with getting the best treatment
and service from these systems.
(Waitemata District Health Board, Colorectal
Cancer Service Improvement Project, December
2006).
Clinical Nurse Specialist - Cancer Care
“What we do”
 The Clinical Nurse Specialist role facilitates the
smooth transition, in a timely and informed
manner, through the multiple services available
across the continuum of care.
 These nursing services give the person with
cancer and their family/whanau the opportunity
to liaise with one person during what an intense
and life changing experience.
Clinical Nurse Specialist
Surgical Services
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Clinical Nurse Specialist - Cancer Care
“What we do”
The Clinical Nurse Specialists roles are multi faceted
and involve being
 Consultants
 Counselors/ Listeners
 Clinicians
 Teachers
 Mediators / Advocates
 Administrators
 Agents of change
as they journey with the patient and their
family/whanau across the continuum linking closely
with other health care providers as required.
Colorectal Cancer Nursing Service – Patient Pathway
Rectal Cancer
Referred with suspected Rectal cancer
for investigation / surgical clinic / colonoscopy
Diagnosis of rectal cancer
CNS Assessment:
For psychosocial support/nutrition/bowel management
Surgery
CNS – Colorectal Cancer Care
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Co – morbidities – referrals tracked/expedited
Pre –admission advice and support – discharge
planning commenced.
Counselling/education for stoma management (if
required)
Single point of contact / emotional support to
patient family /whanau
Preparation for next stage of treatment
Liaise with allied health / carers: eg GP/District
nurses/ Dietitan/ Iwi/and PHO Cancer
Coordinators
Chemotherapy
CNS – Colorectal Cancer Care
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Fortnightly
MDT meeting
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General
CNS – Colorectal Cancer Care
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Assessment of understanding of
alternative treatment options
Options for genetic referral and
testing.
Ongoing assessment for support
and information
Ensure histology report discussed and
referral made and received by Oncologist.
Understanding of treatment options and
side effects.
Verbal & written information on treatment
and side effects
Ongoing psychosocial support and
information
Preparation for next stage of treatment
Radiotherapy
CNS – Colorectal Cancer Care
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Follow up
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Surveillance plan is in place and
understood.
Ongoing assessment for bowel
management and support as required
Ongoing assessment of psychological state
Ongoing assessment of social support
Ongoing support and information
Survivorship Issues
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Assessment of understanding of treatment
option – dual therapy.
Written and verbal information of treatment,
side effects and treatment timing
Ongoing support and information
Breast Care Nursing Service – Patient Pathway
Early Breast Cancer
Referred with suspected Breast cancer
for investigation / Triple assessment
Diagnosis of early breast cancer
Surgery
CNS – Breast Care
Chemotherapy
CNS – Breast Care
Pre op advice and support
Post op wound care advice
Exercises & lymphoedema prevention advice
Prosthetic support
Emotional support
Preparation for next stage of treatment
Liason with other carers: Iwi and PHO Cancer
Coordinators
Fortnightly
MDT meeting
Assessment of understanding of treatment
options
Verbal & written information on treatment
and side effects
Ongoing psychosocial support and
information
Preparation for next stage of treatment
Radiotherapy
CNS – Breast Care
Endocrine Therapy
CNS – Breast Care
Assessment of understanding of
treatment option
Written and verbal information of
treatment, side effects and treatment
timing
Ongoing support and information
Assessment of understanding of
treatment option and duration of use
Written and verbal information on
treatment and side effects
Ongoing support and information
Follow up
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Ongoing assessment of psychological state
Ongoing assessment of social support
 Ongoing support and information
 Survivorship Issues
Clinical Nurse Specialist - Cancer Care
The benefits
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Improve patient outcomes so that the
patient/family/whanau feel informed of and
receives the appropriate care within the Faster
Cancer Treatment times.
Improve use of recommended treatment,
including increased referral to appropriate
services and patient/family/whanau engagement
with these processes.
Improve communication between providers and
build trusting relationships.
Identify and initiate change within ‘the system’
A familiar face who is able to coordinate and
walk alongside the patient and their
family/whanau, particularly throughout their
different treatment modalities, as required
Case Study.
Colorectal cancer.
Maria Stapleton
Assessment – Mrs A
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65 year old female.
Adenocarcinoma of rectum T3N2M1
Smoker for 45 years
Previous hysterectomy, bilateral oophorectomy, previous
appendicectomy. No other significant medical history
Supportive but distressed husband.
Both retired on the pension.
2 children, caregivers for 14 year old twin grandsons.
Live 50 minutes away from hospital.
Husband does not drive, Mrs. A driver for family.
Weight loss 10kgs in last 4 months.
Finds sitting painful.
Frequent loose motions.
Planning and implementation
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Introduction of Clinical Nurse Specialist role
Surgical appointment – plan for stent insertion.
CT Scan / MRI / Blood tests - arranged to be on
same day - reason for explained
MDM referral - explained
Dietitan referral – arranged to see that day
Social worker referral – with follow phone call
Transport assistance – Cancer society
Quit smoking
Continence products arranged.
Cancer Oncology Psychologist information,
distress assessment completed and referral made
for both patient and husband.
Planning and implementation
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OT referral for roho cushion.
Discussion of likely plan of care and time frames, questions
answered.
Folder of information supplied containing.
– Cancer society pamphlets
– Cancer society “Bowel Cancer” booklet
– Colorectal Cancer Nurse coordinator in formation and
contact details.
– Central Cancer Network.
– Notebook and pen for taking notes.
Discussion of likely formation of Stoma, written
information, DVD package supplied.
Letter to GP.
Follow up phone call with in 48hours.
Ongoing monitoring and tracking to ensure appointments
are made and Mrs A is able to attend.
Evaluation
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Rectal stent inserted.
MDM meeting
Neo-adjuvant long course chemo radiotherapy.
Cancer society drivers used daily for 5 weeks during chemo.
Roho cushion, dietary supplements.
Cancer psychologists support in place for family.
Social worker support in place.
Surgery formation of permanent stoma.
Education and management of colostomy.
Adjuvant chemo therapy completed.
Hepatic surgery in Auckland coordinated and completed.
Evaluation
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Journey took just over 12 months and involved
59 appointments at MCH.
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Mrs. A, husband and grandsons all quit smoking!
The Cancer Nurse coordination role
was pivotal to the successful access to
timely treatment
Thank you
Questions