Download Cancer Survivorship The GPs role - Croydon Health Services NHS

Cancer Survivorship
The GPs role
Mike Simmonds
What we will cover:
• How are we doing
• Tools for the job
• How can we do better
Cancer survivors – some evidence
•
Over 40% may have long term effects from the cancer and treatments1
•
Unreported emotional and physical problems1 and poorer health
outcomes
•
Will use GP appointments more than age matched controls2
1-Macmillan Health and Wellbeing of Cancer Survivors Study 2008
2-Armes et al J Clin Oncol. 2009 Dec 20;27(36):6172-9. Epub 2009 Nov 2.Patients' supportive care needs beyond the end of cancer treatment: a
prospective, longitudinal survey.
Treatment Summary and
Cancer reviews
Watson et al 1
- Online survey, 100 oncologists and 200 GPs
- Overall information in Treatment summary is poor
- 50% of Cancer Reviews done opportunistically and only 64% had
any structure
1-Watson et al “Views of Primary Care Physicians and Oncologists on Cancer Follow-up initiatives in primary
care: an on-line survey” Journal of Cancer Survivorship Jun;4(2):159-66. Epub 2010 Feb 25. 2010
Treatment Summary and
Cancer reviews
Adams et al 2
- Most CCRs were done opportunistically
- Patients wanted their diagnosis recognised and provision of general
support
- An active approach and specific appointments might legitimise
discussion of problems
- Both GPs and patients agreed this was a useful thing to do, but could
be improved.
2-Adams et al “Views of cancer care reviews in primary care: a qualitative study” Br J Gen Pract. 2011 April 1; 61(585):
e173–e182.
National Cancer Patient Experience
Survey 2012/13
Care planning:
• Before starting treatment almost half of patients (45%)
were not fully informed about side effects that could
affect them in the future
• Almost four in five (78%) were not offered a written
assessment and care plan
• Around four in 10 (41%) were not given enough support
from health and social services after leaving hospital
National Cancer Patient Experience
Survey 2012/13
Financial support:
• Although significant improvement has been made since
the first survey in 2010, almost half of patients (46%)
who would have liked information about how to get
financial help or any benefits are still not receiving this.
Relational care:
• More than half of patients (58%) said that all doctors and
nurses asked what name they preferred to be called by
Living with and beyond cancer: taking
action to improve outcomes (DH 2013)
47.3% of survivors express a fear of their cancer recurring
40% of prostate cancer survivors report urinary leakage
19% of colorectal cancer patients report difficulty
controlling their bowels
24% of people were offered a written assessment and
care plan (averaged across Trusts)
We know what we want the four million people
living with cancer to say by 2030
National Cancer Survivorship Initiative
Vision (DH 2010)
‘those living with and beyond
cancer are supported to live as
healthy and active a life as
possible for as long as possible’
Living with and beyond cancer: taking
action to improve outcomes (DH 2013)
A framework for survivorship
Information and support from the point of diagnosis
Promoting recovery
Sustaining recovery
Managing the consequences of treatment
Supporting people with active and advanced disease
A new approach to follow-up
Tailored pathway to meet patient needs
Holistic Needs Assessment — at diagnosis and posttreatment
Needs identified and actioned
Written care plans
Treatment Summaries
A new approach to follow-up
Group learning, education and peer support
Lifestyle advice post-treatment
Implementation of remote monitoring systems mean that
many patients will not need to visit the clinic to receive
their results.
Improved access to support and cancer rehabilitation for
those living with the consequences of treatment
The Cancer Care review
QOF Schedule (2013/2014 onwards)
Cancer 3
Good to have this as a QoF measure
..but non-specific and evidence of much variation.
A cancer review consultation checklist
Open questions and invite the patient to list his/her concerns
and questions
Check the patient‘s understanding of aims of treatment
Ask about current physical health and symptoms or side
effects
A cancer review consultation checklist
Assess emotional and psychological state and prompt for
concerns about mood, body image and sexuality
Ask how his/her family, friends and employers have reacted
to their illness
Give information about benefits, prescription exemption,
physical activity opportunities etc.
A cancer review consultation checklist
Is you patient at greater risk of other problems as a result of the cancer or
treatment e.g. osteoporosis
Clarify access in and out of hours
Signpost to other sources of information
EMIS WEB MACMILLAN CANCER CARE REVIEW TEMPLATE
INPS Template
Cancer Care Review Template project results
• GP responses very positive.
•All patient responses very positive (71% v. satisfied)
•Many patients didn't‘t know they were having a ―CCR‖
•Few CCRs involved carers.
Distillation for a better CCR
•
Appointment +/- carer or family.
•
One double appointment
•
One information leaflet / question sheet for patient
•
A structured approach to the CCR (Mac Template
is good!)
Distillation for a better CCR
• A flexible approach to revisiting topics.
• Don‘t forget secondary prevention.
• Consider performing a CCR at all key transitions
(e.g. during treatment, after discharge, recurrence
& palliative phase)
Practice Nurses – a key role?
Macmillan funded project to give Practice Nurses the
knowledge, skills and confidence to extend their role in the
care of people affected by cancer
Uses concept of cancer as a long term condition and builds
on their existing skills
Nurses felt much better equipped to participate in
scheduled CCR and respond opportunistically to patient
concerns
Treatment Summary
Drivers for CCGs
Quality of care
Patient satisfaction
Decreased demand – especially for ‗unscheduled care‘ /
OOH care and A&E attendances
Cost
Avoidance of complaints / criticism
Potential ways forward
Find local champions / allies who can help promote the
Cancer Care review and Treatment Summary
Use summaries of evidence to show room for improvement
Mobilise informed patients on commissioning groups.
Promote role of Practice Nurses and training
Look at balanced set of outcome measures
What do you think makes a good
Cancer Care Review?
How do you carry out a cancer care review?
What do you believe are the key elements?
3. Health and Wellbeing events
Macmillan local
projects
Jam packed
website
Patient Packs
Exercise to
music DVD
Evidence
Reviews
BMJ Learning module – free to all.
National Cancer Survivorship
Initiative Website www.ncsi.org.uk
(Assessment & Care Planning)
Acknowledgements:
Terry Bowley Macmillan GP Advisor
Noeline Young
Project Manager NCSI
Anne Wilkinson National Improvement Lead – Cancer GPA
Group
Nicola Harker MacGP Weston Super Mare
David Plume GPA (Anglia)
Helen Rickard Healthcare Project Officer, Primary &
Community Care Macmillan