Colorectal Remote Follow Up Cassandra Garner Colorectal Support Worker Tuesday 20 th March 2018
Progress to date Go Live November 2016 126 patients recruited, 110 currently active Dedicated Support Worker Monthly Workshops Weekly Virtual Clinics Success wouldn t have been possible without support from clinical teams, IT, Information Governance & Finance whole organisation buy-in
The role of the Support Worker Support and encourage self-management and to promote health and wellbeing Signpost to other support and tertiary services First point of contact - knowing someone is available is paramount to confident selfmanagement Track and co-ordinate surveillance investigations to ensure patients adhere to their follow up protocol Promote and facilitate Health MOTs and HNAs Arrange and partake in weekly virtual clinics, updating patient tracker, recording HNA and any other cancer information on complimentary hospital administration systems i.e. Somerset Cancer Register (SCR) Facilitate patient education workshops and contribute to health and wellbeing events Work as part of an MDT to identify patients suitable for remote follow up Recruit patients to complete the national quality of life (QOL) pilot survey and collate subsequent data Be available to address any issues that arise on completion of the QOL surveys
Impact of support worker on the CNS activity and work load. Timetabled virtual clinic 60 minutes in total for an average of 10 patients to be discussed CNS have seen a reduction in phone calls and patients needing to be reviewed by them in clinic setting, allowing them to focus on new diagnosis and post op patients All requests are prepped by support worker saving time for the CNS Less letters and phone calls to patients with results as the pre written correspondence is sent by the support worker
Enrolment & Protocol Setting
Clinical Portal the tracker
Messaging Facility
Filling the Gap Historic patients 18-24 months post treatment, evidence shows the importance of HNA. Workshop identifies their initial understanding of support available to them outside of the clinical setting. On completion of workshop they have a better understanding of what is actually there for them. Many historical patients have go on to be sign posted for many different support options, ranging from financial support to bereavement and marital counselling. Stratified follow up allows patients the time to identify any ongoing symptoms with thought, this has led us to identify where services can be implemented in the Trust. Cancer related incontinence Physio clinic is currently being discussed at the trust.
"I didn't know that" Evidence is expected to show an increase in referrals to Macmillan Information & Support Services, Move More physical activity programmes, support groups and other social, emotional, psychological and financial support services. Patients will have a better understanding of their treatment, long term side effects and surveillance investigations.
The importance of a holistic approach to "living with and beyond cancer" Identifies areas of concern that may not be addressed in a traditional clinical setting. Once treatment is over the long term effects other than clinical symptoms play a significant part in a patients recovery. Allows patients to raise concerns at a time that they feel is right and in a way that they are comfortable with (option to discuss virtually may make it easier to raise concerns that patients have felt uncomfortable discussing face to face in the past).
Patients wellbeing before enrolment on Remote Follow up. Mr x when registered was depressed He struggled with day to day activities and seldom left the house Since his diagnosis two years ago he s been under the care of a Clinical Psychologist He struggled physically with general aches and pains Could not accept his surgery had left him with a stoma. Financial and family concerns Feeling of not having a purpose
After enrolment Received advice from Macmillan Information and Support Centre regarding finances and signposted Has recently been on holiday alone for a week Better relationships Has been discharged from his Clinical Psychologist Has joined Move More and now attends two classes per week and swims once per week Has been a regular attendee at the local support group Has attended a healthy eating course resulting in a better understanding of managing his output
Clinical needs met On 3 monthly MOT reports reduced output from stoma needing to undergo manual evacuation D/W named consultant who advised clinical review Stenosis and hernia ruled out Patient mentions excess skin in the perineum (post APR) Listed for revision of scar tissue/excess skin Return to Stratified follow up and protocol.
Patients thoughts 38 patients were asked Which method of follow up do you prefer and why? 26 responded 19 (73.4%) opted for Remote follow up 2 (7.6%) had no preference 5 (19%) preferred outpatient clinics The main reason for the choice of outpatient attendance was the face to face approach to clinical follow up. Most who chose Remote follow up stated convenience as the main reason.
Audit results of patients preference Reasons for Remote Follow Up preference: Confident support worker will contact me if there are any concerns on results Quicker results Less daunting Less disruptive to working pattern
Questions?
TrueNTH UK Supported Self-Management and Follow Up Care Programme Hazel Brodie, Project Manager Faculty of Health Sciences, University of Southampton h.brodie@soton.ac.uk 1
Heading here Our Objective: To significantly improve the lives and experiences of men with prostate cancer, their partners, carers and family members Page 01 Title of the presentation October 2014 02
The Project Started 2014 New model of prostate cancer follow up designed and tested 5 sites Over 3000 men now on pathway SUPPORT WORKER ROLE CRITICAL TO ITS SUCCESS 16
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Overview 1. Follow up care what did the support worker do? 2. The evaluation 3. What are the main considerations when adopting this role? 2
Care Pathway A man who enters the care programme is offered: A needs assessment Knowledge and skills to co-manage his health and well being Remote monitoring of his health and well being by the urology team Rapid access to his clinical team if concerned 02
Care Pathway This is achieved by: Deploying a simple needs assessment tool: the Health MOT A transition workshop to introduce men to care programme and give them new knowledge and skills A support worker who acts as the co-ordinator and first point of call for the men An IT platform with patient and clinician facing elements 02
1. Screening and identification of patients 2. Introducing men to the pathway Supported Self Management & Remote Surveillance 4. Ongoing support and surveillance 3. Supported self management workshop
Page 05 Title of the presentation October 2014 In partnership with 02
1. Screening and identification of patients 2. Introducing men to the pathway Supported Self Management & Remote Surveillance 4. Ongoing support and surveillance 3. Supported self management workshop
1. Screening and identification of patients 2. Introducing men to the pathway Supported Self Management & Remote Surveillance 4. Ongoing support and surveillance 3. Supported self management workshop
1. Screening and identification of patients 2. Introducing men to the pathway Supported Self Management & Remote Surveillance 4. Ongoing support and surveillance 3. Supported self management workshop
EVALUATION Enrolled on the Supported Self- Management Programme (n= 3000+) Care Programme Group (n= 293) Comparator Group (n= 334) Programme implemented as service change Subset comprised evaluation cohort Mixed method nonconcurrent controlled cohort 8
EVALUATION Patient outcomes: Unmet need (CASUN), HRQoL (EPIC26 & FACT G), Patient activation (PAM), Psychological distress (GHQ12), Fear of recurrence, Diet and exercise patterns Cost effectiveness Process evaluation Patient questionnaires at baseline, 4 months and 8 months 70+ patient and staff interviews
Qualitative Evidence: Staff Interviews I think the role is really quite crucial now actually and because, you know, the nurses can give me lots of other work that they, you know, necessarily don t need to do themselves. And they can go off and see other patients. And it frees them up to do the more important things really. Support worker She was an absolutely vital member of the whole programme. You know, she inspired them. They had a long conversation. Each patient, you know, had special attention and that made this programme so successful,consultant Urologist In partnership with 18
Qualitative Evidence: Patient Interviews I think the main thing is it's a bit like a club. You may not go to all the meetings, or the building, but you have a feeling of belonging and you know you can go if you want to seek help for a specific thing as opposed to going to your GP, who, you know has a myriad of problems to deal with. So that feeling of not losing touch, of being is it valued or wanted. Yeah, it s just a feeling that you know that there is somewhere in the system you can go that deals with you as a human being 21
CONSIDERATIONS Full time or part time? Plot activity trajectory 0.6 FTE to 1.0FTE can enrol 150 350 men on pathway per year RCHT caseload 1000+, 1 SW, 2 CNS Admin or clinical? Clinical line managed by nurse specialist Raise awareness of role within the wider team early on Protocols and effective support 02
CONSIDERATIONS Cross cover and staff sickness Recruitment process high calibre of applicants. Recruit to multiple roles Staff retention, job satisfaction and career progression Introducing the role earlier in the pathway 02
Questions?