Barwon South Western Survivorship Project Improving outcomes for survivors of cancer
Background The Barwon South Western Cancer Region - Geelong -Victoria s second largest city - Surf Coast - Regional cities and towns - Rural and remote populations extending to the South Australian border.
Objectives Nurse Led Survivorship Clinics. Range of tumour streams from high to low risk Individual survivorship care plans. Coordinated pathways of care - Cancer services, GPs and Allied Health providers. Risk assessment tool to guide decision making regarding transitions of care to GPs. Network of community services/supports for survivors. Model of service to address - needs of survivors - changing health services environment (sustainability)
Survivorship Nurse Led Clinics - 99 participants- within 2 years of completion of curative treatment - 3 sites Geelong, Hamilton and Colac (outreach from Geelong) - Survivorship Care Plans- specific to 8 tumour streams (common template) - Hodgkin Lymphoma, non-hodgkin Lymphoma, Brain, Bladder Ovarian, Breast, Colorectal and Head & Neck Cancers. - Electronic format ARIA (Word based) Nurse Led Survivorship Clinic First meeting Physical and psychosocial assessment Patient centred - goal setting Second meeting - focus Provision of care plan Health education, optimal health, empowerment, health literacy Referrals to allied health and community referrals
GP engagement Treatment concludes Increased engagement of GP Potential shared cancer care with GP Discharge of surveillance and ongoing survivorship care to GP Survivorship Nurse Clinic GPs receive Survivorship Care Plan- patient friendly language One page Tumour Specific Surveillance Guidelines- medical language Discussion and transition of holistic needs to GP Alignment with Chronic Care and Health Prevention Approaches Model support shared cancer care and discharge to GP over time
Evaluation Methods Quality of Life (AQoL-8D) - Baseline Health Literacy Questionnaire (HLQ) - 1 week post Health Education Impact Questionnaire (heiq) - 3 months post Economic costs and resource use Patient satisfaction Professional feedback and acceptance (GPs, Cancer Specialists, Cancer Nurses, Radiation Therapists Allied Health)
% Results- participants
Health Literacy Questionnaire (HLQ)- 9 domains A significant improvement in 4 domains was demonstrated Healthcare Provider Support (feeling understood and supported by health care providers) p =0.025 Having Sufficient Information p =0.002 Critical Appraisal (being able to identify good and reliable information) p = 0.001 Navigating the Healthcare System p =0.041 Actively engaging with healthcare providers, approached significance (p=0.09).
Health Outcomes Quality of Life- AQoL-8D Participants had a lower quality of life at baseline compared to general population (0.68 versus 0.8 pop norm). A slight improvement in quality of life at the 3 month follow-up (0.68 to 0.70). Moderate improvements appear in both the physical and mental health super-dimensions of the quality of life scale (but were not statistically significant).
Results- Cancer Professionals Cancer Specialists returning evaluations (12 of 20) All specialists reported the Survivorship project achieved its aims to a moderate to high level of success. 90% rated the success of the program to be very high in enhancing continuity of care between cancer specialists and GPs. 70% believed that the Cancer Survivorship Project had improved posttreatment care for their patients. The survivorship team has more time and knowledge to address survivorship concerns and provide advice and guidance about life after cancer treatment. Medical Oncologist Ongoing high rate of patient referral continues following the pilot period.
GP- Stage 1 Evaluation GPs when first receiving the Survivorship Documents reported SURVEILLANCE GUIDE- was useful to the ongoing care of the patient 96 % SURVEILLANCE GUIDE - was in a useful format 98 % SURVIVORSHIP CARE PLAN - was useful in the ongoing care of their patient 92 % 0 20 40 60 80 100
Project Recommendations Survivorship is imbedded in cancer trajectory. No right time re-presenting the opportunity is important Culture change- discussed early as part of service delivery. Survivorship services expanded to all tumour streams. Include patients living long term with a cancer diagnosis and on long term treatment regimes (e.g. myeloma). Continue strengthen pathways for shared care & discharge to GPs Engage GP Practice Nurses in the chronic care of survivors. Continue to developing survivorship expertise. Consult and advise on broader application of survivorship services. Develop electronic capacity records, sharing, data.
Top Tips Identify what motivates your key partners. Develop Survivorship Champions. Plan well vs launch in! Build on small successes and share these. Test new proposals with actual patient case studies. Be seen and integrate yourself into the cancer centre. Be aware that words mean different things to different people. Use the language of your key partners. Repeat your survivorship messages. Build on existing frameworks and leverage on related projects.
Treatment is just the tip of the iceberg, survivorship is what lies beneath the surface Contact details- Kate Schofield Project Manager E: kschof@barwonhealth.org.au; P: 03 4215 2789