Summary
Effective education promotes prevention and early detection of skin cancer and, by highlighting risk factors, results in less invasive and better treatments. Harrogate & District NHS Foundation Trust transferred its group session format for skin cancer education and support into a webpage to extend access to a wider patient and public cohort. This created a single access point for all relevant information, optimised capacity and resources, and increased accessibility for: patients unable, or struggling, to attend additional appointments; carers supporting prevention and skin surveillance; family members with familial risk factors, plus patients not referred to the cancer nurse specialist (CNS) service. This included patients with basal cell carcinoma (830 in 2019) and those with high risk factors or anxiety. An unplanned, additional, achievement was maintaining education and support remotely during the COVID-19 pandemic.
Method
A bursary of £6,600 was secured from West Yorkshire & Harrogate (WY&H) Cancer Alliance for “Delivering innovative patient education solutions to underpin supported self-management”. The plan was written, and timelines established, in November 2019. In Quarter 1 (Oct-Dec 2019) agreements and approvals were gained from managers, specific content was outlined, and a web designer was engaged. In Quarter 2 (Jan-Mar 2020) a focus group was set up to establish service user requirements, a webpage mock-up was produced, and a launch date was agreed. Progress in Quarter 3 (Apr-Jun 2020) was impacted by COVID-19, but content was developed and written, images, links and sources were researched, plus licences and permissions were secured. Quarter 4 (Jul-Sep 2020) featured a Trust pilot and a service user pilot. Feedback was obtained and reviewed. Content development continued and a plan for a staged launch was agreed. Invites and web address business cards were produced. Quarter 5 (Aug-Oct 2020) saw the live site launched, with the Cancer Alliance promoting it more widely across the region. Analytics tools were adopted to monitor user uptake and content preference, and feedback forms were added to the website. In Quarters 6 and 7 (Nov 2020-Feb 2021), analytics showed low user uptake, so follow-up calls post diagnosis were employed to signpost and assist with web access. The domain name was shortened and QR code access was added.
Results
During the COVID-19 pandemic the webpage replaced face-to-face support sessions, which could not continue, owing to restrictions or redeployment of staff. Patients had ongoing access to education and support. Skin cancer education and support was extended to a wider patient cohort via web address cards, which were given out in clinic to any patients with any skin cancer diagnosis, risk or anxiety. The webpage was highlighted to patients at diagnosis, with signposting details included in all patient packs, and reinforced during follow-up calls post diagnosis. It was shared across the local Cancer Alliance and was particularly appreciated during the COVID-19 pandemic. Feedback was positive, with constructive suggestions supporting service improvement. Analytics showed a high initial uptake, which then reduced. Reinforcement during follow-up calls, which commenced in November 2020, was successful in increasing hits.
Sustainability and Spread
This resource requires minimal ongoing input and resources, with ongoing maintenance written into job roles. It extends capacity for all service users. With regular review, updated content and ongoing development, the template is sustainable in the long term. The title is a barrier to wider integration and requires rebranding. Ongoing analytics data and user feedback will enable and support future improvement, with tri-monthly page reviews and annual audits underpinning ongoing development. This approach is new, so it is taking time to embed into usual practice. However, it has been an undoubted success for the practitioners, having extended capacity, resources and accessibility and helped to deliver support to a wider patient cohort. Delivering IT capabilities on this budget was a challenge, particularly for healthcare practitioners whose skills lie elsewhere. However, this has been managed by maximising available resources, rather than producing new ones. Long term sustainability is easily supported with minimal ongoing cost and resources, but future audit and review will be essential to ensure it remains current and continues to develop. There is great scope for development, particularly with shared regional and national resources, but further promotion and rebranding are required to achieve this. Skin cancer patients are generally an elderly patient group and online resources are a challenge for some. As a result of COVID-19 restrictions, engagement has improved with support and family involvement. This will not replace face-to-face support and education programmes, but it is an additional supportive resource.
