Summary

There are an increasing number of people living with and after cancer in the UK and patients may be living with moderate to severe side effects after they finish their cancer treatment. A new survivorship prostate cancer pathway has been designed and implemented to incorporate the ‘Recovery Package’ at Guys and St Thomas’ (GSTT). The pathway aims to improve patient experience and quality of care, and to ensure patients live a healthier and active life after treatment. The new pathway has been devised with patients, by collecting data from focus groups, patient experience questionnaires and Holistic Needs Assessments (HNAs), which are patient tools to highlight concerns and anxieties.

Challenge

The National Cancer Survivorship Initiative (NCSI) acknowledged patients are living with multiple different concerns and issues during and after their treatment which are affecting their quality of life (NCSI, 2010). To address these issues the UK is implementing ‘The Recovery Package’ to help attend to these unmet needs and support patients. The urology department at GSTT is one of the busiest in the country, treating 1,500 new prostate cancer patients in 2014/2015. The NHS is facing increasing financial pressure and scrutiny so implementing new national cancer survivorship initiatives within existing resources poses considerable challenges. Patients were seen after their treatment by their urologist or oncologist initially, and then followed up by one of the clinical nurse specialist team, with provision to refer to other healthcare professionals if necessary. There were long waits of up to 9 months for some services such as andrology or continence mainly due to the increasing number of patients requiring assessment and treatment. 

Objectives

To provide prostate cancer patients with a survivorship pathway that gives them the skills and confidence to cope with treatment-related side effects, improves patient experience, improves quality of care and facilitates confidence in the discharge process. To incorporate the ‘recovery package’, which needs to be embedded into current practice to ensure GSTT is compliant with NCSI and London Cancer Alliance (LCA) initiatives. To support prostate cancer survivors to live with and beyond cancer in an effective and cost-effective way.

Solution

A retrospective patient questionnaire was mailed to 250 patients, gaining information on their experience, quality of care received, symptoms they experienced and any unmet needs they were still experiencing. Following this, two patient focus groups were conducted and a professional focus group was also organised for the multidisciplinary team. The aim was to facilitate inter-professional communication and to feed back the patient focus group and patient experience questionnaire results. A blueprint of the prostate cancer survivorship pathway was devised and agreed and each speciality took ownership of a series of seminar sessions, agreeing the process and content. Documentation was completed for all the seminar sessions to enable them to be booked as clinical episodes on the computer system, which was agreed by the Activity Recording Panel (APR). This was also sent to the Service Development Committee and CCGs for financial review 2015/16. Steering groups with key members of the multidisciplinary team were organised bimonthly to agree or solve any pending concerns or problems. Monthly prostate cancer meetings were also held and the project manager gave feedback and updates to everyone on the project.

Results

All patients that attended seminar sessions were satisfied with the experience. Overall, 99% of patients felt more confident in coping with their recovery after they attended the different seminars and 100% of men felt more confident in coping and understanding the discharge process after they attend their discharge seminar. Overall, only 2% of patients felt uncomfortable asking questions in a group setting. However these men did add that they found it helpful to hear other men discussing the issues they did not feel comfortable raising. Only 2.8% of patients felt uncomfortable asking personal questions in the erectile dysfunction and continence seminar. The recovery package has been embedded into the new survivorship pathway to ensure GSTT is compliant with the London Cancer Alliance and NCSI ‘Recovery Package’ initiatives.

Learnings

Evaluation

Evaluating the old prostate cancer pathway showed us that current practice needed to change to be more patient-centred and to address patients’ unmet needs within an acceptable time frame. Delivering interactive group seminars has proven to benefit not only patients but also healthcare professionals. The new pathway has reduced the amount of phone calls and counselling hours and patients are being streamlined in to clinics if they need further intervention within an acceptable time frame. The pathway has been adapted and redesigned seven times to date to ensure it captured all the patients’ needs and concerns based on patient feedback questionnaires and HNAs. This approach to evaluation and ongoing improvement has ensured that the project has remained patient-centred. A retrospective audit of clinic referrals was conducted to measure the impact on andrology and continence services – the biggest bottlenecks in the patient’s follow-up. There was a 100% referral reduction to these clinics which allowed the nurse specialists to see an extra 250 patients a year without extra resources.