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Cancer survivorship summit 25092017-Katayoon Bamdad
- 1. Best Practices for the Implementation of the Effective Cancer Survivorship Programme Katayoon Bamdad Macmillan Cancer Survivorship Programme Lead for Surrey and Sussex Cancer Survivorship Summit, London, UK, September 2017
- 2. Macmillan Cancer Survivorship Programme Surrey and Mid-Sussex Macmillan Cancer Survivorship Programme Lead For Surrey and Mid-Sussex Implementation of the Recovery Package at four specialist hospitals for four tumour groups of Breast, Colorectal, Prostate and Lung 1. Royal Surrey County Hospital NHS Foundation Trust 2. Surrey and Sussex Health Care NHS Trust 3. Frimley Park Hospital NHS Foundation Trust 4. Ashford and St. Peter’s Hospital NHS Foundation Trust Coordination between specialist care providers (secondary care), primary care providers ( GPs), clinical commissioning groups (CCGs), charities and local voluntary services
- 3. Implementation of the Treatment Summary(TS) • 15 TS was designed by CNSs: (The TSs designed by the CNSs included the key element’s of TS) http://www.secn.nhs.uk/files/5114/6579/9500/Final_Report_Macmillan_CS_Proj ect-KB_2014-2016.pdf Implementation of HNA • Implementation of HNA using Macmillan free assessment and care planning folder containing triplicate HNA paper forms. Implementation of the health and wellbeing Event for Cancer patients • A programme designed for the health and wellbeing event. The programme was nominated for “Patient Safety Award” 2015. https://www.england.nhs.uk/wp-content/uploads/2016/04/cancer-guid-v1.pdf Implementation of the Recovery Package (RP)
- 4. Implementation of RP ( Continued) Implementation of the CCR • Collaboration with CCGs • Southeast Clinical network works closely with each CCG, they have developed a dashboard which its number one priority is the implementation of the CCR • Training for the GPs, Practice and District nurses, funded by Macmillan
- 5. MCS Programme’s Additional Achievement • Head and Neck’s “ Moving on” programme across 4 hospitals • TS for patients who undergo chemo and radiotherapy across 4 hospitals • Chemotherapy team at ASPH (haematology cancer patients) have started a “Nurse Led” clinic which they conduct HNA and produce TS. • All the local CCGs (8 CCGs) have already highlighted and added a number of key areas in their strategy for those who are living with and beyond cancer • TS and HNA for Nephrectomy patients at ASPH
- 6. The ‘Big 8’ Components of Cancer Survivorship Programme’s Implementation The Implementation Action Agenda • what we want to achieve? And how we and patients can benefit from it? Organisational Support Process Engagement Flexibility in Implementation Real time Implementation Support Manage the Outcome Tailored Implementation - Negotiate The essence of Implementation is choosing what not to do Utilising the Existing Resources and tools
- 7. The Essence of Implementation is choosing what not to do! • From Good to Great is nice, but knowing when great is good enough is even better • Deciding on whether do you want to perform activities differently or to perform different activities • Information is not enough, a previously available information could very well be less realistic in implementation process, due to reduced execution capacity in your organization • In implementation it is important to see distant things as if they were close and to take a distanced view of close things • Plan and run a workshop
- 8. External organisations such as Charities and voluntary organisations CNSs and other health professionals for each tumour groups Local CCGs Organisational Support Processes: Secondary and Primary Healthcare providers, Lead cancer nurses, CNSs, Oncologists, AHPs, IT depts., cancer and ward managers Shared -decision Implementation Local Champion Collaboration is central to the success of the Implementation
- 9. Engage everybody Early and often • Introduce the Programme’s goals and objective before the start of the programme- RP workshops are the key to success • Identification of key stakeholders who share the interest and need for change • In my experience people are the key differentiator and collaboration is paramount to the success of implementing and supporting any programme • Build consensus for how to proceed • CCGs • Charity, voluntary and patients organisation • Carers charities
- 10. Be Flexible in implementation • Matching structure with strategy • Generic Tools are not always enough • One-size model of care does not fit all • Install strong allies in key positions • Personally preside over the change process and create a collaborative platform
- 11. Implementation Support • Can we identify how we are going to turn the implementation plan into specific results ? • Stakeholders need to be able to contact the local champion immediately if there is an issue • Developing implementation support tools and resources alongside specific guidelines
- 12. Tailored Implementation • Constant listening • Recognise that people are different and tailor the implementation appropriately • Adopt the implementation to the local context • Removes the stress of developing materials by offering support
- 13. Integrate the Existing Resources • The goal of cancer survivorship programme and/or RP is to increase cancer services’ efficiency ( It is a service enhancement not service replacement) • Be familiar with available local resources. • Integrate Voluntary and cancer charities thereby deploying separate resources.
- 14. Manage Result • In the absence of feedback process you look at models and think that they confirm reality • It is also important to monitor feedback • Evaluation needs to answer the questions: Has the intervention changed the participant’s behaviour? How and why? (or just as important questions such as why not?) • What’s the use of measuring speed if you don’t go in the right direction?
- 15. Example of The successful implementation Implementation of the Treatment Summary
- 16. Consultant/Nurse letter vs. Treatment Summary • Unfortunately the name “ Treatment Summary” is misleading • During the implementation of the treatment summary, some of the health professionals will say that “ we send consultant/nurse letter to GPs and we will send one copy to our patients, so there is no need for the treatment summaries” • Explain the differences between the Treatment summary and Consultant/Nurse letters. • What is the difference between the Treatment Summary and Consultant/Nurse letters?
- 17. The difference between Consultant/Nurse letters and the Treatment Summary Consultant/ Nurse Letter( Detailed) Treatment Summary ( Synoptic) • Diagnosis* • Treatment Plan** • Treatment intention: palliative, curative, adjuvant, neo-adjuvant or other** • What treatment or treatments patient had?** • The outcome of the treatment (Result of the treatment or patient’s response to treatment )* • Future direction (whether patient needs further treatment)* • Plan for ongoing monitoring (describes the arrangements for follow-up: how, when and by whom)* • Treatment Plan** • Treatment intention - palliative, curative, adjuvant, neo-adjuvant or other** • What treatment or treatments patient had?** • Provide a summary of their identified/eligible clinical and non-clinical needs and potential barriers after treatment*** • Identify the potential side effect that patient might experience ( late/long and short term)*** • Identify symptoms and signs patient and GP should look out for?( Alert symptoms for patient and GP’s information that requires back to the specialist team)*** • What service referral (clinical and non-clinical) has been made for the patient after his/her treatment?*** • A number of lifestyle/ behaviours can affect patient ongoing health, including the risk for the cancer coming back or developing another cancer ( i.e. diet, alcohol use)*** • Indicate who to contact and how in case of changes, emergencies and so on ( Key contact)*** *Only in the Consultant/Nurse Letters **The same in both the treatment summary and Consultant/Nurse letters ***Only in the Treatment summaries
- 18. Suggestions for the Effective Implementation of the Treatment Summary Remember small steps of change lead to big improvements! Shared -decision making implementation for the Treatment Summary into the mainstream care Remember changing roles, behaviours and mind-sets is vital and challenging but not impossible Introduce the treatment summary’s before the implementation Offer CNSs a range of support options- Be a facilitator between them and other local Departments Recognise that people are different and tailor the implementation appropriately Adapt the implementation to the local context ( resources are different) Work on sustainability from the outset Tools alone are not enough Implementation of the Treatment summary is different for each tumour group so be flexible Have a resilient and consistent communication
- 19. Key Messages • Local Champion is needed for the on-going involvement and commitment • Have I included the relevant stakeholders in this process? Have I involved stakeholders in all levels? What can I do to ensure that I have not missed a crucial stakeholder? • Before any implementation, Plan and Run cancer survivorship programme’s ( Recovery Package) workshop and introduce the programme to main stakeholders such as different cancer tumour CNSs and Commissioners (Where do my stakeholders stand on the proposed practice change?) • Don’t rely on available information and generic tools • Be flexible in implementation. No two implementations will ever go the same • Implementation must be tailored • Provide constant support • Provide regular update ( monthly or bimonthly Highlight reports)
- 20. If it is required for clinicians to adopt the cancer survivorship programme, never make them feel like that is the case!
- 21. Cancer patients face the unknown. They show courage and endurance. Their endurance is our motivation as healthcare providers; their struggle is our commitment; their fight is our certainty to provide individualised care. From their strength, we as healthcare providers advance and reap the great harvest of our dedication and level of care.
Editor's Notes
- as coordinated, commissioned packages of care across clinical service and organisational boundaries, with prompt access back into secondary care and seamless transition to normal life is essential for those who are living with and beyond cancer.
- The implementation of the TS for each tumour group has been started in collaboration with related CNSs and lead cancer nurses at each centre. Depending on the local patient administration system (PAS) at each participated hospital, a different preparation styles for TS has been considered. The overall aim is the integration of the TS into clinical practice across the project’s four tumour groups. For the implementation of HNA, it was vital that the health professionals and CNSs for the four tumour groups adapt an effective way to address the unmet needs of the cancer patients and provide appropriate support and care planning to their cancer patients. It was also essential to identify and promote the confidence needed to implement HNA into clinical practice among CNSs. It was accepted that, for many CNSs, this might mean extra work, consequently, it was decided to ensure the CNSs chose their preferred method of the delivery of HNA. This flexibility in choosing the delivery method was believed to be important in helping CNSs to recognise the range and extent of the needs of their cancer patients, and an emphasis is placed on their ability to motivate and improve their awareness in relation to an effective HNA and care planning. Some of the CNSs and health professionals have decided to sit with the patients and talk through the form and then leave them to complete it. Some others have decided to have a telephone consultation with the patient and go through the form with the patients over the phone. And finally some of the other health professionals will give the HNA forms to patients to take home and bring it back for the next follow up appointment. If at any point during this process the patient decides not to complete the HNA form, they will be free to do so without any requirement to give a reason. A copy of the HNA will be recorded in the patient notes and the patient will keep a copy and a copy will be sent to any other members of the multidisciplinary team, where it is necessary. Based on the result of HNA patients will receive further support
- It is generally believed that GPs are the best person to carry out the CCR, however there are increasing suggestions that practice nurses to be trained to carry out the CCR. There are currently courses are running in the area by Macmillan which some of the practice nurses have participated, however this is not prevalent across all the CCGs.
- Don’t fool yourself: having an Implementation’s information is not enough for an effective implementation choosing to perform activities differently or to perform different activities
- Implementation is not an individual endeavour. A team of individuals should be assembled to prepare and work through the implementation process. The team can be composed of stakeholders and others who have a vested interest in improving outcomes for patient care. You may refer to this team as a taskforce or a steering group. The members of your group can vary over time depending on the issues you are working through. It is important to identify a local champion who will act as the spokesperson and programme lead.
- “In a 4×100-metre relay race, one runner starts before the other, but in the end it’s the sum of the four runners that determines performance”
- You cannot be everything to everybody
- Like vaccination which is the biological enhancement. Enhancement aims at improving certain specific characteristics
- You think in terms of years, not months
- The initial phases of implementation require ongoing reflection about the decisions made and those that will need to be made. Consider the following questions at this point in the implementation process: Is my question or goal clearly stated? How will I know I have achieved it? Have I included the relevant stakeholders in this process? Have I involved stakeholders in all levels of the organization? What can I do to ensure that I have not missed a crucial stakeholder? Where do my stakeholders stand on the proposed practice change? Are the goals for practice change specific and measureable? How can they be measured or observed? Is the target for practice change achievable and feasible?
- Because if you do so, it sounds like it is about you and your job.