Cancer Clinical Nurse Specialist experience of clinical pathways. Cheryl MacDonald. Clinical Nurse Specialist – Lead: Breast Care Maria Stapleton. Clinical Nurse Specialist – Lead: Gastrointestinal Cancer Care

MidCentral District HealthBoard MidCentral District Health Board Palmerston North New Zealand

The Cancer Continuum Ours roles were set up to cover the whole continuum of care  Prevention  Early detection and cancer screening  Diagnosis and treatment  Support and rehabilitation  Palliative care  Research  Surveillance The New Zealand Cancer Control Strategy 2002

Faster Cancer Treatment The new cancer coordination roles are to assist the achievement of the faster cancer treatment times  62 day indicator: all patients referred urgently with a high- suspicion of cancer receive their first treatment (or other management) within 62 days of the referral being received by the hospital.  14 day indicator: all patients referred urgently with a high- suspicion of cancer have their first specialist assessment within 14 days of the referral being received by the hospital.  31 day indicator: all patients with a confirmed diagnosis of cancer receive their first cancer treatment (or other management) within 31 days of a decision-to-treat.

Roles and responsibilities Both roles  Advanced nursing roles.  Single point of contact to support patients and their families to facilitate their journey through the cancer continuum-patient focused at all times.  Works within evidence based and best practice guidelines.  Works collaboratively and in partnership within the multi-disciplinary framework.  Works within the Treaty of Waitangi principles.  Enhances consistency and continuity of care / managing the ‘systems’.

The complexity of the cancer journey  For many - first time engagement with the secondary health system.  Waiting to hear about appointments can be stressful – the unknown is even worse  Health is compromised, loss of sleep/ weight/appetite.  Multiple appointments, often on different days and times.  Financial burden, time off work for both person with cancer and support person/persons, travel costs.  Concern at how the family will react and cope.

The complexity of the cancer journey  Impending threat of change to body image.  Psychological stress of cancer diagnosis, and the uncertainties it brings.  Complex medical terms and abbreviations.  Information overload – often given verbally.  Multiple clinicians and differing roles.  Multiple hand outs and instructions.

Clinical Nurse Specialist - Cancer Care ‘ Know how ’ about the about health care and hospital systems is important to family/whanau, this has to do with getting the best treatment and service from these systems. (Waitemata District Health Board, Colorectal Cancer Service Improvement Project, December 2006).

Clinical Nurse Specialist - Cancer Care “What we do”  The Clinical Nurse Specialist role facilitates the smooth transition, in a timely and informed manner, through the multiple services available across the continuum of care.  These nursing services give the person with cancer and their family/whanau the opportunity to liaise with one person during what an intense and life changing experience.

Clinical Nurse Specialist

Clinical Nurse Specialist - Cancer Care “What we do” The Clinical Nurse Specialists roles are multi faceted and involve being CCCConsultants CCCCounselors/ Listeners CCCClinicians TTTTeachers MMMMediators / Advocates AAAAdministrators AAAAgents of change as they journey with the patient and their family/whanau across the continuum linking closely with other health care providers as required.

Clinical Nurse Specialist - Cancer Care The benefits  Improve patient outcomes so that the patient/family/whanau feel informed of and receives the appropriate care within the Faster Cancer Treatment times.  Improve use of recommended treatment, including increased referral to appropriate services and patient/family/whanau engagement with these processes.  Improve communication between providers and build trusting relationships.  Identify and initiate change within ‘the system’  A familiar face who is able to coordinate and walk alongside the patient and their family/whanau, particularly throughout their different treatment modalities, as required

Case Study. Colorectal cancer. Maria Stapleton

Assessment – Mrs A  65 year old female.  Adenocarcinoma of rectum T3N2M1  Smoker for 45 years  Previous hysterectomy, bilateral oophorectomy, previous appendicectomy. No other significant medical history  Supportive but distressed husband.  Both retired on the pension.  2 children, caregivers for 14 year old twin grandsons.  Live 50 minutes away from hospital.  Husband does not drive, Mrs. A driver for family.  Weight loss 10kgs in last 4 months.  Finds sitting painful.  Frequent loose motions.

Planning and implementation  Introduction of Clinical Nurse Specialist role  Surgical appointment – plan for stent insertion.  CT Scan / MRI / Blood tests - arranged to be on same day - reason for explained  MDM referral - explained  Dietitan referral – arranged to see that day  Social worker referral – with follow phone call  Transport assistance – Cancer society  Quit smoking  Continence products arranged.  Cancer Oncology Psychologist information, distress assessment completed and referral made for both patient and husband.

Planning and implementation  OT referral for roho cushion.  Discussion of likely plan of care and time frames, questions answered.  Folder of information supplied containing. –Cancer society pamphlets –Cancer society “Bowel Cancer” booklet –Colorectal Cancer Nurse coordinator in formation and contact details. –Central Cancer Network. –Notebook and pen for taking notes.  Discussion of likely formation of Stoma, written information, DVD package supplied.  Letter to GP.  Follow up phone call with in 48hours.  Ongoing monitoring and tracking to ensure appointments are made and Mrs A is able to attend.

Evaluation  Rectal stent inserted.  MDM meeting  Neo-adjuvant long course chemo radiotherapy.  Cancer society drivers used daily for 5 weeks during chemo.  Roho cushion, dietary supplements.  Cancer psychologists support in place for family.  Social worker support in place.  Surgery formation of permanent stoma.  Education and management of colostomy.  Adjuvant chemo therapy completed.  Hepatic surgery in Auckland coordinated and completed.

Evaluation  Journey took just over 12 months and involved 59 appointments at MCH.  Mrs. A, husband and grandsons all quit smoking! The Cancer Nurse coordination role was pivotal to the successful access to timely treatment

Thank you Questions