The Wellington Experience Paul Smith and Dr A. O'Donnell Cancer Care Co-ordination

A Regional “Cancer Centre” 1. Wide variation and impromptu care coordination 2. Mixed degree of involvement in the patient journey, specifically around the waiting time initiatives 3. Certain tumour streams have minimalist nursing coordination 4. Area’s of good practice

Silo effect ► Perceived lack of common goals between cancer treatment specialties ► The focus feels inward and the responsibility is upward, not across ► This makes timely coordination and communication difficult to achieve ► Frustration amongst patients who increasingly expect information to be readily available and complete at point of contact.

Where are the gaps ► Secondary to tertiary  Lung, Gynaecology, Sarcoma, Upper GI, Head & Neck ► Complexity of care  Head & Neck, Sarcoma, AYA ► Special needs  Adolescents, Maori and Pacific, non English speaking

Where are the gaps {continued} ► Curative Intent – the need for speed  Proven benefits of early diagnosis and commencement of treatment for Colorectal, Breast, Lymphoma, Sarcoma and Gynae cancers ► High Psychological impact  When initial diagnosis is metastatic disease and requires palliative cancer management

Local issues ► Strength of our local Community Cancer Nurses  How do we augment role and change scope to truly engage primary health care for all cancer treatment modalities.  Shared model enhanced with District nursing  Complexity of need assessment  Referral process ► Medical Oncology waiting lists ► Senior Nurses doing administration

Risky example ► Recent example of a 15 year old Osteosarcoma ► Presented to GP/Practice Nurse and referred to Orthopedic surgeon ► Then referred to Auckland surgeon, but Wellington AYA, Ortho nurses and Paediatric oncologist involved ► Also referred to Medical Oncology SMO and Registrar/CNS/Community Cancer Nursing

► Also seen by Fertility Associates, Nuclear Medicine, Cardiology, Haematology for marrow assessment ► Imaging with CT / PET CT ► Liaison with school, social worker, Canteen, Child Cancer Foundation and Ward Staff

Planned action ► Integration with our District colleagues ► Regional MDM / MDT ► Develop web-based integration ► Integrate existing roles ► Highest need, volume and priority ► Develop systems and process, not person dependent