Workshop So, you think you know your patients?

S Fiona Whyte and Suzanne Nimmo So, you think you know your patients? Macmillan’s Holistic Needs Assessment (HNA) may suggest otherwise…..

Rudyard Kipling I keep six honest serving men they taught me all I knew. There names are what & why & when & how & where & who ?

What? An HNA is a simple questionnaire that is completed by a  person affected by cancer. It allows them to highlight the most important issues to them at that time, and this can inform the development of a care and support plan with their nurse or key worker. The questionnaire can be completed on paper, or electronically.

The changing nature of cancer. Why HNA? The changing nature of cancer. The growing need for support for people living with and beyond cancer.

Improvements in early detection and diagnosis. More advanced treatments Move from acute to long-term condition. Increasing numbers of people living with and beyond cancer Maddams J, Utley M, Moller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202.

Rationale…. The status quo is unsustainable. A growing recognition that cancer follow up and after care is not as effective as it could be. Cancer follow up doesn’t always address rehabilitation, secondary prevention needs or effective self-management.

https://www.youtube.com/watch?v=6WOlzUrWFjY

Not everyone is living well

Persistent Fatigue Financial worries Persistent hair loss Heart disease Nausea, vomiting Urinary or bowel incontinence Lymphoedema Osteoporosis Breathing difficulties Swallowing / speech problems Mental health problems Body image issues Persistent Fatigue Financial worries

I don’t need any more forms! I know my patients

https://www.youtube.com/watch?v=vJG698U2Mvo

"Usually I would keep this to "You actually came at things from a different angle.  Made me think about things that were under the surface and I was maybe trying to block out." "Usually I would keep this to myself but completing the checklist brought it out into the fore and up for discussion.  It was really nice that the nurse listened to me." "It took a lot off my mind filling in the Concerns Checklist.  It's a private thing and I don't want everyone to know my business so it was very helpful." "It was good to be able to talk to someone in a different way"

When?

Key stages where people need support (National Cancer Survivorship Initiative NCSI 2009) Diagnosis Living with cancer Disease progression Care transition End of Life

Where?

Where? In the out-patient clinic. In the person’s own home. In the GP’s surgery. In the ward area. In a Macmillan library Space. Or a Macmillan information hub.

Provides the opportunity to think about and identify any needs or concerns they may have. Person centred i.e enables issues and concerns to be identified that might not otherwise be addressed in a HCP led assessment Relieves anxiety

Consistent and structured approach Provides a framework so needs are identified from a PABC perspective (often can be unexpected) e.g family concerns, work and finance

DVD of health care professionals

Improved patient survey results Amalgamation of data can support service development Consistent framework for care and support planning Recognises the importance of the healthcare professional role in supporting care and support planning

Lets try it out

Hub Function Supporting the Person Navigation Identifying Needs Navigation Addressing Needs Financial Information Practical Emotional Systemic Hub Function The hub function delivers the following core elements: a conversation with the PLWC about their needs carry out a needs assessment or review an existing assessment produce a care plan help the plwc to navigate their way to the support they need. Clinical Practical