The Treatment Record Summary, Cancer Care Review Cathy Burton Macmillan GP Advisor

National Cancer Survivorship Initiative Treatment summary project Effective monitoring and management of cancer survivors by improved communication between the specialist cancer team and multi disciplinary primary care team

National Cancer Survivorship Initiative Primary Care Perspective Increasing number of survivors Variable letters from hospitals – some examples of good practice e.g. highlighted letters Summary details vary between hospitals What follow up is required? Who is responsible? Possible post treatment long term effects Aim of treatment, outlook Likely recurrence and signs/symptoms to watch for

National Cancer Survivorship Initiative Developing and Piloting the TRS July – August 2009 Tested out prototype with 4-5 Oncologists as ‘critical friends’ Feedback from Oncologists and GPs A standard format for a possible TS was formulated Formal pilot phase in 11 test sites through NHSI “ A summary of treatment provided to a patient’s GP by the patient’s consultant

National Cancer Survivorship Initiative Treatment Summary Insert Trust Logo and Address Insert GP Contact Details Address Dear Dr X Re: Add in patient name, address, date of birth and record number Your patient has now completed their initial treatment for cancer and a summary of their diagnosis, treatment and ongoing management plan are outlined below. The patient has a copy of this summary. Diagnosis:Date of Diagnosis:Organ/Staging Local/Distant Summary of Treatment and relevant dates:Treatment Aim: Possible treatment toxicities and / or late effects:Advise entry onto primary care palliative or supportive care register Yes / No DS1500 application completed Yes/No Prescription Charge exemption arranged Yes/No Alert Symptoms that require referral back to specialist team:Contacts for re referrals or queries: In Hours: Out of hours: Other service referrals made: (delete as nec) District Nurse AHP Social Worker Dietician Clinical Nurse Specialist Psychologist Benefits/Advice Service Other Secondary Care Ongoing Management Plan: (tests, appointments etc). Required GP actions e.g. ongoing medication, osteoporosis and cardiac screening A Cancer Care Review is also required Summary of information given to the patient about their cancer and future progress: Additional information including issues relating to lifestyle and support needs: Completing Doctor: Signature: Date:

National Cancer Survivorship Initiative Each Test Site developed their own way of using it Electronic version, completed by consultant in clinic Discharge letter template amended to include TRS headings Word document completed by consultant (medical info) and CNS (holistic info) jointly Form completed by CNS, signed off by consultant

National Cancer Survivorship Initiative Challenges and Barriers Technology Time Duplicating present systems to greater or lesser extent Present systems can’t accommodate (tapes to India) Too complex Not appropriate for all types of cancer (haematological) Agreeing at what stage(s) in journey to send TRS; may depend on tumour type

National Cancer Survivorship Initiative Figure 2:Rating of how useful TRS sections are Rating usefulness of each section

National Cancer Survivorship Initiative Figure 4:Has it made a difference to the way you manage your patients? Has it made a difference to the way you manage your patients?

National Cancer Survivorship Initiative Who is it useful for? Figure 5:Who do you think the Treatment Record Summary would be useful for?

National Cancer Survivorship Initiative Would you like this service to continue? Figure 6:Would you like this service to continue?

National Cancer Survivorship Initiative Levers Feedback from GPs and patients GP commissioners

National Cancer Survivorship Initiative Influencing G.P. contract arrangements

National Cancer Survivorship Initiative EVALUATION OF TEMPLATE PROJECT Assess the extent of usage Introduce to wider number of practices Patient views G.P. views

National Cancer Survivorship Initiative Aspects covered in the cancer care review

National Cancer Survivorship Initiative User friendliness

National Cancer Survivorship Initiative Prompts in the template Figure 4:Prompts

National Cancer Survivorship Initiative Usefulness of resources

National Cancer Survivorship Initiative Patient satisfaction

National Cancer Survivorship Initiative G.P. INTERVIEWS. ‘Sometimes when patients are diagnosed, they’re so busy with hospital. They need medical certificates from us but they don’t need other input at that stage’ ‘(the cancer care review is) to support patients and see how they’re doing’ looking at it from an holistic point of view in terms of a patient’s physical symptoms but also social and psychological needs’.

National Cancer Survivorship Initiative Benefits helpful, you don’t forget things. Useful as an aide de memoir’ ‘ useful for prompting’ ‘reminder of topics to cover’ ‘make sure we don’t miss things and offer consistent service’ ‘ trigger for us to remember to ask’ ; it is easy to miss that aspect which is potentially important because you have not approached it in a structured manner’ Useful for coding’ and that it is ‘auditable’ I

National Cancer Survivorship Initiative Barriers It does the basics but you need detail… more patient driven things,’. If you sit and ask the question and look at the computer and press a button. But that’s not the way we use it’

National Cancer Survivorship Initiative Macmillan Practice Nurse Pilot Developing training package for practice nurses, to provide skills/knowledge to allow nurses to better support cancer survivors in the community 2 whole study days plus 7 half days over 2 ‘terms’ Nurses will be encouraged to identify a patient for a full review, plan the review and then report back, using peer support Variety of approaches will be used, co-creating health/motivational interviewing plus training resources to provide nurses with wide range knowledge covering late effects, secondary prevention, holistic needs, supported by Macmillan patient information resources GP in practice agrees to mentor nurse Practice receives £1000 bursary

National Cancer Survivorship Initiative Practice nurse course Mind Map 1

National Cancer Survivorship Initiative Practice nurse course mind map 2

National Cancer Survivorship Initiative Practice nurse course mind map 3

National Cancer Survivorship Initiative Acknowledgements Rosie Loftus Terry Bowley Lucy Thompson Charles Campion-Smith Noeline Young

National Cancer Survivorship Initiative Thank you Any Questions?