 Survivorship  How we changed our service  How to manage service changes  Results

Macmillan estimate that :  About 2 million people are survivors of cancer.  1:10 people over 65 Are living with a cancer diagnosis  Need to do something else for follow-up !

Looked at the value of a clinic appointments:  To monitor for local recurrence,  Manage the late effects of treatment  Provide information, support and reassurance for patients.  Many patients are willing to take responsibility for seeking medical attention in the event of symptoms arising (Gulliford et al 1997)

 What is the problem with clinics?  What do patients ask us?  What is available now?..BCC courses  What can we provide ?

 BCC course as baseline  Four week educational programme  Covering all areas that our patients question  Developed pilot study  Continuous assessment / evaluations

 69% response rate  84% attended all the course  94% found course beneficial

 Being in a group and hearing from other women. Also being lead by very well trained facilitators and nice refreshments.  I liked being with other ladies who had been through similar treatments and the speakers who came especially the exercise and diet, plus the Lymphoedema advice.  Very informative and as the breast nurses and experts made the session very revealing. Getting to know other people in the group.  I enjoyed all of it more than I thought I would have done.

 I would liked the course sessions to be longer.  I enjoyed all the course but at times I found it too involved and a little frightening.  The first part where we did not need to be reminded.  Nothing I found everything refreshing and very helpful  Diet for healthy living

Breast Care Nurses16 Prosthetic/Bra Services14 GP 12 Breast Clinic8 Reconstruction Services6 Genetics Service 5 Breast Cancer Care4 The Haven (Leeds)4 Lymphoedema Services1

 The majority (84%) attended every session on the course. Reasons for the 15% that did not attend were ‘being unwell’.  94% (48) of patients found the course beneficial.  In relation to what the patient’s liked most about the content of the course, the most common themes were – reassurance; sharing experiences and meeting people who have gone through similar experiences.

 In relation, to what patients liked the least about the course content, the most common themes were – Talking about the diagnosis and treatment; diet and healthy living talks; relaxation and psychological skills talk was rushed.  Majority of patients were ‘very happy’ with the fact they have not been required to attend any hospital breast care appointments a year after attending the course.  Majority (69%) of patients have contacted their breast care nurse during the past year for things such as – test results to information about particular concerns they had.

 Service was better quality  Patients were satisfied  No extra calls or appointments  Award winning!  Transferrable to other specialities

 Identify the drivers for the project : a) Survivorship issues and self management policies as suggested by DOH. b) Providing excellent quality service provision c) To many patients, to little clinic time d) No proven benefit to follow-up clinics e) Supported by the YCN f) Money savings?

A) Follow-up policies b) Nurse-led initiatives

 CNS support  MD team support  Managers support  Commissioners support

 Project manager on site required to co ordinate project  Key members required: business manager, general manager, contracting dept. representative, CNS

 Any available audits of clinic satisfaction  Service Specification  Patient Pathway  Staff/costings: table  Template/ chart of processes timetabling

 Developing the programme. The follow-up programme running at CRH/HRI has been well evaluated.  Our research is based on our programme format so any great deviations from this would not be research based.

 Recording attendees and DNA’s.  Sending out joining information.  Patients do not always turn up at the course and will need to be chased with key information if they are not having hospital appointments.  Volunteers, can support the programme

 Venue  Speakers

 The course was well run and staff were approachable and informative.  The speakers were confident and reassuring. I took away lots of positives, enabling me to move forward and I enjoyed meeting all the other participants.

 100% of participants strongly agreed they were satisfied with the quality of the course  All sessions were very useful and interesting. It was lovely to meet people with the same experiences. Excellent course!’  93% of participants felt the course fully met their needs and expectations. 7% felt it met their needs in part.

 Changing service provision is acceptable if everyone is in collaboration  Patients accept what you tell them if it is valuable and an acceptable alternative, for you and them.

But I think I got away with it……….