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Survivorship Care Plans (SCP)

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Presentation on theme: "Survivorship Care Plans (SCP)"— Presentation transcript:

1 Survivorship Care Plans (SCP)

2 Survivorship Care Plans (SCP)
Cheryl MacDonald Clinical Nurse Specialist Lead Breast Care Mid Central Health Ltd

3 Definition of survivorship
Cancer survivorship can be defined as starting from the time of initial diagnosis and continuing through the balance of life (National Coalition for Cancer Survivorship, 2010; National Cancer Institute, 2010) The NHS believes that survivorship in cancer encompasses 3 elements; those undergoing primary treatment, those who are in remission following treatment, and those who are cured or have active or advance disease (NHS,2009).

4 When primary treatment finishes….
Some people can have feelings of vulnerability and abandonment. They can feel like their safety net has gone once primary treatment has finished. This can be as stressful as the initial diagnosis. Its important that care planning starts at the time of diagnosis, thus reducing anxiety and giving a clear direction which will enable a smooth transition from treatment to follow-up

5 Rehabilitative support
Rehabilitative support following cancer treatment aims to maximise the ability of those who have been treated for cancer to function as normally as possible by promoting independence, quality of life, and adapting to living with cancer long term (NZGG, 2010).

6 The evidence Research suggests that people have a much better understanding of their health condition when they are involved in the decision making process with their health care professional (Turton & Cooke, 2000). SCP’s are not only a conduit between active cancer care and survivorship care, but between health professionals and cancer survivors (Hill-Kayser, Vachani, Hampshire, Jacobs & Metz, 2009).

7 Why SCP???? It has been recommended that at the completion of cancer treatment, patients should be provided with a treatment summary and a detailed plan of ongoing care which includes: Follow-up schedules Clinical examinations Lifestyle adjustments Psycho-social support Ad hoc follow-up schedules internationally. Some are discharged back to gp, some see surgeons, some alternate with medical and radiation oncologists. No clear evidence to suggest what is appropriate for follow-up appts. Clinical examinations Lifestyle, eg weight, exercise and diet, smoking, alcohol, etc Adjusting to safety net going with frequent visits whilst on treatments, financial consequences of illness, and impact on work etc.

8 What is a SCP??? A comprehensive and individualised summary and follow-up plan once the acute phase of cancer care has ended Owned by the survivor Undertaken in partnership with health care professionals Enables the survivor to take responsibility and ownership of their care, particularly in the area of lifestyle Provides the survivor with a guide on what to respond to

9 The Benefits of SCP’s A SCP provides a unique opportunity for those involved in oncology care to strengthen the coordination of services for cancer survivors to ensure that their continuing needs are met. This shifts the paradigm of cancer care from a medical model to a wellness model, and supports the transition from patient to survivor.

10 What should a SCP contain??
Issues of health maintenance and surveillance lifestyle behaviours Late effects of treatment Possible signs of recurrence Who to contact should they have concerns. Support services and their contact numbers

11 Slide Master

12 Survivorship Care Plan
This useful tool will help guide your future health care needs. 12

13 Conclusion Survivorship care plans (SCP) should be tailored to the needs of the individual and effective coordination and communication between the primary and secondary tertiary care teams is vital. Promoting self-management for people living with and beyond cancer should move from a clinically led approach to a supported self-management one, which is based on the individual’s needs and preferences. This will empower individuals to take on responsibility for their health condition which is supported by the appropriate clinical assessment, support and treatment.

14 A quote from Herbie Mann
“When you have cancer , its like really time to look at what your life was and is, and I decided that everything I’ve done so far is not as important as what I am going to do now”

15 Helpful websites

16 And Finally……. Supporting cancer survivors to live healthy and active lives for as long as possible should be a priority for health care providers across primary and secondary services. This can be achieved through the implementation of individualised assessments and forward care planning which includes information and support to enable people to get back to as normal a life as possible after cancer treatment has concluded.

17 References Hill-Kayser, C. E., Vachani, C., Hampshire, M. K., Jacobs, L. A., & Metz, J. M. (2009). An Internet Tool for Creation of Cancer Survivorship Care Plans for Survivors and Health Care Providers: Design, Implementation, Use and User Satisfaction. Journal of Medical Internet Research, 11(3), e39. National Cancer Institute (2006). About cancer survivorship research: survivorship definitions Retrieved 15th October 2010, from National Institute for Clinical Excellence (2004). Guidance on Cancer Services: Improving supportive and palliative care for adults with cancer - The manual. London New Zealand Guidelines Group (2010). Guidance for Improving Supportive Care for Adults with Cancer in New Zealand. Wellington: Ministry of Health. Turton, P., & Cooke, H. (2000). Meeting the needs of people with cancer for support and self-management. Complimentary Therapies in Nursing and Midwifery, 6(3), Template taken from -

18 Thank you , any questions?


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