1. The Development of an Innovative Nurse-Led Ovarian Cancer Survivorship Clinic
Sarah Burton Macmillan Clinical nurse specialist, Clare Churcher Clinical Nurse Specialist, L Hanna Consultant Clinical Oncologist , R Jones Consultant Medical Oncologist and E Hudson Consultant Clinical Oncologist
Background
Velindre Cancer Centre is the largest non-surgical cancer hospital in Wales providing radiotherapy, chemotherapy and other specialised treatments. It is one of the ten largest cancer centres in the UK and has a commitment to high quality care which means that Velindre is widely regarded as a centre of excellence.
In April 2011, Velindre funded two Gynae-Oncology Clinical Nurse Specialists, prior to this there had been no Specialist Nurse cover for twenty months. Due to the increase of cancer incidence and patients living longer, a clinic Audit was conducted in 2011 which formed the basis for the need for change. This audit looked at Gynaecological Oncology follow up service delivered by Velindre.
This identified alternative ways to deliver efficient, effective care to patients addressing waste, harm and variation. Velindre were unable to maintain the level of follow up appointments as there were too many patients to be seen by the number of consultants available. Patients often had to wait up to four hours to be seen and a travelled long distance for what was quite often a routine appointment with no clinical problems identified. Over running clinics was a regular occurrence as well as patient dissatisfaction.
Method
In May 2011, the Gynae-Oncology team at Velindre established an Innovative nurse-led ovarian cancer survivorship follow up clinic; this clinic would re-define what ovarian cancer follow-up should look like and deliver effective follow up care for women with Ovarian cancer.
The patients were informed of the change in the way we provide our follow-up care at Velindre, by writing patient information leaflets. We gave these leaflets to patients on their last cycle of chemotherapy.
With the help of medical records, the clinic was given its own unique clinic code (RJ5); this clinic would run weekly on a Tuesday afternoon from 2pm to 5pm by the two Specialist Nurse’s, Sarah and Clare. Each patient was originally given a twenty minute slot, however after the first clinic this became clear it was not enough time for each patient, therefore this was changed to thirty minutes each patient.
During the consultation by the specialist nurse a full assessment is carried out using the eight domains of survivorship
After a six month pilot of the clinic the effectiveness of the service was evaluated by using a patient satisfaction questionnaire.
Results
We distributed by post, thirty questionnaires to patients and twenty-five questionnaires were returned, giving a response rate of 83.3%. These returned questionnaires showed 100% patient satisfaction with the service provided by the specialist nurses.
When asked: On a scale of 1-5 how pleased were you that you were seen in the nurse led follow up clinic? (1. Not pleased at all 5. Extremely pleased)
52 % of patients replied scoring 4 and 38% of patients replied scoring 5
Comments:
“This saves a lot of time waiting to see the doctor and makes sense”
“As I am currently feeling well I feel the doctor’s time is better spend with patients who are not well”
Physical symptoms
Financial
Psychological
Social
Emotional
Spiritual
Nutritional
Sexual function
When asked : Do you feel confident with the specialist nurse who saw you in clinic? (1. Not confident at all 5. Extremely confident)
29 % of patients replied scoring 4 and
71% of patients replied scoring 5
Comments:
“She explained every question I asked her in detail, I was extremely confident”
“I was made to feel relaxed and found her easy to talk to”
When asked : Were you satisfied that the specialist nurse's explanations were adequate for your needs?
(1. Not confident at all 5. Extremely confident)
19 % of patients replied scoring 4 and
81% of patients replied scoring 5
Comments:
“The nurse’s explanations were great. She made me feel a lot more confident and happy”
“Very useful to know that I or my family can ring specialist nurse if there are unclear matters to be clarified”
Patient pathway before nurse led clinic
Patient pathway including nurse led clinic
Evaluation
The service was evaluated by the questionnaire, which showed 100% patient satisfaction with the service provided by the Specialist Nurses. Comments included –
Consultant led follow up clinic
Patient initiated on follow up
Nurse led survivorship clinic
Consultant follow up clinic
Consultant follow up
(1st visit post chemo)
Patient initiated on follow up
“Faultless” “They were great” Very Respectful”
“How privileged and fortunate we are to have such a great service in an uncertain time”
On our next evaluation of the service, we would prefer to give the questionnaire out personally to the patient after clinic to complete, rather than sending them out by post. Future evaluation will include financial impact of the service change and staff opiinions.
Recommendations
As this service had 100% patient satisfaction it is the aim of the Gynae-Oncology team to continue the survivorship clinic and expand it to include other patients with Gynaecological malignancies.
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