1 Final Version© Ipsos MORI Final Version Evaluation of Adult Cancer Aftercare Services...
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1 Final Version © Ipsos MORI Final Version Evaluation of Adult Cancer Aftercare Services Quantitative and Qualitative Service Evaluation for NHS Improvement
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Transcript of 1 Final Version© Ipsos MORI Final Version Evaluation of Adult Cancer Aftercare Services...
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Final Version© Ipsos MORI
Final Version
Evaluation of Adult Cancer Aftercare Services
Quantitative and Qualitative Service Evaluation for NHS Improvement
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Final Version© Ipsos MORI
Overview
To establish a baseline in patient experiences of cancer aftercare services against which to measure the implementation of risk
stratified pathways
To provide NHS Improvement with the information needed to take the programme forward
To evaluate care coordination services for people living with and beyond cancer in the 8 test sites and to explore people’s
perceptions and preferences for these
The development of risk stratified pathways of care
Care coordination as an enabling project
Background
Objectives
Outcome
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Final Version© Ipsos MORI
Living with and beyond cancer
Source: Effective follow up: Testing risk stratified pathways, NHS Improvement – Cancer, May 2011
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Final Version© Ipsos MORI
Methodology
Engagement and initial interview days
Final telephone depths with patients
Patient contact interviews
Staff telephone depths
Charity contacts telephone depths
Baseline postal survey across 7 sites
Car
e C
oo
rdin
atio
n
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Final Version© Ipsos MORI
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Overview of quantitative findings.....
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Final Version© Ipsos MORI
Overall, how would you rate the quality of the care and services you have received since your initial treatment finished?
Overall patients were very satisfied….
32%
27%
15%
5%
19%
Excellent
Very good
Good
Poor
Very poor (1%)
Terrible (1%)
74% of patients rated their care as good or excellent
Not stated
Base: All respondents (1,301); Fieldwork dates 21 April – 2 September 2011Source: Ipsos MORI
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Final Version© Ipsos MORI
and care plans, for those who had them, were proving useful….
Source: Ipsos MORI
21%
69%
4%
Have you been given a care plan?
YesNoI was offered one but I didn't want it
Base: All respondents (1,301); Fieldwork dates 21 April – 2 September 2011 Base: All who have a care plan (279); Fieldwork dates 21 April – 2 September 2011
41%
43%
6%3%
6%
How useful do you find your care plan?
Very usefulFairly usefulNot very usefulNot at all usefulI have never looked at my care plan
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Final Version© Ipsos MORI
How confident do you feel about managing your own health, if at all?
Most patients were confident in managing their own health
Base: All respondents (1,301); Fieldwork dates 21 April – 2 September 2011Source: Ipsos MORI
30%
53%
8%2%
3%
Very confident
Fairly confident
Not very confident
Not at all con-fident
Don't Know
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Final Version© Ipsos MORI
Do you have all of the.....
Information provision varied
Source, Ipsos MORI
78% 77%
55%
14% 16%
37%
Yes No
Base: All respondents (1,301); Fieldwork dates 21 April – 2 September 2011
...information and advice that you need about the signs and symptoms of the cancer so that you can tell if the cancer comes back?
...information and advice that you need about the effects of your treatment?
..information, advice or support you need to help manage your health?
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Final Version© Ipsos MORI
10%8%
77%
2%
45%
47%
Series1 38%
5%
71%
2%
22%
9%
*
1%
3%
*
*
2%
1%
Three-quarters of patients knew who they should contact...
Do you know who to contact during office hours if you had a health concern related to
cancer, or your treatment for cancer?
Base: All who have contacted a health care professional during office hours (607); Fieldwork dates 21 April – 2 September 2011
My GP
Yes
NoNo, but I would know how to find out
Have you ever needed to contact a health care professional about a health concern related to cancer, or your treatment for cancer, during office hours?
Who did you contact?
Yes
No
I don’t know/can’t remember
My GP practice nurse
Cancer hospital nurse
My pharmacist
My cancer doctor or their secretary
My district nurse or community cancer nurse
Someone else
Base: All respondents (1,301); Fieldwork dates 21 April – 2 September 2011
Healthcare at home representative
Hospice
Macmillan nurse
Radiotherapist
Trials practitioner/nurse
Other support teams/centres
Source, Ipsos MORI
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Overview of emerging qualitative findings.....
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Final Version© Ipsos MORI
Nurse/ consultant
Service
Service
Service
Service
Service
Service
Patient
How is care coordinated at the test sites? Medical model
• Traditional ‘medical’ model
• Patient attends follow-up appointments at regular intervals
• Referred on as necessary to other services
• Patient has details of CNS to contact if they have concerns
• Care is coordinated for the patient
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Final Version© Ipsos MORI
Nurse/ consul-
tant
Service
Service Service
Service
Service
Service
Patient
How is care coordinated at the test sites? Self-management model (patient-centric)
• Self-management model
• Patient no longer attends follow up appointments
• Patient may have remote monitoring
• Patient is given information and advice to support them – signposting to other services
• Patient coordinates their own care
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Final Version© Ipsos MORI
Nurse/ consultant
Service
Service
Service
Service
Service
Patient
Service
How is care coordinated at the test sites? Self-management model (in practice)
• Self-management model
• Patient no longer attends follow up appointments
• In some sites they are offered an appointment with the nurse instead or a telephone appointment
• Patient may have remote monitoring
• Patient is given information and advice to support them – signposting to other services (information days)
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Final Version© Ipsos MORI
Nurse/ consult
ant
Service
Service
Service
Service
Service
Patient
Service
How is care coordinated at the test sites? Self-management model (in practice)
• Self-management model
• Patient no longer attends follow up appointments
• In some sites they are offered an appointment with the nurse instead or a telephone appointment
• Patient may have remote monitoring
• Patient is given information and advice to support them – signposting to other services (information days)
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Final Version© Ipsos MORI
Nurse/ consultant
Service
Service
Service
Service
Service
Patient
Service
How is care coordinated at the test sites? Self-management model (in practice)
• Self-management model
• Patient no longer attends follow up appointments
• In some sites they are offered an appointment with the nurse instead or a telephone appointment
• Patient may have remote monitoring
• Patient is given information and advice to support them – signposting to other services (information days)
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Final Version© Ipsos MORI
Care coordination – key questions
• How well was care coordinated between services at each test site?
• How well was care coordinated across primary and secondary care?
• Did patients have access to a range of different services?
• Did patients know who to contact about problems?
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What is good care coordination?
• Patients described good care coordination as being:
• Someone is looking after them
• Leading to best possible quality of life
• Never out of touch with services
Reliable
Responsive
Smooth
QuickClear answers
Right person at the right time
Confidence
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Potential enablers to good care coordination
• To identify the support that a patient might need
• To make patients aware of the support available
• To provide patients with the skills, knowledge and confidence they needed
• Patients saw the CNS as having a coordinating role
• Assessment and care planning
• Information days
• Self-management programmes
• The role of the CNS
• To record and share information • Hand-held record
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What happens when it goes wrong?
Examples of bad care coordination were infrequent but consisted of:
• Seeing a different doctor every time
• Lack of information sharing or poor information sharing
• Admin errors (not receiving letters)
• Patient not involved in decisions
• Not feeling listened to
• Feeling rushed
• Possibility of falling through the net
• Worry that they will fall through the net even where not the case
• General stress
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Staff views
Self management as an end goal
Concerns about patients’ ability to
manage their own care
Self-referCoordinate
services
• Assessment and care planning
• Information days• Self-
management programmes
• Rapid Access Service
Actions
• Information days• Self-
management programmes
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Challenges for care coordination
• Communication channels between primary and secondary care
• Cross site working
• Resourcing issues – moving demand?
• Under self-management, responsibility for coordinating care lies with patient (to a greater extent):
• Lack of care to be coordinated; or
• More services involved for the patient to coordinate themselves• Lack of confidence
• Information overload
• A desire to feel ‘looked after’
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Final Version© Ipsos MORI
What next?
• Final interviews with patients
• Analysis of the qualitative data
• Evaluation of care coordination
• What else can the data tell us? • To what extent are patients self-managing their care?
• What does this involve?
• How do they feel about it?
• What information needs do patients have?
• Quantitative follow up survey
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Final Version© Ipsos MORI
Final Version
Thank [email protected] | 020 7347 3996
[email protected] | 020 7347 3151
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© Ipsos MORI This work was carried out in accordance with the requirements of the international quality standard for market research, ISO 20252:2006 and with the Ipsos MORI Terms and Conditions which can be found here
