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The Treatment Record Summary, Cancer Care Review
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Transcript of The Treatment Record Summary, Cancer Care Review
The Treatment Record Summary, Cancer Care Review
Cathy BurtonMacmillan 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 AddressInsert GP Contact DetailsAddress
Dear Dr X Re: Add in patient name, address, date of birth and record numberYour 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 completedYes/NoPrescription Charge exemption arrangedYes/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 AHPSocial Worker DieticianClinical Nurse Specialist Psychologist Benefits/Advice ServiceOther
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
0% 20% 40% 60% 80% 100%
Diagnostic information
Treatment details
Treatment intent
Treatment toxicities/Late effects
Alert symptoms
Service access arrangements
On-going management plan
Actions needed by GP
Medication information
Information provided to patient
percentage of respondents
Very useful Useful Not sure Not useful Not useful at all
Rating usefulness of each section
National Cancer Survivorship Initiative
Figure 4: Has it made a difference to the way you manage your patients?
0% 20% 40% 60% 80% 100%
Fewer calls to secondary care
Reduced duplication
Fewer referrals to A&E/secondary care
Better directed access
Better use of time
Mad
e a
diffe
renc
e to
the
way
pa
tient
s ar
e m
anag
ed
percentage of respondents
Yes, definitely Yes, to some extent No, none at all
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?
4035
31 30
6
05
1015202530354045
GPs District Nurses CommunityMacmillan
Team
GP out ofhours service
Other
TRS useful for …
No. R
espo
nses
National Cancer Survivorship Initiative
Would you like this service to continue?•
Figure 6: Would you like this service to continue?44%
46%
10%
Yes in place of routineclinic letters
Yes in addition to routineclinic letters
No - continue with clinicletters only
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
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Review ing any medication the patient is taking for their condition
Providing the patient w ith information about cancer
Discussing the patient’s cancer diagnosis
Providing information or signposting to sources of informationabout benefits the patient may be entitled to
Recording w hether or not the patient has had radiotherapy orchemotherapy treatment
Recording the details of any carer(s) w ho are supporting thepatient
The date of the next cancer care review
Anything else
Cove
r in
canc
er c
are
revi
ew
percentage of respondents
Always Very frequently Frequently Sometimes Never
National Cancer Survivorship Initiative
User friendliness
0%10%20%30%40%50%60%70%
Not at all userfriendly
Not very userfriendly
Not sure Fairly userfriendly
Very userfriendly
How user friendly is the template
perc
enta
ge o
f res
pond
ents
GPs Macmillan GPs
National Cancer Survivorship Initiative
Prompts in the template
Figure 4: Prompts
0% 20% 40% 60% 80% 100%
Discussion about cancer diagnosis
Noting the details of the main carer
Review of medication
Discussion about the financial impact ofcancer
Discussion about information needs
Prom
pts
in th
e te
mpl
ate
percentage of respondents
Not at all useful Not useful Somewhat useful Useful Very useful
National Cancer Survivorship Initiative
Usefulness of resources
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
"Help w ith the cost of cancer” (signposting to information onbenefits and f inancial support)?
"Money w orries: how w e can help” (information on Macmillangrants and the Macmillan benefits helpline)?
"Hello and how are you?” (information for carers)?
"Things you might like to discuss w ith your doctor” (checklist onpossible discussion topics and signposting information on
Macmillan resources)?
"How are you feeling?” (guide on the emotional effects ofcancer)?
"The Cancer Guide" (general information about cancer)
"Talking to children w hen an adult has cancer" (a guide designedto help talk to children about cancer)
percentage of respondents
Not at all useful Not useful Somewhat useful Useful Very useful
National Cancer Survivorship Initiative
Patient satisfaction
1 12 2
15
02468
10121416
1 - Not at allsatisfied
2 3 4 5 - Verysatisfied
Overall satifaction
No. R
espo
nses
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