University hospital southampton nhs trust

Meet University Hospital Southampton NHS Foundation Trust

University Hospital Southampton NHS Foundation Trust (UHS) provides services to approximately 1.3 million people in Southampton and South Hampshire. The oncology unit is one of 12 regional cancer centres in the UK, serving a population of 1.7 million people. The number of men with newly diagnosed prostate cancer attending the centre is estimated to be 370 per annum.

The big idea

UHS has a recent and continuing record of cancer service development. This has included a redesign of services for patients who have completed curative treatment for breast, colorectal and testicular cancer to enable them to take an active role in their recovery.

The problem

There is a clear rationale for change in prostate cancer aftercare. With increasing diagnosis and survival rates for men with prostate cancer, there is an increasing need to provide follow-up care. The pathway for prostate patients post-treatment was variable depending on the consultant involved; many patients experienced long waits to take part in short meetings where they receive PSA results, and there was little consideration of their wider needs.

Evaluation of recent service developments has shown that patients responded positively to the opportunity for managing their own follow-up as long as they are well prepared and confident that they can get back into the system if needed. Finally, capacity in the system is currently limited; the introduction of a support worker (Band 4) to help support the follow up can free up CNS and consultant time to concentrate on clinical intervention.

Improvements made

UHS appointed a new supported-self management team – comprising a CNS and a support worker to deliver a new aftercare pathway for prostate cancer, in partnership with the uro-oncology MDT. The pathway enabled men coming to the end of treatment to enter a self-managed pathway which incorporates remote PSA monitoring and timely re-access as required.

As part of the pathway it was important to ensure there was a clear selection criteria, monitoring schedule and recall criteria. There was a supported self management workshop developed for all men on the pathway

An IT platform allowed patients to access their PSA results within hours of the blood test being taken. The IT portal also enabled men to access education, self management, symptom control, and health and well being resources to support them in self managing their prostate cancer.

Men continue to have direct access to the clinical team via phone or email so clinical advice remains available within 24hrs (phone) or 48hrs (email).

Challenges

  • Development of the IT portal & PSA Tracker. This has taken a considerable amount of time and patience during the overall project. Men have found the IT portal frustrating with the expectation that this should be able to do everything. Once an explanation at the workshop or individually has taken place then their understanding becomes clearer and the frustrations dissipate.
  • Making a change to the follow up pathway. With good communication through the implementation meetings, the project team has kept momentum going over the 18 month period that referral onto the self management pathway is now becoming the standard follow up.
  • Sustainability - University Southampton Hospital has recognised the success of this project and acknowledges that self management follow up is an improved experience for the patient and made the support worker role a substantive post.

Outcomes

The new pathway is now embedded into the prostate service and supported self management is becoming the normal follow up arrangement.

Results from the patient experience survey show that men feel more informed about their condition and better able to self manage. Over 90% of men feel more confident in self managing their ongoing prostate cancer follow up after attendance at the self management workshop.