Improving wellbeing support services in a hospice setting

Meet the Hospice of St Francis

The Hospice of St Francis serves West Hertfordshire and cares for patients with life threatening illnesses, including men with prostate cancer. Together with The Peace Hospice, the Hospice of St Francis serves a population of 600,000. Secondary care services in the area for prostate cancer include those at the Mount Vernon Cancer Centre (East and North Hertfordshire NHS trust), and the urology department at Luton and Dunstable University Hospital.

Hospice services include care given either in the inpatient unit (14 beds), out in the community (current caseload is 170 patients), or through the ‘Spring Centre’, which is a well-being centre for people at any stage of their illness, regardless of prognosis.

The big idea

It was identified that there was a need to expand the support services for men with prostate cancer. Support after diagnosis and treatment was generally lacking, and particularly so for men given they have specific needs in relation to living with prostate cancer or the consequences of it.

There was also a need to improve access to wellbeing support services for all men with prostate cancer. In West Hertfordshire men with prostate cancer fall within a wide age range (predominantly 50-90 years). The Hospice has traditionally tended to see men in the oldest age ranges. This made it important that the project targeted younger men to ensure they also accessed the Hospice’s out of care services.

The project aimed to fill these gaps by extending the reach of the Hospice services, and giving more men with prostate cancer a ‘voice’. The project was implemented across two sites, the Hospice of St Francis and The Peace Hospice.

With thanks to the Movember Foundation, we funded one Prostate Cancer CNS (Band 7, 0.8 FTE) and a Communications Educator (Band 8b, CNS, 0.2 FTE) to deliver the project.

Making it happen

Over the 18 month period of the project the following services have been developed:

Prostate cancer wellbeing clinic

Clinics are held weekly on both hospice sites. A Holistic Needs Assessment (HNA) is offered at the first appointment. Following the assessment, a care plan is written and referrals are made to wellbeing services according to their needs and preference.

Prostate cancer wellbeing course

These were designed to support men following treatment for prostate cancer. The course consists of six, weekly sessions on a different topic. The topics were semi-structured but were ultimately chosen by the men attending the group. They included:

• Supported self-management
• Diet and exercise
• Body changes and intimacy
• Management of side effects
• Fatigue, stress and relaxation
• Moving forward
• Communication (Walnut Programme – see below)

Walnut Communication Training Programme

A training workshop that explores the barriers to effective communication. It helps the men develop strategies to deal with sensitive conversations with health professionals and those close to them. It has been delivered as a standalone workshop and also as part of the Prostate cancer wellbeing course. Watch a video on how to deliver this course.

A support group

Two support groups were already established in the area prior to this project starting. The CNS completed an audit to establish whether a further support group was required. Only two responses were received form men who were interested in attending, who were signposted to the established groups. However, a new support group has evolved out of the Prostate cancer wellbeing course with CNS support.

Since April 2015 men with stable prostate cancer within West Hertfordshire are now offered follow-up within Primary Care. The CNS has worked with the NHS Herts Valleys CCG, Transforming Prostate Cancer Follow Up group to develop this service. The Prostate cancer wellbeing clinic and the wellbeing course are now an integral part of the new pathway out of secondary care.

To support this process the CNS has developed a Prostate cancer holistic needs assessment tool and a tool kit for Primary Care Nurses to support them in their follow up of this group of patients. The CNS has also delivered five educational sessions to Primary Care Nurses and GPs.

Challenges

Collaborative working:

• Working across two sites was challenging. The practical aspects of desk space, IT support and travel time proved difficult, but for the most part these problems have been resolved over time.
• Both organisations use different tools to asses and evaluate services. Unifying assessment on both sites continues to be challenging but the CNS is working with the key people to establish a way forward
• Promotion of the service; ensuring both organisations are fairly represented. Initially, flyers and posters were produced for both sites, but now a single resource with both logos is being produced. A joint logo for both centres would have been a useful resource from the outset.

Forming relationships with primary/secondary care:

• Promoting the service and meeting with key stakeholders is vital but time consuming and is a process that is ongoing. Initially every GP surgery was visited, but after about 25 it became apparent that this was not the best use of time. Attending GP evenings, Nurse Education and MDT meetings provided suitable exposure and took up less time.
• Access to secondary care was problematic. Acquiring an Honorary Contract eased this issue considerably.

Lessons

• At the beginning of your project, spend time deciding on what tools you are going to use when evaluating the service and what data you need to record.
• Keep your evaluations and data collection up to date.
• Consider long term funding earlier into the project.
• Working on two sites is challenging, there can be issues around desk space and IT support. Information governance needs to be adhered to, resources to enable access to patient information at either site is essential.
• Involve all key stakeholders as the project develops. It is these stakeholders can help influence the sustainability of the project.
• Keep the local community involved, use your communication teams.
• Continued promotion of the service is needed; choose various way to promote the service.
• Establish honorary contracts with organisations you are working closely with.

Outcomes

• 93% of the men who attended the Prostate cancer wellbeing clinic, and completed an evaluation form, felt that the overall experience was excellent. 6% reported the service as very good.
• 83% of men who attended the Prostate cancer wellbeing course reported an improvement in their level of sense of wellbeing.
• 100% of men who attended the Wellbeing course and Walnut programme would recommend it to others with 75% going onto access other services within the wider wellbeing services.
• 198 health and social care professionals reported increased awareness and knowledge around prostate cancer.

Next steps

Given the success of the project, the Hospice of St Francis has agreed for the CNS role to be made a substantive position. This will allow for continued expansion and integration of the programme in West Herts. The CNS will also develop a local cancer strategy in the future.

Find out more

This project has been funded through our Health and Social Care Professionals Programme, thanks to support from The Movember Foundation.

If you would like to learn more about this project, please contact us.