Establishing a uro-oncology Clinical Nurse Specialist to provide holistic support

Betsi Cadwaladr University Health Board (BCUHB) is the largest health organisation in Wales and provides primary, community, mental health and acute hospital services for a around 676,000 people across the six counties of North Wales (Anglesey, Gwynedd, Conwy, Denbighshire, Flintshire and Wrexham) as well as some parts of mid Wales, Cheshire and Shropshire.

About 570 cases of prostate cancer are expected in BCUHB per annum according to national statistics.

Due to good survival rates, there are approximately 4,000 prevalent cases of men living with or beyond prostate cancer in North Wales.

Prior to this project men did not have a CNS supporting them through their pathway. This role therefore provided men with a named CNS who could then support them throughout their diagnostic, treatment and follow-up pathways.

Specifically, the role focussed on:

More consistency and integration in the prostate cancer care pathway

• This will be achieved by the post holder taking a lead on addressing current variation in practice through production of single pathways and an MDT presence.
• This will be further demonstrated by the post having a managed case load.

More appropriate and effective use of resources

• A system of nurse-led patient triage ahead of consultant contact will ensure fewer radical surgical interventions.
• Reconfigured pathways will deliver more appropriate hospital and community based care.
• This is measured by a reduction in the number of professional appointment contacts prior to diagnosis and an improvement in meeting the 31 and 62 day cancer targets.

Men have an improved experience of follow-up care

• This will be achieved through a number of processes including improved patient information and support, and raised awareness/better training amongst primary care teams.
• This is to be measured using patient reported satisfaction measures.

• 552 men have been supported by the CNS across the project
• There has been a reduction in radical surgical interventions - 16% of patients chose surgery in 2013/14 before the post was in place but that figure dropped to 7% in 2014/15
• A patient audit showed that all patients who had contact with the CNS have an overall improved experience. They felt the information which was given was very useful and they reported that they were supported well during and after the radiotherapy.