Establishing a uro-oncology Clinical Nurse Specialist to provide holistic support
Meet Betsi Cadwaladr University Health Board
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.
The big idea
BCUHB identified that there was a variation in the level of CNS support prostate cancer patients were offered across their pathways.
Establishing a new CNS post was seen as an opportunity to streamline the pathways and improve the patient experience by ensuring all men received an equitable and suitable level of CNS support. This role also provided an opportunity to support the National Cancer Survivorship Initiative by ensuring men living with prostate cancer get the holistic support they need to lead as healthy and active lives as possible.
It was envisaged that this project would allow for all men to have a named CNS, create risk stratified pathways, result in men being supported throughout their pathway to ensure seamless care is provided, and ensure men are offered HNAs and treatment summaries.
Another element of the role was to develop better integration between primary and secondary care. This would involve supporting GP practices and primary care to provide follow-up care, developing robust nurse-led approaches and protocols that are supported by the multidisciplinary team.
It was thought that this new approach would use existing resources more effectively and more efficiently.
Finding out what works
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.
It was a struggle to make a reduction in the number of professional appointment contacts prior to diagnosis because of the sheer numbers involved and the fact that there was no CNS already in post.
An improvement in meeting the 31 and 62 day cancer targets has been difficult to achieve due to having recruitment problems within the Trust for Urology Surgeons. This problem has now been solved so breaches of these targets should now reduce in number.
- 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.