Meet NHS Fife
Each year, 450 patients in Fife are seen with a suspected diagnosis of prostate cancer and around 250 of these men are diagnosed with prostate cancer. Following biopsy results, these men require ongoing support. The team at NHS Fife engaged with the prostate cancer support group to find out what could improve care and the overwhelming feedback was that patients felt they would benefit from having a single point of contact. This project aimed to improve immediate support for men with prostate cancer in Fife by introducing a nurse as the single point of contact.
The big idea
The project’s primary aim was to improve the immediate support for men with prostate cancer in Fife. This was achieved through 12 months’ funding for a Band 6 CNS post to provide three main activities, including:
- A nurse-led clinic to prepare men for biopsies by providing support at all stages of the patient journey
- A nurse-led clinic for the pre-arranged follow-up appointments, to allow the CNS to spend time discussing biopsy results, diagnosis and treatment options
- A single point of contact for the patient, to coordinate patients’ care and answer any questions via telephone. The service is available to men with prostate cancer already receiving treatment and men who hear about the service and would like support.
Finding out what works
Since April 2014, the project has provided telephone or face-to-face support to more than 700 men from the point of the original biopsy, throughout treatment and on a long-term basis. Patients now receive a 30-minute appointment with the CNS before they undergo a transrectal ultrasound (TRUS) biopsy. During this appointment, the CNS explains details of the prostate and prostate cancer, as well as why the patient has been referred. As a result, men feel better educated regarding the reason for biopsy. Patients also have a single point of contact following the biopsy and are now receiving their diagnosis directly from the CNS.
Discussion of the shared care model with GPs has been the most challenging aspect; particularly, developing a model for the new financial agreement that will be required between primary and secondary care. In addition, moving from a consultant-led to a nurse-led histology clinic received some resistance early in the project. However, the team addressed this by agreeing to a trial period, which proved successful and helped with agreement for this change long term.
The activities of the CNS in secondary care have had positive outcomes, as the nurse-led support at biopsy has reduced the average waiting time between having the biopsy and receiving histology results by nine days. Overall, patients are better informed as a result of the more holistic support offered by the nurse at biopsy and diagnosis, with patients able to have ‘a much more meaningful conversation’ with the consultant. Secretarial staff received fewer calls from patients, particularly about test results. Instead, calls were directed to the CNS who had already had personal contact with the patient. The CNS was able to provide clinical and emotional support and notify patients of results over the phone, at all stages of their journey. In addition, the service has significantly reduced the time between the biopsy and a consultant-led appointment. Awareness of the service has spread by word of mouth and feedback obtained indicates that it makes a difference to those who use it. Supportive consultants were key to the development of the CNS post. Since appointment, the CNS has also been involved in providing support to the Consultant Urologist to explore a shared care model for the management of men with prostate cancer in Fife. Although the CNS workload in contributing to the shared care model is too early in its development to have yet realised all its desired outcomes, progress towards a shared care model will be a legacy of this work.