Developing a new community care pathway for hormone refractory prostate cancer patients
Meet Peterborough and Stamford Hospitals Foundation Trust
Peterborough & Stamford Hospitals Foundation Trust (PSHFT) comprises two hospitals: Peterborough City Hospital, and Stamford and Rutland Hospital. Both Oncology and Urology services are based at Peterborough City Hospital. Patients requiring radiotherapy, chemotherapy, and newer treatments such as abiraterone and enzalutamide are seen in the oncology department, and those requiring surgery and hormone treatments are seen in urology.
The big idea
Developing a new community care pathway for hormone refractory prostate cancer patients. It tests a holistic approach to support a personalised model of care for men and their families with the rationale being:
1) There is a need to free up consultant capacity
Against the backdrop of an increasing number of patients being seen with prostate cancer (due to increased awareness and diagnosis), consultant clinics are often overbooked. Patients on chemotherapy and newer treatments such as abiraterone and enzalutamide are seen initially on a 2-weekly basis, and there is scope for introducing nurse-run clinics with this group.
2) Patient experience and quality of life can be improved
Providing a community based outreach (and tele-medicine) service would mean that patients have an improved experience, since they would spend less time travelling to appointments. This project would also include holistic assessment, and so would hopefully help to identify problems/needs earlier and therefore prevent patients from coming into hospital or seeing the GP unnecessarily. The target group of patients is likely to have more holistic needs since they are more likely to be palliative patients.
Finding out what works
The Prostate Cancer UK funding has been used to test the feasibility and potential impact of nurse-led clinics for patients with hormone resistant prostate cancer.
Clinics have been established for patients on chemotherapy, newer treatments such as abiraterone and enzalutamide, hormone therapy, PSA follow-up, and palliative care.
Some of the benefits for the following groups include:
- Improved patient experience due to less time travelling to appointments and reduced waiting times
- Improved quality of life/patient empowerment to improve their ability and confidence to self manage their health needs
- Reduction in waiting times for appointments, due to more oncology consultant clinic capacity
- Reduction in waiting times in clinic, due to the introduction of the nurse led clinics
- Increase in the number of new patients being seen over the duration of the 18 month project, due to more oncology consultant clinic capacity
For healthcare professionals:
- Improved knowledge for post-holder
- Increased knowledge for primary care staff
For the oncology service:
- Reduction in the number of overbooked consultant clinics
- Reduction in the number of emergency admissions for prostate cancer patients as hopefully symptoms and holistic needs/problems will be identified sooner and appropriate referrals made
There have been logistical difficulties in setting up a co-ordinated service for prostate cancer patients across different counties/boundaries.
These have included difficulties with the transportation of medications, different IT systems and the differences between primary and secondary care settings.
The initiatives to overcome these difficulties have required a commitment from all involved to rectify this, working with IT teams and key individuals in different counties/NHS Trusts and community teams. This was essential to ensure a co-ordinated and “joined up” approach to patient care.
The nurse has set up two weekly face to face clinics at Peterborough Hospital, one weekly face-to-face clinic at Stamford Hospital, plus a monthly face to face clinic at outreach sites, which include Wisbech Macmillan & Hudson Palliative Care Centre, the Johnson Hospital in Spalding and Oundle GP surgery. Patients are being added to these clinics on a weekly basis.
On average patients booked into these clinics are travelling between 20-40 miles less to appointments when attending outreach clinics.
The nurse has also set up a weekly telephone consultation clinic for stable patients post radiotherapy and prostatectomy, of which 235 patients have appointments in the future and this is increasing on a weekly basis:
- 100% of patients felt the telephone consultation clinic mirrored the advice, care and treatment provided by a face to face consultation.
- 100% of patients said they would be happy to use the telephone consultation clinic service in the future.
The initiative has freed up consultant time to enable them to see more new patients and more complex patients. Since the introduction of the nurse led service, there are free slots and no overbooked clinic slots.
Waiting times for first clinic appointments have improved, and two of the three oncology consultants have doubled the amount of new patients seen within a month. The time in which patients have been able to be seen has improved considerably and more than halved for one of the three consultants.
Feedback from patient questionnaires has demonstrated improved patient choice, satisfaction and experience focusing on “holistic needs”:
- 100% reported they felt waiting times had improved
- 100% reported they were satisfied with the new nurse led service
- 100% of patients appreciated having longer clinic appointments
- 100% reported they felt able to talk to the nurse about their holistic concerns, treatments and symptoms
The project has helped to reduce emergency admissions by initiating interventions earlier and preventing the need for acute care.
As a result of working closer with community services to co-ordinate the patients’ pathway and cancer journey, referrals to other services, such as district nurses, community Macmillan nurses, dietitians and hospice care have all increased.
Symptom management for palliative patients and facilitation of the wishes of these patients regarding their end of life care planning has improved.
The initiative has helped to decrease the length of stay for prostate patients by assessing them if admitted and ensuring investigations, interventions and treatments are initiated and co-ordinated earlier.