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.
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:
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.
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.
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:
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:
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”:
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.
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.