Develop a standardised 'recovery programme' for those that have had a radical prostatectomy
Meet The Royal Marsden NHS Foundation Trust
The Royal Marsden NHS Foundation Trust cares for the largest number of cancer patients in London, and with its academic partner, The Institute of Cancer Research, it comprises the largest comprehensive cancer centre in Europe with a combined staff of over 4,600. The Royal Marsden has two hospital sites, in London and Surrey, and a chemotherapy medical daycare unit at Kingston Hospital, as well as delivering Sutton and Merton community services. It is one of the 17 organisations within the London Cancer Alliance.
The big idea
Develop a standardised ‘recovery programme’ for those that have had a radical prostatectomy which embraced Patient Reported Outcome Measures (PROMs) to define, evaluate and reassess supportive care needs. The recovery programme included a pre-habilitation health and wellbeing event designed to promote self-care with signposting to supportive care services “closer to home”. Regular contact was then made with the patient either by telephone or face to face at 4 weeks, 3, 6, 9 and 12 months post-surgery, ending with a further community based health and wellbeing event.
Finding out what works
The purpose of the project was to formalise a structured recovery pathway that will:
- Improve patient outcomes by embedding PROMS and HNA’s in the reassessment of men’s needs
- Improve patient experience
- Provide adequate information to enable early self-management of symptoms, increasing awareness in accessing local services, through pre-hab seminars and post treatment Health and Wellbeing Events (HWBE)
- Standardise men’s follow-up to co-ordinate the transfer of care from secondary to primary care
- Increase awareness of men’s health needs and improve training for other healthcare colleagues
- As a result of an increased awareness of men’s health needs, create additional services such as a weekly survivorship clinic to support men with urinary symptoms and erectile dysfunction following prostate cancer treatment.
Some of the lessons learnt from the project have included:
- Inviting men to HWBE takes a multi-modal approach – use leaflets, posters and face-to-face inviting.
- A survey 3 months post HWBE showed that 44% reported accessing the services promoted during the event & 22% reported no unmet needs and no access to services required
- Feedback from the pre-treatment seminars and HWBE has been largely positive
- For HWBE, integrate multiple health professionals to increase & spread knowledge in the HCP workforce
- Administrative support is essential
- Projects require a funded project lead to oversee the work
- Engagement with staff and services is needed as early as possible to gain support with the project
- Some inconsistencies in staff working on the project during the early phase has meant spending additional time on recruitment processes
- Robust data gathering was not established early on but was overcome by adapting the approach from community delivery to hospital based structured pathway
- Delivering HWBEs is reliant on venue availability, professionals and organisations volunteering time and resources, and so requires collaborative working and flexibility
- Implementation of a structured pathway into practice requires regular communication with all members of the urology team to update and feedback on progress
We used the following validated questionnaires to assess health-related quality of life (HRQOL), emotional, functional and social role needs: IIEF-5, ICIQ, IPSS, EORTC-25, Holistic Needs Assessment (HNA)
- 278 men have been involved in the project
- Of the 69 men discharged so far: 13% were discharged at 3 months and 38% at 6 months under the formalised structured pathway.
The HWBE’s are picking up very well. I have helped to run them and there is nothing but positive feedback from the patients who attend