Meet Royal United Hospital Bath

The Royal United Hospital (RUH) Bath NHS Trust serves a population of approximately half a million people. It is a medium to large district hospital offering a comprehensive prostate cancer service through the urology and oncology departments. Although it is not a cancer centre, the RUH is able to offer most treatments on-site; including laparoscopic radical prostatectomy, brachytherapy, and conformal external beam radiotherapy.

The big idea

The majority of Uro-oncology Clinical Nurse Specialist (CNS) roles have developed from surgical need. Whilst the majority of newly diagnosed patients at the RUH will meet a CNS and all men who have surgery or brachytherapy will be seen regularly for follow up appointments in a nurse led clinic, it became apparent that men having external beam radiotherapy were not exposed to the same level of intervention from the CNS. It was felt that this patient group would benefit from the same style of clinic, as often patients felt lost between ending their treatment and being seen by a Doctor in the oncology setting. This could be up to four months. It was also felt that there were more ways in which the patient experience could be enhanced with a nurse specialising in the care of men with prostate cancer.

We funded a CNS (Band 6, 1.0 FTE) to deliver the project.

Making it happen

The service focussed on improving support for men post treatment, particularly post radiotherapy, by creating:

• A nurse led clinic that provided follow-up support, including the completion of Holistic Needs Assessments, for all patients who receive radical radiotherapy.
• A telephone clinic to support men who underwent surgery or brachytherapy at home 2-3 days after discharge from hospital.

These services ensured men could access advice and support in a timely manner which is appropriate to their patient journey.

To assess effectiveness of the new service, the project initially involved completing an audit of the existing service and undertaking a postal survey of men who had undergone external beam radiotherapy from April 2012 - March 2013. A regular CNS clinic was then set up for patients who were six weeks post treatment. Each appointment was scheduled for 30 minutes and an oncologist was available for advice if needed. After six months the new service was audited.

Lessons learnt

• It is vital to have a constructive and supported orientation programme to ensure post holders become a part of the established CNS team, who are able to advise and support the development of the post.
• If possible, have project posts as supernumerary during their orientation and the project scoping phase.
• Work closely with urology and oncology teams to undertake service provision evaluation and make subsequent recommendations regarding future utilisation of a CNS post.
• Advanced communication courses for specialist nurses are essential.
• The increased use of chemotherapy drugs for those with advanced prostate cancer will provide an opportunity to expand the role and provision of CNS services within the oncology settings.

Outcomes

Prior to setting up the new post-radiotherapy clinic a questionnaire was sent to the 135 patients identified as undergoing radiotherapy from April 2012-March 2013. There was a 79% response rate (107 men) of which:

• 78% of men were seen by a CNS at time of diagnosis
• 73% had a named CNS
• 94% received written information about their condition
• 75% had troublesome symptoms during treatment (mainly bowel/urinary problems, impotence and fatigue), but most of these men (89%) knew who to contact
• Of those seeking help, 65% contacted a radiographer and only 35% a CNS
• 60% thought a post-treatment CNS clinic would be useful

Six months after introduction of the post radiotherapy clinic a postal questionnaire was sent to the 65 men who had attended to assess their experience. There was a 77% (50 men) response rate of which:

• 89% of men were seen by a CNS at time of diagnosis
• 100% of men post radiotherapy had been seen in the new CNS clinic
• 98% found this helpful
• 95% were happy their questions had been answered and advice given
• 78% completed a Holistic Needs Assessment, and 92% found this useful
• 96% would recommend the Prostate Cancer UK CNS service

Next steps

Following completion of the pilot, the role became a substantive post through RUH funding. The services and support provided by the CNS will continue to be assessed to ensure they meet the needs of the men.

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