Wirral CCG commissions most hospital care and community services across the Wirral. Within its footprint, Wirral University Teaching Hospital (WUTH) provides the regional Urology Specialist MDT service for bladder, prostate and kidney. Currently, patients are referred into WUTH to be seen either at Arrowe Park Hospital or Clatterbridge Hospital.
Wirral has a prostate cancer incidence ratio 15% higher than the England average and 18% higher than the North West average; and mortality for prostate cancer is low compared with other cancers. Taken together, these factors suggest that the development of survivorship services for men with prostate cancer could have a significant impact on the quality of care for patients in the region.
The project introduced a new Prostate Cancer Nurse Service, which aimed to reduce unnecessary referrals back into the hospital and therefore increase clinic space for new referrals, support shared care arrangement so that stable patients are discharged back to GPs, and provide patients and their carers with timely support, advice, referrals and signposting relevant to their individual needs.
The Prostate Cancer Nurse Service established community based clinics and worked in partnership with secondary care to provide all prostate cancer patients with a Holistic Needs Assessment (HNA) at key points in their pathway to support self-management and improve quality of life.
The aims of the service were to:
The team gained valuable insight into the benefits that HNAs can offer both patients and their relatives. They used the 'Identifying your concerns' check list which was developed as part of the National Cancer Survivorship Initiative. This tool is completed prior to their assessment and allowed patients to discuss sensitive issues that may have not otherwise been addressed.
The 'Living with Prostate Cancer' course has been a valuable learning experience and has shown how a group of men can be supported and educated through a six week programme. They enjoyed an introduction to exercise, education of symptom management and gained valuable peer support from other members of the group. This course has enabled us to get a better understanding of the impact that prostate cancer has on men and their families and will assist in shaping the future service.
Initially the team found integrating with the local Secondary care hospital team challenging. This has been due to restructuring of services, change in Service Leads, meetings being arranged in a timely manner and time constraints of staff in order to support the integration process.
However within the local hospital they made progress in overcoming these challenges and now have regular contact via phone and email with the Uro-Oncology nurses. Monthly meetings in the hospital were also established to support integration of the roles.
Initially raising awareness and getting referrals into to the service was challenging. This was overcome by emailing and contacting GP surgeries introducing the service, getting the commissioners involved to raise the profile and offer support. Writing to all consultants personally to explain what the service entailed and how to refer. Posters were put up in all GP surgeries and clinics within our local community. The team developed patient leaflets with contact details on and have attended link groups and local support groups.
The Prostate Cancer Nurse Service has been a successful and popular service. It won the Wirral Community NHS Trust 'Patient at the Heart' award, and there was strong community support for the service.
Using the HNA as a tool, the service has identified the issues that men were most concerned by such as continence and erectile dysfunction. This has ensured men have timely support, advice, referrals and were signposted to relevant services.
The clinics were run in the community which helped in providing care closer to home.
80% of men surveyed felt that the support from the nursing team improved their quality of life and 100% of men surveyed had a very good experience of the service.
Five Living Well with Prostate Cancer Survivorship Courses in partnership with Maggie's Merseyside and Livewell services were run. The pilot course was evaluated and 70% of men felt more in control of physical symptoms and 100% were satisfied with amount of support and encouragement received on programme.
A business case has been submitted and Wirral Community Trust is reviewing options.
If you would like to learn more about this project, please contact us.
We publish new best practice guidelines on active surveillance, as NICE advise it should be offered to men with low risk localised prostate cancer.
