Personalised Stratified Follow-Up

A Global Initiative

Discover more about Movember's TrueNTH initiative and our work across the major factors of prostate cancer care

About TrueNTH


 

TrueNTH Supported Self-Management

This cost-effective programme for personalised stratified follow-up delivers better outcomes for prostate cancer patients and has been shown to free up capacity in the follow-up pathway. 

The programme moves follow-up care from outpatient clinics to remote monitoring. Men who are eligible for remote follow up therefore don't need to attend routine appointments unless an issue arises.

It has four key elements:

Online community man of men

1) Online Patient Service

Access to an online portal that allows patients to check test results, complete assessments, view patient information and message their clinical team.

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2) Remote Monitoring

A PSA tracking system that can alert the clinical team to missed tests and results that fall outside the personalised safe ranges, ensuring no man is lost to follow up. 

health professional

3) Support Worker

The band 4 support worker acts as a key worker during their follow up care. This person is solely dedicated to the follow-up pathway and are critical to ensuring its safe and effective delivery.

An example job description can be viewed below.

Prostate Cancer Support Worker Job Description
Man of Men group

4) Workshop

A 4-hour supported self-management workshop with a group of 8 to 10 men to develop knowledge, skills, and empower confidence to manage their prostate cancer follow-up. The sessions also introduces the patient to the remote monitoring IT portal. 

Online learning to support you to deliver these workshops will be made available soon.


 

The Evidence

From 2015, researchers from the University of Southampton (funded by the Movember Foundation, delivered in partnership with Prostate Cancer UK) trialled the initiative in five NHS trusts. 

The results show that a shift to a supported self-management model of care with remote surveillance and a transition workshop;

  • resulted in high satisfaction levels with the model of care
  • meets NICE cost-effectiveness criteria
  • addresses capacity issues by replacing a one-size-fits-all model with a new, personalised approach for men who are progressing well
  • places emphasis on a positive patient role in recovery and looking after their health and well-being
  • patients reported equally good outcomes when monitored remotely compared to having appointments for their follow-up care. 

Read the full report here


 

'How To' Resources

Guidance Booklet

A brief overview and guide for implementing supported self-management can be found here

Click here to view

The Toolkit

This toolkit aims to support implementing stratified follow-up in prostate cancer, and can be tailored for other cancer services

Click here to view


 

Patient Case Study - Daniel's Story

Royal Cornwall Hospital

The Royal Cornwall Hospital is one of five NHS Trusts that took part in the pilot programme

Learn more


 

Further Reading

Protocol

Cheshire & Merseyside protocol for breast, colorectal, and prostate cancer

click here

Toolkit Appendices

Further reading and guides as outlined in the toolkit can be found here

Read On

FAQs

A list of the most common queries regarding Personalised Stratified Follow Up

Click here

Insights

Read more about how this model of care can save NHS resources and support men better

Read the article