GETTING IT RIGHT FOR OUR PATIENTS And for the staff!
WHY DO WE NEED TO CHANGE Improved health, physical fitness and nutrition decreases risk of breast cancer recurrence and death from breast cancer Current follow-up is a huge strain on NHS resources but more importantly it does not provide the quality we are aiming for. We believe there is a different way which improves efficiency and quality. We will then have the capacity to see patients quickly at time of need
Moving Forward after Breast Cancer I wish to discharge most patients early from active follow-up; knowing we have given them the knowledge and information and confidence they need to return to as near normal life as possible (better in many). I want our patients to know that should they have a problem they have sufficient knowledge to seek help from the most appropriate health care professional. See the right person quickly.
cliniciansNo of OPDsReason BSU Diag Radiologist/ BCN 2+?lobular/multifocal/axilla Symptomatic Diag Surgeon/ BCN 2+Psych/staging/recon Treatment (Surgery/ NACT/PET) Surgeon +/- BCN May need further surgery Results Surgeon/ BCN 1Treatment Summary Referral to CCOOncol +/-BCNseveral PRN Wound clinic Nurse +/-cons 1+ (may be lots) Routine F/upCons or ANPUpto 10 Individual/info on demand/ Extra F/ups via GP/BCN/CCO Cons +/-BCN1-2 minNew problem * New referral GP/CCO/Radio Cons/BCNRe-start
Reason BSU Diag ?lobular/multi /axilla (pt letters diet/exercise) Symptomatic Diag Psych/staging/ recon Treatment (Surgery/NACT/PET) May need further surgery HNAs Survivorship.Moving Forward file Results NEW Treatment Summary/Bone health letters etc. Advice re diet/excercise Referral to CCO RT/CHEMO education PRN Wound clinic Routine F/up Individual/info on demand ???????????? Extra F/ups via GP/BCN/CCO ? New problem * Route taken ? New referral GP/CCO/Radio ? recurrence/ second ca
clinicianOPDs Reason BSU Diag Radiol / BCN 2+ ?lobular/multi /axilla (pt letters diet/exercise) Symptomatic DiagSurgeon/ BCN2+ Psych/staging/ recon Treatment (Surgery/NACT/PET)Surgeon +/- BCN May need further surgery Holistic needs assessment BCN/ ANP 1 Survivorship. Moving Forward File ResultsSurgeon/ BCN1 NEW Treatment Summary/Bone health letters etc Referral to CCOOncol +/-BCNseveral RT/CHEMO education PRN Wound clinic Nurse +/-cons 1+ (or many) ROUTINE F/upCONS / ANP upto 10 Individual/info on demand ???????????? Extra F/ups via GP/BCN/CCOCons +/-BCN1-2 min ? New problem * Route taken ? New referral GP/CCO/RadioCons/ BCN Re-start ? recurrence/ second ca
WHY DO PATIENTS COME TO CLINIC Reassurance and psychological support: Test results: ? write and phone for benign Trial protocol To ask about : side effects of treatment, problems after surgery, should their family be checked?, can they have reconstruction To check whether it has come back X
Health/Well-being/Education Exercise: Shoulder physiotherapy Warm up Exercise physiotherapist Personal exercise plan Cancer patient group exercise class Mainstream exercise Morale boosting/Buddying/FUN! Information Family history Reconstruction X-ray F/up Side effects,post-surgical problems, pain Late effects chemo/RT Psychosexual/confidence/ Fear of recurrence Financial/work Nutrition/smoking
cliniciansNo of OPDsReason BSU DiagRadiologist/ BCN2+ ?lobular/multifocal/axilla. Pt info from start. Pts weight Symptomatic Diag Surgeon/ BCN 2+ Psych/staging/recon/smokin g/diet/excercise HNABCN Psych/reduce need for phone calls /attendances Treatment (Surgery/ NACT/PET) Surgeon +/- BCN May need further surgery Results Surgeon/ BCN 1Treatment Summary Referral to CCOOncol +/-BCNseveral PRN Wound clinic Nurse +/-cons Only when really necessary more education to reduce attendance Health and Well- Being Clinics 1 x ANP/Cons /BCN 4-8 sessions but upto 40pts Move from support Patient self-management Final reviewBCN/ANP +/_Con
How do we do this? Health/wellbeing: away from breast unit (St Caths) after adjuvant treatment. (3/12 post RT, 6/12 chemo) Groups of women do chatting and support well All will be advised this is an impt part of Follow-up Px like Ais, RT and Chemo Not all will manage d/c from active f/up. ?annual review, phone calls, GP Will still get mammos/ trial f/up Separate clinics for recon/FH info in MF files At final review: Is d/c appropriate for this particular patient Need agreement for easy,quick referral for new assessment GP may feel at Cancer Review OPD that patient needs more individual in-put from us