Information for prospective Macmillan Virtual MDT Expert Pool members

Transcription

1 Overview of the Macmillan Virtual MDT (vmdt) for Complex Consequences of Cancer Treatment The Macmillan vmdt allows referrers to access written expert opinion from across the UK, within 2 weeks, on the management of a person who is experiencing poor quality of life and ongoing symptoms due to complex consequences of cancer treatment (CoTs), for which local expertise may be lacking. It is intended to be faster, more efficient and more effective than the usual methods that health professionals use (phone, , corridor chat, outpatient referral) to obtain colleagues opinions about a patient. It aims to extend the range of experts that a professional could choose to seek opinion from. In providing timely advice to the referrer, it aims to achieve a more co-ordinated patient journey, facilitating a reduction in outpatient and diagnostic appointments, saving patients time and NHS resources. It also acts as an educational resource, as closed cases are summarised and made available to browse. The vmdt system can only be used by registered professionals, and all patient information is completely anonymised and is fully compliant with HSCIC Governance. Advice provided by vmdt Experts is just that advice. There is no obligation on referrers to follow vmdt advice. All responsibility for patient care remains with the professional who makes the referral to the vmdt, and as such we do not anticipate any medicolegal issues to arise from individual advice provided. A medical defence organisation has advised that such activities would be covered even by least risk membership categories, but recommends that members wishing to provide expert advice should notify their respective medical insurance organisation. The flow chart of the process is in Appendix 1 (subject to change). Phase 2 testing of the vmdt Macmillan is testing the vmdt for a range of cancer types in (see Appendix 2). The project requires a wide range of experts to join the vmdt expert pool and be willing to be called upon for online advice about management of complex consequences of treatment as per the details below. We are aiming to recruit a full range of experts that covers every consequence of treatment as far as we are able. We aim to build a truly multi-professional multi-specialty pool of experts, from whom a unique time-limited vmdt Expert Panel will be created for each patient referral, depending on the referrer s request. Appendix 2 lists examples of experts we are seeking to help with the project. Expert members of the vmdt What to expect A. What will the vmdt project require of Expert members? 1. It is recommended that Experts obtain support from their Medical or Clinical Director prior to participating in the vmdt. An outline letter is provided in Appendix Ensure you have regular access to an NHS N3-connected device, the VMDT system will run via N3 and you will not be able to log in and provide expert advice if you do not have access to N3. 3. Register on the vmdt system (when it goes live). This will require the Expert to give personal information (but only name and profession will be visible to other registered users of the vmdt system) including: Title, name, job title, profession, clinical qualifications, specialty(s) Contact details

2 Organisation and work address Expertise in assessing, identifying and managing consequences of cancer treatment which consequences, length of experience in these areas Do they already offer a dedicated consequences of treatment/late effects clinic? If so, what are the referral criteria? 4. Respond in a timely way (within 8-10 working days) on the vmdt system to requests for advice on referrals, as appropriate to each case. Typically this will mean reading the referral online and typing in a paragraph in response to the referrer s questions. An upper limit on cases per month will be agreed (usually 2 cases per month on average about mins, unless a lower or higher limit is preferred). Experts will be able to indicate availability, so that they are not contacted during holidays etc. 5. Review promptly the case summary of any referrals that the Expert has responded to, correcting any errors, prior to the vmdt co-ordinator releasing the case summary to the referrer. 6. Act as an advocate for the vmdt Project with clinical colleagues, e.g. encouraging referrals, demonstrating outcomes. 7. Provide feedback on the system and operational functions of the vmdt to the vmdt project staff. 8. It is currently planned to test this second phase of the vmdt until mid 2018, at which time there will be a review of whether the system has achieved its objectives and what its future should be. Therefore we would like Experts to commit for up to 2 years but they are free to take breaks or leave at any time. 9. Optional extra participate in the vmdt Project Clinical Reference Group whose overall role is to help to optimise the vmdt system, ensure benefits are maximised, and help with the evaluation and future plans. 10. Optional extra attend vmdt project events/workshops. B. What will Expert members gain through involvement in the vmdt Project? 1. Anticipated personal benefits of being an Expert Pool member in the vmdt: CPD, similar to how regular cancer MDT participation is CPD valid (subject to relevant approvals) Networking with other experts in consequences of treatment Recognition of expertise by peers Learning re: multi-organ toxicities and their management Access to the learning and teaching resources that will be accumulated as part of this online project Potential identification of research topics Regular reports of vmdt activity Satisfaction from having contributed. 2. Anticipated wider benefits of being an Expert member in the vmdt: Local and national aggregated data on demand for vmdt advice, which may provide evidence for commissioning local/national CoT services and/or educational events

3 Raising awareness of CoTs at a national level. 3. The vmdt Co-ordinator will: Ensure secure storage of all information submitted to the vmdt including Experts personal details. Act as main point of contact for any queries Experts have with the vmdt system. Respond to Experts queries within 1 working day, except for the 2 weeks per year when the vmdt is not operational.

4 DRAFT VMDT FLOW CHART December 2015 Information for prospective Appendix 1 vmdt flow chart as at December 2015 (subject to change) REFERRER (oncologist) vmdt CO-ORDINATOR Runs system within N3 EXPERT PANEL Limited to 2 cases per expert per month Completes referral form online Submits form Able to view experts' responses as and when posted Checks all info is present and case is fully anonymised Posts case onto vmdt online forum Alerts expert panel members as required Chases experts if necessary Writes responses directly onto vmdt online forum (immediately viewable by referrer) Summarises experts' responses Case summary is checked by person in supervisory capacity Able to view other experts' responses as and when posted Receives case summary Case summary is posted on vmdt online forum within 2 weeks of referral Recieves case summary Decides re patient management Case is closed to further comments *and tagged to enable case-finding *Could consider a 3/6/12 month follow up with referrer to ask re outcome for patient/resource usage etc

5 Appendix 2 Experts are sought from any profession and any specialty with experience of managing physical and/or psychosocial consequences of cancer treatment. For the Phase 2 project, the priority fields are shown below. Please note, when registering as a vmdt Expert, Experts will be required to indicate which categories below they would classify themselves as having expertise in. They will only be contacted for advice when the referrer (oncologist) has indicated that they would like advice on that field of specialism Oncology Consequences of pelvic cancer treatments Specialty / area of expertise All professions medical, nursing, AHPs Pelvic radiotherapy / pelvic cancer oncology Late Effects services Gastrointestinal and Nutritional Urological Sexual / fertility Hormonal Gastroenterology Colorectal surgery Intestinal Failure Parenteral Nutrition Dietetics Ano-rectal physiology Endoscopy Community Continence services Physiotherapy Biofeedback Stoma care Pelvic Radiation Disease Radiation proctopathy Lower Anterior Resection Syndrome Urological surgery Physiotherapy Urodynamics Community Continence services Erectile dysfunction Male sexual difficulties (other) Andrology Female sexual difficulties Gynaecology Psychosexual medicine / therapy / counselling Infertility / fertility preservation Fertility counselling Menopausal symptoms Hormonal symptoms in men Other complex endocrinopathies

6 Psychological / Cognitive Musculo-skeletal Skin Pain / Neuropathy / Neurological Loss of body part / scarring Lymphoedema Fatigue Work and Finance Psychiatry Psychology Counselling Cognitive dysfunction Endocrinology Osteoporosis Orthopaedics (pelvic fractures/necrosis) Physiotherapy Spinal cord compression Post-radiation myopathy Dermatology Skin lesions Anaesthesiology / Pain services Peripheral neuropathy Neurology Palliative and supportive care Body image counselling Plastic surgery Lymphoedema practitioners Lymphology Haematology Physical activity for cancer patients Palliative and supportive care Vocational rehabilitation Occupational therapy Financial advice

7 Oncology Consequences of bone marrow transplant treatment as adult Consequences of treatment for childhood/young person (CYP) cancer Specialty / area of expertise All professions medical, nursing, AHPs CYP oncology Haematology Bone Marrow transplant Graft versus host disease (GVHD) Diagnostic imaging/screening for second primary cancers Gastrointestinal and Nutritional Sexual / fertility Cardiovascular Hormonal Psychological / Cognitive Musculo-skeletal Skin Pain / Neuropathy / Neurological Respiratory Gastroenterology Dietetics Intestinal Failure Parenteral Nutrition Erectile dysfunction Male sexual difficulties (other) Andrology Female sexual difficulties Gynaecology Psychosexual medicine / therapy / counselling Infertility / fertility preservation Fertility counselling Cardiology / cardio-oncology Cardiovascular surgery Endocrinology Menopausal symptoms Hormonal symptoms in men Psychiatry Psychology Counselling Cognitive dysfunction Endocrinology Osteoporosis Orthopaedics Physiotherapy Spinal cord compression Dermatology Anaesthesiology Pain services Peripheral neuropathy Neurology Respiratory physician Lung physiology

8 Hearing Loss Sight loss Loss of body part/scarring Immune system Lymphoedema Fatigue Education, work and finance Ear, Nose and throat surgery Audiology Ophthalmology Body image counselling Plastic surgery Immunology Lymphoedema practitioners Haematology Physical activity for cancer patients Education support Vocational rehabilitation Occupational therapy Financial advice

9 Appendix 3 Outline letter to Medical or Clinical Director (please amend as required) Dear Macmillan Cancer Support Virtual MDT project I am writing to ask for your support for my involvement in a Macmillan Cancer Support national project to test a new method of providing advice to oncologists on the management of complex long term side effects of cancer treatment. It will involve me providing advice online in a Virtual MDT system which will draw on expertise from other selected professionals across the UK who are asked to comment on individual anonymised patient cases. The duty of care always remains with the referrer, and they are under no obligation to act on the vmdt advice. I have developed expertise in the management of [ describe areas of expertise] and would like to be involved in this project as I feel it would have a number of benefits CPD (subject to RCP approval) Learning re: other multi-organ toxicities and their management Networking with other experts in consequences of treatment; possible research collaborations. Raising the national profile of this issue and attracting the interest and support of commissioners. Consequences of cancer treatment have been an under-recognised part of the post-treatment experience for patients, but awareness is increasing, and several professional bodies (in partnership with Macmillan) have published clinical guidance for specialists and generalists, in order to support improved outcomes for patients (see The vmdt project will help in building both clinical knowledge and an innovative service model that aims to support patients with complex and severe side effects of their cancer treatment. Tackling this issue is part of the 2015 England Cancer Strategy Taskforce recommendations. The project limits me to providing advice on a maximum of 2 cases per month, which is estimated would take up to 1 hour of my time. The project does not offer any funding for this, but I regard it as formalising an existing part of my job plan, which is to provide advice and education to colleagues. I would be grateful if you could indicate your support. Thank you.