Cancer as a long term condition: a course for practice nurses

Transcription

1 Cancer as a long term condition: a course for practice nurses Cancer Course for Practice Nurses East and West Suffolk Title of report: Managing Cancer as a Long Term Condition Recommendation: Support from Primary care to release one practice nurse for three study days and support to complete 3-4 self-directed / e learning study days (Flexibly over a period of six months) by signing up to this course you are agreeing to develop and make changes to your practice which will ensure the effective assessment, cancer care review and support of people affected by cancer in your practice. Summary: The incidence of cancer is rising and more people living longer after diagnosis and treatment the demands on GP s and Primary Care from this group are increasing. The long term impact of cancer means that it is now being considered as a long term condition. Practice Nurses play a key role in the management of long term conditions in Primary Carer, such as diabetes, COPD and heart disease. The skills they use could also be employed with patients living with cancer. Macmillan has developed and refined a cancer course for Practice Nurses. Over ten courses have already been delivered to over 100 Practice Nurses resulting in increased knowledge, confidence and skills for participants, as well as positive changes to their day to day practice and subsequently a better experience for people affected by cancer. Attendance on the course will be supported by a grant from Macmillan; therefore no cost to practices The course will result in the participants having increased knowledge, confidence and skills to improve the experience of care for people affected by cancer.

2 The course will enable Practice Nurses to develop transferrable skills to take on an enhanced role in managing cancer as a long term condition, thus extending the work force able to support the current case load and the anticipated demand on services as the numbers of patients living with cancer increases. The Practice Nurse will attend 3 half study days and will undertake 3-4 self-directed/e learning modules, over a 6 month period, they will ask a GP colleague to act as a supporter during the course and to support the practice nurse in embedding learning in practice throughout the course and beyond. The Practice Nurse will then be available as an expert resource within the practice. A community of practice will be established to support nurses who have undertaken the course with bi-annual meetings to facilitate education and peer support. Issues in Suffolk: The incidence of cancer is rising with estimates that 1 in 3 people will be diagnosed with cancer at some point in their lives. 1) There are more people than ever surviving cancer with 2 million cancer survivors in England currently with this number predicted to rise to 4 million by It is estimated that within a GP population of 10,000 patients there will be up to people who are at least 5 years from a cancer diagnosis. 2) Higher numbers of patients living with and beyond cancer will lead to increased demands on services in Primary Care and extending the skills of other health professionals will help to spread the workload. 3) Cancer Research UK estimates that 50 per cent of patients who were diagnosed in will survive for 10 years; however this also means people will be living with and beyond cancer managing the consequences of their treatment. 4) Currently most GP s take on the responsibility for Cancer Care Review, however Practice Nurses are now taking on the majority of management of long term conditions, they are therefore more experienced in managing these patients and tend to do so in a more holistic way. Training Practice Nurses to undertake the Cancer

3 Care Review will reduce work load for GP s 5) There is evidence that at least a third of cancer survivors have five or more unmet needs following treatment, with the associated issues related to: persistent side effects which continue after primary treatment immediate or long term physical effects the late effects of cancer treatments difficulty returning to work or discrimination when they do so risk of relapse psychological impact sexual and/or relationship problems Financial impact. 6) Patients affected by cancer initially consult their GP once more per year than their peers and consultation rates only converge around 10 years from diagnosis 7) Patients with cancer are a high-risk cohort for medical morbidity, not only because of the possible relapse of their cancer and the treatments that they have undergone, but also because the risk factors for their cancer may also be risk factors for other diseases 8) Patients affected by cancer often have unmet psychological needs, 20-30% report ongoing psychological problems, including poor quality of life. Evidence shows that many patients are unaware of the physical and emotional impact of living with and after cancer and would welcome more advice and information Relevance for Primary Care 9) Primary care is well placed to address these issues and to minimise future ill health for people living with or beyond cancer. However, this will need a change in emphasis to more proactive and structured care. 10) Certain needs can be managed well by the GP, such as troublesome side effects of treatments, but often cancer patients need more time to be able to express a range of issues impacting on their life but which may find difficult to discuss in the time with a GP in a regular appointment. 11) Practice Nurses are now taking on the majority of management of other long term conditions, releasing time from regular GP appointments and assessing patients in an holistic way that can address a wider range of needs.

4 12) Practice Nurses already have a wide range of skills to support people living with long term conditions, a recent Macmillan study showed 49% patients affected by cancer have at least one other chronic condition Therefore equipping this group of professionals is an effective way or dealing with people who will have more than one condition. 13) Practice Nurses could also, in time, support the GP in undertaking the Cancer Care Review to reduce work load for GP s. The Cancer Care Review is key to the Recovery Package which is promoted as a group of interventions that will make a positive long term difference to the lives and recovery of people affected by cancer. 14) Macmillan has developed a Cancer Care Review template which will enable Practice Nurses to conduct a holistic standardised Cancer Care Review. The templates have been well evaluated with 79% of GP s finding it fairly useful or very useful 15) Practice Nurses are well placed to promote physical activity during and after cancer treatment, physical activity has been demonstrated to improve the experience of and recovery from cancer treatment and to reduce the risk of cancer recurrence and cancer mortality. Physical activity can also reduce the risk of patients developing other conditions. The diagnosis of cancer is recognised as a teachable moment. Practice nurse are often well placed and experienced in giving support and information with regard to adopting healthy lifestyle. 16) Fear of cancer recurrence is very common but many patients do not know what to look out for. Many patients will be offered less contact with secondary care teams after active treatment as funding for follow up appointments is reduced. 17) Training more health care professionals in Primary care to carry out Cancer Care review will help to minimise uncertain and maximise confidence for people living with and beyond cancer. Evidence suggests talking about cancer recurrence does not increase anxiety and may even reduce it 18) Practice Nurses are already experienced in supporting patients to self-manage other long term conditions, evidence shows that people surviving cancer would also like to know how to look after themselves, and with additional training, practice nurses would be ideally placed to inform, enable and empower patients 19) Increasing the skills of wider range of professionals to identify cancer risk and

5 appropriate referral will support the early detection of cancers, as proposed in the CCG Strategic Plan 20) Practice Nurses are well placed to promote physical activity during and after cancer treatment, physical activity has been demonstrated to improve the experience of and recovery from cancer treatment and to reduce the risk of cancer recurrence and cancer mortality. Physical activity can also reduce the risk of patients developing other conditions 21) Training for Practice Nurses would: empower them to make holistic assessments of the needs of patient affected by cancer reduce unmet needs of cancer survivors educate the work force to support patients to adopt healthier lifestyle which may reduce common side effects and reduce risk of long term consequences of cancer & it s treatments such as osteoporosis and cardiovascular disease enable increasing workload of support for people affected by cancer to be shared within the practice enable practice nurses to develop transferrable skills to use when assessing/supporting patients with other long term conditions Practice Nurses could adopt a changed pattern of care involving more proactive and scheduled interactions with people living with cancer. They will be able to make use of appropriate clinical tools in order to identify patient needs and know how to encourage people to self-manage. They will be seen as a resource for cancer by colleagues in their practice and act as a catalyst for the practice to provide better support to people living with and beyond cancer, as well as those affected by cancer 22) From a recent evaluation of Practice Nurses who attended a course in 2013 reported and further evaluation of the Surrey course currently running will be available in July/August. 76% agree the course improved their knowledge about cancer and its treatment by a great deal, with 79% feeling the same about their improved knowledge about the diverse needs of people affected by cancer. 73% agree the course improved their skills in communicating with people affected by cancer a great deal, with 68% reporting a great deal of improved confidence in managing cancer as a long term condition. 66% felt the opportunity to apply learning in practice helped to improve their knowledge, skills and confidence, and as a result of this 60% report that a fair amount or a great deal of the time they are seen as a resource about cancer by their colleagues. 65% report a great deal of improvement for their skills in assessing the needs of people affected by cancer. 85% report a great deal of improved knowledge about resources available for people affected by cancer.

6 67% agreed their skills in signposting people affected by cancer to other sources of support and information have improved a great deal (a further 30% said a fair amount) 23) The Practice Nurse Course will be run locally, with training from local specialists and will include information to enable appropriate signposting and use of local resources. 24) The CCGs are committed to the NHS Outcomes Framework. Training a wider range of Primary Care Staff will enable them to: Enhance the quality of life for patients living with the long term effects of cancer Help people affected by cancer to recover from acute treatment Improve the experience of care 25) In time primary care will be supported by improved distribution from secondary care of Care plans and End of Treatment summaries which will aim to: Give clarity to patients and Primary care on triggers for referral back to secondary/specialist support and how to access this support Clearly identify the key worker Empower patients to self-manage Improve links between primary and secondary care Patient and public engagement: Patient s feedback is used throughout the course. Patients will attend to present and their stories will be used throughout the course.