Addressing the complex needs of people with cancer and co-existing dementia

Transcription

1 Addressing the complex needs of people with cancer and co-existing dementia Lorraine Burgess Dementia Clinical Nurse Specialist Christie Hospital NHS Foundation Trust RCN Older People s Conference, March 2014

2 Contents The Dementia Team at the Christie Cancer and Dementia- the facts CQUINs and beyond How are we achieving targets and changing practice? Case Study- Mrs Christie Learning Points Questions

3 The Dementia Team at the Christie The Christie, Specialist Oncology Treatment Centre in South Manchester. 40,000 pts a year. Dementia Team Based within Psycho-oncology service and consists of : Consultant Specialist Occupational Therapist Myself Funded by CQUINs money 2013/14

4 Cancer and Dementia : The Facts Generally people with dementia have poorer outcomes when admitted to hospital Worsening of dementia symptoms Increased chance of going into institutional care Higher mortality rates In terms of cancer, people with dementia have higher mortally rates 6 months after diagnosis

5 Background Dementia and cancer Cancer: a disease of the older person (1) Poorer outcomes for patients with dementia (2,3) People with living with condition but not living well (4) 3 out of 5 cancers diagnosed in people over 65. I in 3 over 80 with dementia (5 6) Lack of evidence on how to deal with a person with both cancer and dementia (7)

6 CQUINs and Beyond Commissioning for Quality and Innovation 2013/14 Find, Asess,Investigate and Refer ( FAIR) Clinical Leadership Supporting carers A springboard for: Innovative practice Service Development

7 How are we achieving targets and changing practice? Education 2013/14-92% Staff trained in Dementia Awareness Level 2/3 training Bespoke and Role Modelling Dementia Champions Dementia Friends Non medical staff Partnership- e.g pharmacy

8 How are we achieving targets and changing practice? Screening and Audit FAIR Process Additional screening in Head and Neck, Lung and Preoperative clinics Benefits Picking up patients early Anticipating concerns ( from pt, cares and MDT) Pre Assessment of care Monitoring progress Discharge planning

9 How are we achieving targets and changing practice? Care Pathways and Strategies Policies Working with Dementia guidelines Safeguarding Falls Nutritional Management Defining a pathway for people with dementia and cancer Electronic Case Notes Working in partnership e.g Estates

10 How are we achieving targets and changing practice? Clinical and Care Practices Best Practice- Person Centred Care Care and discharge planning Risk Management Mental Capacity and Best interest Decisions Ethical implications Pre planning care

11 How are we achieving targets and changing practice? Carer Support The Memory Drop-In A supportive service for pts, carers and staff who are concerned about their memory or a loved one s memory A unique service in a cancer setting Seeing a range of patients- a social element Individual Cases Supporting through diagnosis Reassurance Discharge planning Support staff

12 How are we achieving targets and changing practice? Continued Reminiscence Volunteers Environment Clocks, signage to improve orientation

13 Case Study Mrs Christie 68 year old retired lady Expressive dysphasia Referred from acute Trust for treatment Lived alone in terraced house Partner passed away a year ago with cancer 2 sons, one closer than the other Proposed treatment 6 cycles of chemo for NHL

14 Concerns Cognitive impairment No diagnosis of dementia Lacking mental capacity in decision making Risk of going home whilst having treatmentanother capacity issue Not eating weight loss/ acopia

15 Action Seeking info from family and views MRI brain- full dementia screen Best interest meeting- decision to treat Working with staff/ interactions Encourage eating Use of volunteers Diagnosis given/relief Educating and supporting family

16 Plan 6 cycles of Chemotherapy IV - curative Residential care After 2 cycles gastric bleed EOL- blood tranfusion. Supporting staff/mrs C Recovered Chemo 18 months, EOL- IVI, blood transfusion for symtom control. gastric bleed, pain, distress Recovered

17 Issues Advocacy Quality of life v Further treatment Family distress Ethical implications Pain control Family support Staff support

18 Outcome Improvement Liaised with hospice for symptom control Up and down Deteriorated Admitted Improved Passed away 3 weeks later.

19 Learning Points Quality of life vs treatments Patient and carer choice- MCA Importance of knowing the person and involving the team and family- Roller coaster for family Only looking at treatment and not the bigger picture?. Was it in her best interest?

20 Conclusion Not easy Double and sometimes a triple whammy of diagnosis Aim for best outcome but is it?

21 Your thoughts? Any Questions? Lorraine Burgess

22 References 1. Cancer Research UK (2012) Cancer Incidence in the UK, Cancer research UK [online], available from: [Last Accessed: 15th April 2013]. 2. Robb, C. et al (2009) Patterns of care and survival in cancer patients with cognitive impairment. Critical Reviews in Oncology/Haematology, 74(3), pp The Alzheimer s Society (2009) Counting the cost: Caring for people with dementia on hospital wards. The Alzheimer s Society, London. 4. Kings Fund ( 2011) How to improve cancer survival. London Kings Fund Report 5. Alzheimer s Society (2013) The hidden voice of lonliness, London, Alzheimer s Society 6. Dept of Health ( 2013) The Prime Minister s Challenge on dementia. March 26 th England. 7. Moriaty, J. Rutter, D. Ross, PDS and Holmes P ( 2012) SCIE Reseach briefing 40, End of life care for people with dementia living in care homes. London. Social Care Institute for Excellence.