the treatment record summary, cancer care review cathy burton macmillan gp advisor

The Treatment Record Summary, Cancer Care Review

Cathy BurtonMacmillan GP Advisor

National Cancer Survivorship Initiative

Treatment summary project

• Effective monitoring and management of cancer survivors by improved communication between the specialist cancer team and multi disciplinary primary care team


Primary Care Perspective

• Increasing number of survivors• Variable letters from hospitals – some examples of good

practice e.g. highlighted letters• Summary details vary between hospitals• What follow up is required? Who is responsible?• Possible post treatment long term effects• Aim of treatment, outlook• Likely recurrence and signs/symptoms to watch for


Developing and Piloting the TRS

• July – August 2009 • Tested out prototype with 4-5 Oncologists as ‘critical friends’• Feedback from Oncologists and GPs• A standard format for a possible TS was formulated• Formal pilot phase in 11 test sites through NHSI• “ A summary of treatment provided to a patient’s GP by the

patient’s consultant


Treatment Summary Insert Trust Logo and AddressInsert GP Contact DetailsAddress

Dear Dr X Re: Add in patient name, address, date of birth and record numberYour patient has now completed their initial treatment for cancer and a summary of their diagnosis, treatment and ongoing management plan are outlined below. The patient has a copy of this summary.

Diagnosis: Date of Diagnosis: Organ/StagingLocal/Distant

Summary of Treatment and relevant dates: Treatment Aim:

Possible treatment toxicities and / or late effects: Advise entry onto primary care palliative or supportive care register Yes / No

DS1500 application completedYes/NoPrescription Charge exemption arrangedYes/No

Alert Symptoms that require referral back to specialist team: Contacts for re referrals or queries:In Hours:Out of hours:

Other service referrals made: (delete as nec)District Nurse AHPSocial Worker DieticianClinical Nurse Specialist Psychologist Benefits/Advice ServiceOther

Secondary Care Ongoing Management Plan: (tests, appointments etc) .

Required GP actions e.g. ongoing medication, osteoporosis and cardiac screening A Cancer Care Review is also required

Summary of information given to the patient about their cancer and future progress:

Additional information including issues relating to lifestyle and support needs: Completing Doctor: Signature: Date:


Each Test Site developed their own way of using it

• Electronic version, completed by consultant in clinic• Discharge letter template amended to include TRS

headings• Word document completed by consultant (medical

info) and CNS (holistic info) jointly• Form completed by CNS, signed off by consultant


Challenges and Barriers

• Technology• Time• Duplicating present systems to greater or lesser extent• Present systems can’t accommodate (tapes to India)• Too complex• Not appropriate for all types of cancer (haematological)• Agreeing at what stage(s) in journey to send TRS; may

depend on tumour type


Figure 2: Rating of how useful TRS sections are

0% 20% 40% 60% 80% 100%

Diagnostic information

Treatment details

Treatment intent

Treatment toxicities/Late effects

Alert symptoms

Service access arrangements

On-going management plan

Actions needed by GP

Medication information

Information provided to patient

percentage of respondents

Very useful Useful Not sure Not useful Not useful at all

Rating usefulness of each section


Figure 4: Has it made a difference to the way you manage your patients?

0% 20% 40% 60% 80% 100%

Fewer calls to secondary care

Reduced duplication

Fewer referrals to A&E/secondary care

Better directed access

Better use of time

Mad

e a

diffe

renc

e to

the

way

pa

tient

s ar

e m

anag

ed


Yes, definitely Yes, to some extent No, none at all

Has it made a difference to the way you manage your patients?


Who is it useful for?

Figure 5: Who do you think the Treatment Record Summary would be useful for?

4035

31 30

6

05

1015202530354045

GPs District Nurses CommunityMacmillan

Team

GP out ofhours service

Other

TRS useful for …

No

. R

esp

on

ses


Would you like this service to continue?•

Figure 6: Would you like this service to continue?44%

46%

10%

Yes in place of routineclinic letters

Yes in addition to routineclinic letters

No - continue with clinicletters only


Levers

• Feedback from GPs and patients

• GP commissioners


Influencing G.P. contract arrangements


EVALUATION OF TEMPLATE PROJECT

• Assess the extent of usage• Introduce to wider number of practices

• Patient views• G.P. views


Aspects covered in the cancer care review

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Review ing any medication the patient is taking for their condition

Providing the patient w ith information about cancer

Discussing the patient’s cancer diagnosis

Providing information or signposting to sources of informationabout benefits the patient may be entitled to

Recording w hether or not the patient has had radiotherapy orchemotherapy treatment

Recording the details of any carer(s) w ho are supporting thepatient

The date of the next cancer care review

Anything else

Cov

er in

can

cer

care

rev

iew


Always Very frequently Frequently Sometimes Never


User friendliness

0%10%

20%30%40%50%

60%70%

Not at all userfriendly

Not very userfriendly

Not sure Fairly userfriendly

Very userfriendly

How user friendly is the template

per

cen

tag

e o

f re

spo

nd

ents

GPs Macmillan GPs


Prompts in the template

Figure 4: Prompts

0% 20% 40% 60% 80% 100%

Discussion about cancer diagnosis

Noting the details of the main carer

Review of medication

Discussion about the financial impact ofcancer

Discussion about information needs

Pro

mp

ts i

n t

he t

em

pla

te


Not at all useful Not useful Somewhat useful Useful Very useful


Usefulness of resources

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

"Help w ith the cost of cancer” (signposting to information onbenefits and financial support)?

"Money w orries: how w e can help” (information on Macmillangrants and the Macmillan benefits helpline)?

"Hello and how are you?” (information for carers)?

"Things you might like to discuss w ith your doctor” (checklist onpossible discussion topics and signposting information on

Macmillan resources)?

"How are you feeling?” (guide on the emotional effects ofcancer)?

"The Cancer Guide" (general information about cancer)

"Talking to children w hen an adult has cancer" (a guide designedto help talk to children about cancer)


Not at all useful Not useful Somewhat useful Useful Very useful


Patient satisfaction

1 12 2

15

0

2

4

6

8

10

12

14

16

1 - Not at allsatisfied

2 3 4 5 - Verysatisfied

Overall satifaction

No

. R

esp

on

ses


G.P. INTERVIEWS

• . ‘Sometimes when patients are diagnosed, they’re so busy with hospital. They need medical certificates from us but they don’t need other input at that stage’

• ‘(the cancer care review is) to support patients and see how they’re doing’

• looking at it from an holistic point of view in terms of a patient’s physical symptoms but also social and psychological needs’.


Benefits

• helpful, you don’t forget things. Useful as an aide de memoir’ ‘useful for prompting’ ‘reminder of topics to cover’ ‘make sure we don’t miss things and offer consistent service’ ‘trigger for us to remember to ask’;

• it is easy to miss that aspect which is potentially important because you have not approached it in a structured manner’

• Useful for coding’ and that it is ‘auditable’

I


Barriers

• It does the basics but you need detail… more patient driven things,’.

• If you sit and ask the question and look at the computer and press a button. But that’s not the way we use it’


Macmillan Practice Nurse Pilot• Developing training package for practice nurses, to provide

skills/knowledge to allow nurses to better support cancer survivors in the community

• 2 whole study days plus 7 half days over 2 ‘terms’• Nurses will be encouraged to identify a patient for a full review, plan the

review and then report back, using peer support• Variety of approaches will be used, co-creating health/motivational

interviewing plus training resources to provide nurses with wide range knowledge covering late effects, secondary prevention, holistic needs, supported by Macmillan patient information resources

• GP in practice agrees to mentor nurse• Practice receives £1000 bursary


Practice nurse course Mind Map 1


Practice nurse course mind map 2


Practice nurse course mind map 3


Acknowledgements

• Rosie Loftus• Terry Bowley• Lucy Thompson• Charles Campion-Smith• Noeline Young


Thank you

Any Questions?

[email protected]

the treatment record summary, cancer care review cathy burton macmillan gp advisor

Documents

cancer care review slide

specialist cancer team

views slide

management of cancer

patients consultant

treatment record summary

tumour type slide

treatment aim