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Survivorship: A vision for 2012-15

Survivorship: A vision for 2012-15. Professor Sir Mike Richards March 2012. Survivorship vision 2012-15: An overview. Brief reflections on progress to date The challenges ahead A vision for the next 3-5 years. Survivorship vision 2012-15: 2 disclaimers.

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Survivorship: A vision for 2012-15

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  1. Survivorship: A vision for 2012-15 Professor Sir Mike Richards March 2012

  2. Survivorship vision 2012-15: An overview Brief reflections on progress to date The challenges ahead A vision for the next 3-5 years

  3. Survivorship vision 2012-15: 2 disclaimers The new survivorship ‘document’ has not yet been written. These are ideas in evolution This presentation was prepared before hearing other presentations today: Apologies for omissions

  4. Survivorship vision 2012-15: Brief reflections on progress Our thinking has moved on substantially, but very few patients are yet being touched by new models of care This is perhaps unsurprising: We are planning major changes in the “aftercare” of hundreds of thousands of patients each year

  5. Survivorship: Some highlights to date Dec 2007: National Cancer Survivorship Initiative announced January 2010: NCSI vision published November 2011: BJC supplement on survivorship research 2008-2012: Testing of new models of care (NHS Improvement and Macmillan) 2012: PROMs pilot survey to be published shortly

  6. Survivorship: Cancer prevalence in England 2008 Derived from Maddams et al BJC 2009

  7. Five-Year Survivors of Childhood Cancer by Age at Start of Year, Great BritainCourtesy of Stiller CA, UK National Registry of Childhood Tumours

  8. NCSI Vision 2010: The five shifts A cultural shift – greater focus on recovery, health and well-being Holistic assessment, information provision and personalised care planning Support for self-management Tailored support (not a single model of clinical follow up) Routine measurement of experience and outcomes for cancer survivors

  9. NCSI 2012: Five key elements Support through primary treatment from the point of diagnosis Promoting recovery Sustaining recovery Reducing the burden of consequences of treatment Supporting patients with active and advanced disease – interfacing with end of life care services

  10. NCSI 2012: First key element • Support through primary treatment from the point of diagnosis • All patients are offered/given: • Information about cancer and treatment options • Support for decision making • Optimal treatment to maximise chances of cure and minimise risk of long term consequences • Support through treatment itself • Advice on work and finances (starts here)

  11. NCSI 2012: Second key element • Promoting recovery • All patients to be offered a tailored package of care including: • A treatment summary and a care plan • Multiprofessional advice on recovery (e.g. through a health and wellbeing clinic or equivalent programme) • Exercise programmes – tailored to the individual • Information

  12. NCSI 2012: Third key element • Sustaining recovery • New models of care to replace ‘routine clinical follow up’ e.g. • Remote monitoring (supported self management) • Telephone follow up • Nurse-led follow up [Remote monitoring will require effective IT systems to ensure surveillance tests such as CEA, CT scans, PSA, mammography etc. are done at appropriate intervals, with results being checked and patient/GP being informed] • All patients knowing how to re-access specialist services if concerned • More patients taking recommended levels of physical activity • Information

  13. NCSI 2012: Fourth key element • Reducing the burden of long term consequences of treatment • Information: All patients being informed of possible consequences of treatment at start and again at end of primary treatment, with advice on what symptoms to look out for and what to do • New advice being communicated to long term survivors as and when it becomes available • Information/training for GPs about the prevention, detection and management of common consequences of treatment • All patients having access to specialist services for ‘rare’ and ‘intermediate’ consequences of treatment

  14. NCSI 2012: Consequences of treatment • A possible classification: • “Rare”: Only affects hundreds of survivors in England/UK. [Brachial plexopathy following radiotherapy for breast cancer is an example] • “Intermediate”: Affects thousands of survivors [pelvic radiation damage is an example] • “Common”: Affects hundreds of thousands [cardiac consequences of treatment and osteoporosis are examples]

  15. NCSI 2012: Fifth key element • Supporting patients with active and advanced disease • Identifying all patients with active and advanced disease – and recording date of recurrence/metastasis • Multiprofessional assessment of needs and care planning • Access to CNS/key worker • Effective interface with end of life care services

  16. NCSI 2012: Key challenges for 2012-15 The culture shift: Engaging and influencing stakeholders. Refining the vision Spread of “roll-out ready” elements Further testing of “promising” proposals, with emphasis on costs and benefits (to influence commissioners) Costing of whole pathways Development and implementation of metrics for survivorship Development of IT for remote surveillance

  17. NCSI 2012: Service implications New services to promote recovery Fewer patients requiring routine follow up Remote monitoring/surveillance Better ambulatory care assessment/management of patients when they develop problems Fewer emergency admissions New services for patients with consequences of treatment New models of care to support patients with active and advanced disease i.e. A fairly radical change

  18. NCSI 2012: Metrics (1) • We need good measures of: • Structuree.g. Service models established Key workers/CNSs for active and advanced disease • Process • Outcomes • Linked to NHS Outcomes Framework

  19. NCSI 2012: Metrics (2) • Examples of process measures: Number/proportion of patients • With access to CNS at diagnosis and recurrence • Receiving information at different phases of the survivorship pathway • Receiving treatment summaries/care plans • Accessing rehabilitation/reablement programmes • Accessing services for consequences of treatment • Emergency admissions in first year of diagnosis • Emergency admissions after first year

  20. NCSI 2012: Metrics (3) • Measuring outcomes • Domain 1: Survival Incidence of life threatening conditions • Domain 2: QOL (PROMs: National and local) • Domain 3: Recovery (PROMs and length of stay) • Domain 4: Patient experience of care (surveys)

  21. NCSI vision for 2015 All cancer networks, CCGs and providers will have responded to “NCSI 2012” with local action plans “Rollout ready” services will have been implemented in x% of Trusts, with y% of patients being managed differently at point of recovery and z% being managed remotely during follow up Whole system ‘demonstrators’ will have shown benefits to patients and affordability to commissioners

  22. NCSI 2012-15: Summary The key elements of good care for survivors of cancer are becoming much clearer Some elements are ‘rollout ready’. Others need further development Our next challenge is to start the whole system transformation

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