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Leeds LTFU: The Glaser/Dutton effect
Dan Stark, Michelle Kwok-Williams, Adam Glaser- MDs
Heather Berry, Naseem Sarwar - CNSs
Jennifer Dutton - Patient Services & MDT co-ordinator
Where we were
• Date – 19??-2005
• > 900 patients– Paed-cardiac-
endocrine-fertility collaboration
– Excellent nurse specialist
Dutton, Glaser et al 2011
Pressures
• Waiting lists
– Patient lobbies
– Re-referrals
– DNA rates
• Morbidity unmet
– Re-referrals, sad stories
Summaries
Needs assessments
Care plans
• Derived from a risks checklist based upon disease & treatment
• Dictated by clinician into each letter, based upon earlier letters
Referrals
• Paediatric survivors
Development Team
• Adam Glaser
• Yorkshire Cancer Network– Geraint Hughes, Carol Ferguson, Sean Duffy
• Leeds Teaching Hospitals NHS Trust– Jennifer Dutton (Patient Services & MDT co-ordinator), Shirley Siner (Paediatric
Administrator), Elizabeth Brown & Barbara Hills (Secretaries)
– Heather Berry (CNS), Naseem Sarwar (CNS), Bev Horne (CNS- e platform development)
– James Tatersall (Renal Physician/I.T. advisor), Rob Murray (Endocrinologist)
– Jo Cannings & Heather Cooper-Waite (Specialist Doctors, Paediatric Oncology), Michelle Kwok-Williams (Clinical Oncologist), Dan Stark (Medical Oncologist), Adam Glaser (Paediatric Oncologist)
– Angie Craig, David Fox – Adult Oncology service managers
TYA service appointments- IOG 2006• TYA service - Dan, Michelle,
Karen (Dyker), David (Bowen), Rod (Johnson), Simone (Wilkins), Bob (Phillips)
• Relationships– Shared pressures– Patients and professionals– Managers/Nurses/Doctors
• Nursing time• Admin time• Treatment summaries
– Regional TYA structures• Network group, service design
Pathways
Risk stratification- Dutton et al 2011
Nurse-led and telephone clinics
Health promotion
• Structured
– Cardiovascular- exercise, weight, tobacco
– Alcohol
– Sun
– Contraception
– Vaccination (Splenectomy)
Letter templates
• Standard structure– Summary
– Specific interaction that day
• Patient copies and patient actions– invitation to enquire back to us
• GP copies and actions
• Care plan
– Write to the patient, copy the GP (or Vice –Versa)
Patient satisfaction with transition -(Clic-Sargent)
The staff I saw at the clinic- used medical terms that I didn’t understand (scored 1–5)- did their best to keep me from worrying (scored 5 – 1)- would have been irritated if I’d asked too many questions (scored 1–5)
Now
• Combined medical input
• Nurse-led clinics
• Telephone–delivered (managers sympathetic)
Improvement in Number of Patients Seen in Clinic with Complete Care Plan
LTFU Data Collection for July -November 2011
Total attended July to November clinics
% per clinic with complete care plan in July 2011
% per clinic with complete care plan in Nov 2011
Adult Medical Clinic 113 25% 91%Adult Nurse Led 39 100% 100%Adult Telephone 98 100% 100%Paediatric Medical Clinic 74 44% 93%Paediatric Nurse Led 7 25%Paed Telephone Clinic 27 100% 100%
358 70% 95%
Other complimentary activity
• Psychosocial oncology research- Penny Wright• Patient-reported outcomes in survivors
• Q-Tool
• Learning re IT- Clinical Cancer Portal• Process, confidentiality
• PPM and integration
Q-Tool
Care plans• In ppm- dynamic, easier to use & reflected in patient
letters
Adult referrals(developing wider adult service collaboratively)
Adult LTFU Referrals for 2013
0
5
10
15
20
25
30
35
40
45
Paed
Germ Cell
Sarcoma
GP
Ext Cons
Haem
Self
Paed 11
Germ Cell 12
Sarcoma 1
GP 11
Ext Cons 1
Haem 4
Self 1
Adult 2013
Month 1
Next- Primary care?- survey 2011
Dutton et al 2011
Commissioning of remote surveillance with a bundled tarriff