Enhancing Survivorship Care: A Guide to Implementing Stratified Pathways

1. Supporting people with active and advanced disease • Need better data collection • Discussion at MDT – new diagnosis support • Identify best practice • Early palliative care support improves quality and quantity of life

2. Key survivorship messages • A shift in professional culture is essential to enable supported self management. • New models of cancer aftercare gives opportunities to improve quality and reduce cost. • Many people can self manage their health with support, with rapid access to professionals when needed. • There is significant unmet need arising from consequences of treatment, which can be successfully addressed through prevention and treatment. • Good survivorship care requires timely communication across boundaries.

3. Aligning with the NHS Mandate in England

4. Taking Action - a ‘how to guide’

5. Learning from experience: University Hospital Southampton • Stratified pathways for breast, colorectal and testis patients. • Stratification based on: • Complexity/gravity of the disease • Complexity /type of patient need • By type of care provider Influencing factors: • Clinical safety • Patient acceptability • Cost effectiveness

6. Stratified Pathways: Patient Activity

7. Clinical indicators which delay entry to a self managed pathway.

8. Other factors which prevent entry to a self managed pathway • Pressure of time on clinicians in clinic for sufficient preparation and discussion with patient. • Clinician attitude to their practice. • Patients on clinical trials which mandate face to face consultation with physical examination -around 13% breast and 11 % colorectal patients • Unacceptable to patient. • Limited CNS contribution to aftercare – ie focus on diagnosis and treatment

9. Five enablers to implementing stratified pathways of care • Remote surveillance system • Patient preparation and discussion with the key Consultant • Preparation through education or self management ‘event’ • Coordination and support from the Cancer Support Worker • Commissioner engagement and support

10. Clinician Engagement • Absolutely key to success of the outcome of the project • Presence of a champion is vital, but even so may be slow to spread. • If slow going assume that as time goes on and service developments take place, that when events impinge on individuals – they will engage!

11. What commissioners want • Assurance that patient experience and quality are central and will not be compromised by change. • Communication and collaboration with primary care to ensure appropriate level and place of care provision. • Release of resource – enabling capacity for new diagnoses • To know the pattern of access to Outpatient attendances, and use of primary/community services by self managed patients. • Plans for spread of stratified pathways