Thursday 19th September 2013
Ruth Fox explains how a nurse-led pathway for people with skin cancer is working at Northampton General Hospital.
In January 2012 I began nurse-led clinics, based in Northampton’s dermatology department, with the support of the skin cancer multidisciplinary team.
At first, I set up a clinic to see people who were coming back to receive their test results and diagnosis. Patients are referred to the clinics after biopsy of a suspected melanoma lesion, and I will give them their results and diagnosis. The clinic allows me to see as many people as possible at this stage, so I can help to explain their diagnosis, introduce the key worker role and make sure they receive written information and a thorough holistic assessment.
I also make contact as soon as possible with people diagnosed with melanoma when I am absent, or who are diagnosed by their GP or in other settings. I invite these people to meet with me for further assessment and support.
Since the nurse-led clinics began, the number of patients referred to this service for face-to-face contact has increased by 15%, as the service has become better known by relevant staff. I hope that more melanoma patients will be referred to my clinics for their diagnosis as this new way of working becomes better embedded.
To complement the clinics where I see people at diagnosis, I’ve also established a nurse-led follow-up service. If I see a patient at diagnosis who has a low-risk melanoma, I book them into my follow-up system.
Higher-risk patients go into the consultant follow-up system. If a GP or consultant sees a low-risk melanoma patient at diagnosis, they will refer them to my clinic. I then see the patient every three months over the year after their diagnosis. During these appointments, I physically examine the patient, teach self-examination techniques and give out sun protection advice and written information. I’ve completed an MSc module in Skin Lesion Recognition and Management to prepare me for these sessions.
This follow-up clinic gives an opportunity to assess how someone who has had a melanoma is getting on physically and psychologically, and to address any other problems. The final follow-up appointment takes place with the consultant who referred to patient to my clinic. The patient will then be discharged back to the care of their GP.
People with metastatic disease, high-risk primary melanomas, or who have other complex problems that have affected their ability to cope following diagnosis, are also offered ongoing nurse-led appointments for more intensive assessment and support.
By being in contact with patients from diagnosis to regular contact and needs assessments, I can forge relationships that allow me to support people through all stages of their illness.
The nurse-led clinics don’t yet have high numbers, as the referral process has taken time to establish, and some new melanoma patients are inevitably given their diagnosis by their GP or one of the consultants in a private healthcare setting.
However, results of a survey sent to people I saw over a six month period were favourable. Of 49 people surveyed, there was a 78% response rate, and 79% of respondents gave a maximum satisfaction score of 10. Plus, no one surveyed said they would rather have seen a doctor than attend the nurse-led clinic.
Email Ruth Fox, Macmillan Skin Cancer Nurse Specialist, Northampton General Hospital or call 01604 545215.
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