Friday 30th September 2016
Mac Voice, the magazine for Macmillan professionals: Autumn 2016
Janet Thompson tells us how Southport and Ormskirk Hospital have been supporting lung cancer patients through the eHNA
We complete the electronic Holistic Needs Assessment (eHNA) with patients at pre-diagnosis, just after diagnosis and post treatment. The information gained is very valuable to us because we use it at the lung multidisciplinary team discussion to advocate the needs and wishes of the patient. We pass it to the palliative care team when appropriate and signpost to other agencies. The main concerns identified revolve around finances and symptom management – usually breathing difficulties, pain and fatigue. Other concerns commonly identified include depression, eating problems, weight changes and sleeping.
The knowledge gained from the eHNAs enables us to signpost patients to some of the wonderful things Macmillan are doing: our excellent patient information centre; our new ‘Move Forward’ exercise programme; or Health and Wellbeing events. It’s invaluable for our lung cancer patients to see us at these events and be able to discuss issues confidentially. We can then book them back in to our clinic to follow up. Everything complements each other resulting in a more patient-focused system and increased confidence for the patients to self-manage. Phone calls about benefits and symptom control have reduced significantly. In addition, we can put names to faces in clinic and if a patient is admitted with signs of disease progression, we know where they are up to in their pathway. The eHNA promotes better communication between departments and more efficient discharge.
The main disadvantage of the eHNA is that a lot of our lung cancer patients are elderly and don't have the technical experience to use the ipad. Although it takes more time to go through the questions together, I do feel we’re able to assess their concerns in more detail than if they were doing it alone. Other challenges are internet problems and the increased admin time – I like to formulate a letter to accompany the care plan to ensure GPs are on board with the plan.
Making a difference
Formal feedback from patients has included a man who I started to arrange a Macmillan grant for there and then in clinic. When he next returned, he was wearing his new winter jacket – he was so pleased as his old jacket did not fit due to weight loss. It was quite emotional. Another lady on medication for symptom control had put on a lot of weight and was struggling with her exercise – adding to her breathlessness. We referred her to our new physical activity programme, which was tailored to her needs, and she’s now doing fantastically.
We’re currently a Thursday morning only clinic and we’d like to expand to a whole day. I’d also like to look at eHNA at home where patients can log on and do their own assessment if they can’t get to clinic, particularly for our palliative care patients. And I would like to see palliative care nurses get on board with these eHNAs so it’s streamlined throughout the pathway. Now we’re through the teething problems, the enhanced communication is very valuable. We’re looking forward to expanding on what we’ve achieved so far.
Macmillan Lung Cancer Nurse Specialist
Southport and Ormskirk Hospital