Tuesday 24th June 2014
Mac Voice, the magazine for Macmillan professionals: Summer 2014
A nurse-led clinic where people are given their bowel cancer diagnosis is getting positive feedback – Lucinda Mackay explains.
At the Royal Sussex County and Princess Royal Hospitals, a bowel cancer diagnosis has traditionally been explained by a consultant surgeon or oncologist. Clinics could take place across two hospital sites and be managed by a number of consultants, so it was a challenge for the clinical nurse specialist to be present at each appointment.
People gave feedback about the stress they felt from waiting for results. They also said they weren’t always receiving the right level of verbal or written information. So my colleagues Mark Danieletto, Gill Hilton and I looked into ways to improve their experience.
We were discussing this with people affected by cancer at Brighton’s bowel cancer support group, C-Side, when one person asked why the consultant had to give the diagnosis when the Macmillan nurse could. The group supported this idea so we took it to our multidisciplinary team. It was debated and concerns were resolved before a six-month pilot was agreed.
Clinics on both sites started in September 2012. Now, whenever a histology result is received and discussed at our multidisciplinary team meeting, and it’s felt appropriate, the person is offered a nurse-led appointment within three working days. The 45-minute slots allow us to undertake a holistic needs assessment, and offer support and information to the person and their family or carer.
After the pilot, we audited the clinics by sending a survey to 62 people. We received 27 responses (44%).
The audit focused on:
- the type of information given, its quantity and quality
- feedback on how people were told they had cancer and by whom.
70% of survey respondents said a Macmillan nurse gave them their diagnosis. One said, ‘I didn’t mind who gave me my diagnosis, I just wanted to know ASAP and the Macmillan nurse was superb’. All respondents who attended a clinic felt the right person informed them of their diagnosis, except one who was ‘unsure’.
Everyone surveyed felt they received enough verbal information in a way they could understand. We have a standard information pack we give to everyone with a cancer diagnosis, which we adapt as appropriate. 80% felt they received enough written information. One person felt they received too much, whereas five people received none. We also asked about information prescriptions. The majority were in favour of these, but would prefer to be given a website address or booklet – as is our current practice.
It was surprising that 52% of patients felt they had been given their cancer diagnosis before their clinic appointment. Most of these thought they had been diagnosed during endoscopy (35%) where, we presume, the doctor warned that something suspicious had been biopsied. With this evidence, we will work more closely with endoscopy staff to support people more effectively.
With the positive feedback we’ve received, both from the audit and verbally from patients, carers and colleagues, we will continue to expand the nurse-led clinic.
Email Lucinda Mackay, Colorectal Macmillan Nurse, Princess Royal Hospital
Email Gill Hilton and Sarah Back, Colorectal Macmillan Nurses, Royal Sussex County Hospital