30 March 2017
A Glasgow project which tested a new approach to supporting people after breast cancer treatment led to significant improvements in patient aftercare.
Patients were more than twice as likely (66% versus 24%) to say their needs were fully met when managing the side effects of treatment.
The pilot project at Stobhill Hospital in Glasgow also saw a 50% reduction in demand for follow-up consultant appointments.
The project is part of the Scotland-wide Transforming Care After Treatment programme
(TCAT) – a partnership between Macmillan Cancer Support, Scottish Government, NHS Scotland and local authorities.
It offered a new personalised model of medical follow-up to 150 women who had finished treatment for breast cancer.
As part of the pilot, they were offered emotional, financial and practical support based on a detailed assessment of their individual needs.
Prior to the pilot, women who finished breast cancer treatment attended an annual mammogram and an appointment with a consultant.
The women involved in the pilot still attended the yearly mammogram, but instead of an automatic consultant appointment were offered a holistic needs assessment (HNA).
This was reviewed by a Clinical Nurse Specialist who, following a discussion with each woman, then created an individual care plan and helped them access the most appropriate support services for them.
This personalised approach to aftercare resulted in only 50% of the women being referred onto a consultant for follow-up.
It also led to an increase in referrals to emotional, financial and practical support services,
and to NHS clinics for help managing side effects.
Surveys of 34 women who received care before the new approach and 46 women who took part in the pilot, found the new approach led to significant improvements in patient ratings of their care after treatment.
Women in the pilot rated their support after treatment at 8.9 out of ten, compared to an average of 6.5 from the pre-TCAT project women.
Two thirds (66%) of women in the pilot also said their needs were completely met when managing the consequences of treatment compared to just 24% of those who received the traditional model of follow-up care.
A review of the clinical histories of the women in the pilot found far fewer than the 50% who
saw a consultant after treatment ended had a clinical reason to do so.
Keith Ogston, Consultant Surgeon at Stobhill Hospital, said: “This project has helped free up senior medical time. I am now able to offer patients with more complex needs an extended appointment time, while more straight-forward patients, who don’t necessarily need to see a doctor or medical consultant, can attend a mammogram and access other support that is relevant to their needs.”
Marion Macdonald, 58, from Glasgow, who was diagnosed with breast cancer in 2015, said: “The first time I came back after a year for a mammogram, I was asked if I wanted to see a consultant but I didn’t think I needed to. I was absolutely fine. All I wanted to know was that the mammogram was clear and that there were no concerns.
“I think if the clinical team’s appointments are used in a way that allows patients to access the service when they actually need it, it is a much better use of resources.
“This was my experience when a week before my last mammogram, I had some concerns. I phoned one of the nurse specialists and asked if I could see someone on the day of my mammogram. Within half-an-hour I was offered an appointment with the consultant that same day. Fortunately, I was cleared and I was able to go away confident that all was well.
“What more could you possible ask for in a National Health Service?”
Macmillan’s National Programme Manager Gordon McLean said: “I am really pleased patients found the project supportive. It is also good that it allowed consultants to spend more time with people who needed additional support and enabled patients to access this help quickly.
“I hope other health boards will look at the successes of this project and consider how its lessons can be used to improve care after treatment across Scotland.”
This new model of care is now being rolled out to everyone who has finished treatment for breast cancer in Stobhill and is being embedded into everyday practice.