Introduction to the newly developed London Holistic Needs Assessment Natalie Doyle Nurse Consultant: Living With & Beyond Cancer LCA London Cancer 20th November 2013 The London Cancer Alliance West and South What is our goal? “…to support cancer survivors to live as healthy and active a life as possible for as long as possible.” Richards et al 2011 The London Cancer Alliance West and South Concept of Survivorship “Cancer survivorship is a process beginning at diagnosis involving uncertainty. It is a life changing experience, with duality of positive and negative aspects, unique to the individual but with some universality” Doyle 2008 The London Cancer Alliance West and South Survivorship: 5 Attributes • • • • • A process beginning at diagnosis Uncertainty Life changing experience Duality of positive and negative aspects Individual experience with universality Doyle 2008 The London Cancer Alliance West and South The Recovery Package (NCSI/Macmillan 2012 ) The London Cancer Alliance West and South The Recovery Package • Holistic Needs Assessments and Care Planning – at key points of the care pathway • Treatment Summary – completed at end of acute treatment phase and sent to GP. • Cancer Care Review –completed by GP or practice nurse to discuss persons needs, and • Patients education and support event, such as Health and Wellbeing Clinics to prepare for:- • Transition to supported self management, which will include advice on healthy lifestyle and physical activity. NCSI/Macmillan 2012 The London Cancer Alliance West and South The challenges we faced • • • • • • • • • • • “Distress” or “concerns” Local preference or a pan-London approach Metrics IT Assessment the old fashioned way Documentation The Official Secrets Act One size does not fit all or the utilitarian argument “We” are different Concern is what the person says it is Communication The London Cancer Alliance West and South Biggest challenge… Assessment the old fashioned way • How do you know what someone is thinking or is concerned about? • Do you second guess based on experience? • Do you always get it right? • Would you know if you were wrong? • Are you surprised when you are wrong? • What happens then? The London Cancer Alliance West and South Because it ain’t what you do... It’s the way that you do it And that’s what gets results Bananarama & The Fun Boy Three 1982 The London Cancer Alliance West and South Communication is the key Solution focused care Motivational interviewing 11 West and South The London Cancer Alliance Try to lead from the front “The Arabs taught me that no man could be their leader except he ate the ranks' food, wore their clothes, lived level with them, and yet appeared better in himself” T.E Lawrence 12 West and South The London Cancer Alliance Harnessing the Forces for Change... Minimise Accentuate POSITIVES NEGATIVES Essentially, focussing our Driving energies on people who Driving Driving PRESENT STATE or DESIRED STATE were motivators and Restraining Driving Force-field Analysis, Karl Lewin enablers! 13 The London Cancer Alliance West and South Shared Vision People who work together will win, whether it be against complex football defences or the problems of modern society Vince Lombardi The London Cancer Alliance West and South Strengths •It’s the patient perspective •Clinical judgement decides when to discuss •Stimulates conversation •Invites discussion •Gives permission to discuss & have problems •Springboard for information and advice, difficult conversations •Goal setting -: prioritisation and practical resolutions •A formal record of discussion/conversation •Provides evidence of CNS effectiveness Opportunities •Demonstrates quality •Enhances communication between teams •Promotes the CNS (AHP etc) role •Patients can discuss things they wouldn’t with medics! •“Un-sticks” patients that aren’t moving forward Weaknesses •Time •Space •Generic form for differences in disease •Could be a means in itself or “tick box exercise” •Only in English and for the literate •May cause distress Threats •Informatics •Where to signpost to? Are there services •Space and privacy (could raise a risk) •Cost implications The London Cancer Alliance West and South The New Pan-London Tool The London Cancer Alliance West and South The New Pan-London Tool (2) The London Cancer Alliance West and South The “Green Bay Packers” team for Holistic Needs Assessment • London Cancer (LC)… Sharon Cavanagh and her team • London Cancer Alliance (LCA)… The Survivorship Pathway group The London Cancer Alliance West and South For me without Nic Glover, LCA Project Manager, there wouldn’t be the vital Cunning Plan The London Cancer Alliance West and South We can make this happen across the whole of London and together we will make this happen Self efficacy is a belief in one’s ability to achieve something Bandura 1977 The London Cancer Alliance West and South #NatalieDoyleSaidSheDoesn’tKnow ButWillFindOut The London Cancer Alliance West and South Natalie Doyle Nurse Consultant Living With & Beyond Cancer natalie.doyle@rmh.nhs.uk The Royal Marsden NHSFT Fulham Road London SW3 6JJ Tel 0207 352 8171 ext 1791