Background
Cancer survivorship is traditionally delivered in an acute hospital setting. Community Health may offer a more accessible, relaxed environment with the opportunity to change the narrative from illness to wellness, empowering clients to be aware of their own surveillance, promoting self-management.
Aim
SHDH established a nurse led cancer survivorship clinic within Community Health to build capacity of local clients with their survivorship needs, regardless of whether they were treated locally and or elsewhere. Initially a pilot of breast cancer clients but accepting of all cancers.
Methods
The survivorship clinic was established within a Community Health service one day per week with one Cancer Survivorship Nurse 0.2FTE.
20 Supportive Care Plans (SCP) have been completed.
Referrals were received from members of the multidisciplinary team. The clinic utilised the NCCN Distress Thermometer and Problem List to identify patient’s needs and adapted existing Supportive Care Plan templates to design a SCP to suit local needs.
Patients were invited to complete a supportive care plan and summary of treatment over several appointments including face to face, telehealth and phone calls.
Clients were referred to local services as needed including, screening programs, dietitian, women’s health clinic, social work and online services.
Patients with or without a SCP were provided with education and followed up by telehealth or phone approximately 6 weeks after their SCP or education was completed.
Clients were provided with a deliberately minimal information pack and a letter designed to empower them and to build capacity for self-management where possible. Evaluation of service was via a qualitative questionnaire on the perceived benefits of the nurse lead survivorship clinic.
Conclusion
Clients reported the SCP and follow-up care was very supportive with reference to knowing there was a wraparound service.
Enablers include Department of Health Tier 2 funding, existing staff and local services to refer to.