It is generally recognised that haemato-oncology departments are facing an unprecedented and immediate challenge in outpatient services because of the need to follow up with patients with pre-malignant conditions and early-stage diseases.
One solution is to improve the utilisation of outpatient capacity by stratifying patients to self-supported management (SSM) to slow down the growth of face-to-face and telephone appointments where appropriate, and to reduce variation in follow-up practice through the development of evidence-based pathways. This collaboration between clinical teams and support services ensures that patients can access support, tests, advice and, where necessary, treatment within recommended timelines.
The shift in focus from the traditional clinic environments to SSM has already been successfully introduced for monoclonal gammopathy of undetermined significance (MGUS) patients at Clatterbridge Cancer Centre – Liverpool.
Bringing self-supported management to Clatterbridge Cancer Centre – Liverpool
The introduction of SSM at Clatterbridge Cancer Centre – Liverpool in 2019 was supported by The Cheshire and Merseyside Cancer Alliance, who were responsible for leading the local delivery of the National Cancer Strategy. As with many service improvement initiatives, it was initially met with some ambivalence but gained support from Consultant Clinical Leads and General Managers within the site reference group. Internal reviews identified several caseloads, including low-risk MGUS patients who were managed by nurse led–clinics, as suitable for removal from the traditional outpatient appointment system and referral to the SSM system.
Digital tools aid self-supported management
The use of approved digital platforms, such as My Medical Record, has accelerated the delivery of the agreed follow-up pathways and reduced the reliance on the clinical environment. This has reduced the burden of unsustainable increases in clinic attendance.
These platforms are accessible to both medical professionals and patients who wish to have some control over their patient journey
They are designed to facilitate the scheduling of blood tests with reminders for appointments, results tracking, a point of contact, general health improvement advice and rapid re-access to a traditional appointing system if warranted.
Cancer Support Workers are key to remote monitoring
A critical component of SSM is remote monitoring, which aims to ensure continuous assessment with reliance on the Health Needs Assessment Form (Health MOT) and workshops designed to offer an informal meeting space for patients outside of the hospital environment.
Workshops are run and managed by the Cancer Support Workers (CSWs) with clinical support from a lead CNS. Workshops usually cover a range of subjects, which may include setting up and using digital platforms, signs and symptoms to be aware of, psychological effects of diagnosis, and health and lifestyle advice.
The coordination of remote monitoring by CSWs allows the redeployment of clinical time and a commitment to positive user experiences. The new CSW roles, which were developed with guidance from The Cheshire and Merseyside Cancer Alliance, are recognised as an important contact in providing seamless coordination of practical support and care.
Many trusts in the region have now completed business cases and are committed to providing substantive CSW roles, demonstrating the efficacy of the SSM model, and the benefit of reducing pressure on CNS capacity whilst maintaining hospital monitoring for MGUS patients.
If you would like to find out more about the service at The Clatterbridge Centre – Liverpool, please contact the CSEP Team at csep@myeloma.org.uk
Written by Caron Plimley
Cancer Support Worker
Clatterbridge Cancer Centre – Liverpool