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Group chemotherapy information mornings transform care

A project transforming care for patients about to begin chemotherapy has reduced anxiety and cut waiting times, writes Elaine Cole

A project transforming care for patients about to begin a course of chemotherapy has reduced anxiety and cut waiting times, writes Elaine Cole

Nurse-led group chemotherapy information mornings for newly-diagnosed cancer patients are preventing patients at Cheltenham General Hospital from becoming overwhelmed at a vulnerable time.

Alison Peett
Project leader Alison Peett. Photo: Stephen Shepherd

The sessions ensure patients get the right information before starting treatment and a chance to develop peer support networks (see Box 1).

Previously patients at the busy regional oncology centre, part of Gloucestershire Hospitals NHS Foundation Trust, attended a 40 to 60-minute one-to-one session with a nurse.

‘Information patients received was not standardised and the process was labour intensive,’ says project lead Alison Peett.

‘Appointments sometimes took an hour and a half. Patients reported feeling overwhelmed.

‘I wanted to improve patient experience at a time they feel most vulnerable. Newly diagnosed patients want to know what is going to happen really quickly. It was important to standardise information on side effects, keeping safe, getting help and receiving support.’

Alison, who was later to be shortlisted in the Cancer Nursing category of the RCNi Nurse Awards 2016 for her work on this project, first conducted a review before holding a multiprofessional stakeholder meeting.

She visited two oncology centres with similar models to see how they delivered information to patients. She designed an information checklist, redesigned pre-chemotherapy care plans, chemotherapy alert cards, patient information booklets and an appointment letter. A resource folder has been created for the pre-chemotherapy nurse team with chemotherapy toxicity prompt cards to ensure nurses give standard advice.

Although it was a challenge, she eventually found a suitable venue to house all three components: the group session, nurse one-to-one and healthcare assistant appointments – and successfully bid for equipment including privacy screens, a drinks trolley and hot water flask.

After recruiting four volunteers and completing staff training, the group sessions went live in June 2015.

Increase in footfall

Collaboration with the information team has made a huge difference. Members give a presentation to the group about free sessions such as relaxation, reflexology and massage. Then all patients have an appointment with the team to book sessions, or make appointments at later visits. Footfall has increased, especially among men.

‘Patients use the coffee breaks to talk to each other, which helps to reduce concerns,’ adds Alison. ‘Carers make a beeline for each other. They enjoy having the opportunity to talk to other people in a similar situation.

'When the patient comes in for treatment, they often know someone from their group session. It is a familiar face when they are feeling fearful.’

Informal feedback has been positive with comments such as ‘the group presentation was terrific’ and ‘it helped me overcome my anxiety of being alone…I felt cared for’.

‘We had excellent feedback from patients who had already had the traditional one-to-one appointment,’ adds Alison.

Needs being met

The team did a four-week evaluation of 96 patients in May and had a response rate of more than 80%. ‘I am still awaiting formal feedback, but I could see the majority were extremely positive about the new sessions,’ says Alison. ‘They said their information needs were being met and they felt supported.’

The trust, too, has seen significant benefits including a weekly saving of eight hours of nurse time, correct skill mix use and better informed patients. ‘This means fewer problems,’ says Alison. Waiting times have fallen from 9.6 days to 7-8 days and there are now 34 appointments available a week instead of 20.

Collaborative working with clinical nurse specialists has also improved. One place is reserved for haematology patients. The cancer nursing specialist attends and runs through information with them.

There is a better partnership with research nurse colleagues. ‘We did not know what patients had been told when they were selected for trials,’ adds Alison. ‘They were bombarded with information or not told at all. Now the right people come to talk to them at the right time.’

And despite some nurses being nervous about presenting, they have grown in confidence.

‘The hard work has been worth it. I feel we are really making a difference at a time when patients could be feeling fearful and overwhelmed,’ Alison says.

The group session format
  • A maximum of eight patients attend an information morning before having chemotherapy with a relative/carer.
  • A nurse gives a 20 minute presentation about treatment and side effects, then the information team give a 5 minute presentation.
  • Each patient then has a private appointment with the nurse, who takes a holistic approach to identifying individual needs.
  • Patients are taken to the information centre to receive tailored written information and to be signposted to support services.
  • Patients have their height and weight recorded, bloods taken and observations completed in a session with the healthcare assistant.
  • Volunteers serve drinks to patients waiting for their nurse appointment and patients get a chance to talk to people in similar situations.
‘It’s so relaxed now I even get a few laughs’

Alison Lovett-Turner, practice development and educational support nurse, on how the information sessions have improved practice and patient care:

'Previously one nurse would cover the one-to-one clinic all day. In 40 minutes they would have to measure height and weight, complete baseline observations, bloods, vein assessment, gather next of kin details and GP info, complete approximately 10 pieces of paper on top of delivering all the information on health and safety, side effects, appointments and tour the unit. It was a huge ask.

It was emotionally challenging. Clinics would run late because patients were overwhelmed, struggling to digest information and consider side effects and wrestling with their diagnosis. We are well versed in psychological support, but because of the intensity and frequency I felt emotionally fatigued by the end of the day.

Now the group session gives standardised information. The nurse can engage with the audience ­– I even manage to get a few laughs. I enjoy how positive it is, informal and relaxed, in stark contrast to many one-to one clinics.

Initially I had reservations about presenting to a group, but Alison Peett supported me. I am now more confident and I enjoy teaching. I have gone on to complete a postgraduate certificate of education.'

 

 Cancer Nursing Practice would like to thank Macmillan Cancer Support for sponsoring the Cancer Nursing award at the RCNi Nurse Awards 2016

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