Introduction to the newly developed London Holistic Needs Assessment Natalie Doyle

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
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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
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Holistic Needs Assessments and Care Planning – at key points of the care
pathway
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Treatment Summary – completed at end of acute treatment phase and sent
to GP.
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Cancer Care Review –completed by GP or practice nurse to discuss persons
needs, and
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Patients education and support event, such as Health and Wellbeing Clinics
to prepare for:-
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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
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“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
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How do you know what someone is thinking or is concerned about?
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Do you second guess based on experience?
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Do you always get it right?
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Would you know if you were wrong?
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Are you surprised when you are wrong?
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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!
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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
[email protected]
The Royal Marsden NHSFT
Fulham Road
London
SW3 6JJ
Tel 0207 352 8171 ext 1791