16th reach to recovery international breast cancer support conference a pilot program of the...
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16th Reach to Recovery International Breast Cancer Support
Conference
A pilot program of the implementation of Cancer Case
Manager (breast) in Hong Kong in 2010
Vanessa ChunAdvanced Practice NurseDepartment of SurgeryKwong Wah Hospital
Hong Kong11 November, 2011
Background Breast cancer is the commonest female
cancer in Hong Kong.
Multidisciplinary team approach can ascertain quality care and better results.
The emphasis is on patient and her journey of breast cancer treatment.
Objectives To streamline clinical pathway and logistical
issues To coordinate across specialties and enhance the
communication within multidisciplinary team To address patient needs for education,
psychosocial support and access to resources To act as patient advocacy and single-point
contact between patient and clinicians To coordinate and monitor treatment progress
and follow up appointments To identify potential gaps in service
Expected outcomes Patient empowerment (to facilitate informed decision on
treatment) Patients experienced improved outcomes (improve and
standardize the quality of care – protocol driven) To maintain optimism while fighting breast cancer To enhance patient satisfaction with care (establish the
nurse-client rapport) Enhanced quality of life (early discharge, early return to
society) Cost saving (decrease the length of hospitalization)
Methodology
Before the commencement of the program, a standard clinical cancer care module for breast cancer is developed.
Supporting IT program is designed for operational convenience and data capture.
Role of case manager combine into pathway of breast cancer patient
New case of
breast cancer (D1-10)
Breaking
bad news (D10-14)
Operation(W6-8)
Post-op rehab (Post-op
D7-21)
Post-opPathologydisclosure(Post-op D20-27)
1st oncology consultation(Post-op D30-37)
1st surgicalFU appt
(Post-op W26-34)
1st oncologyFU appt
(Post-op W26-34)
Neo-adjuvant
chemotherapy
MDT meeting
Newly diagnosis stage
To initiate protocol To check and arrange
early baseline investigation (MMG) collateral meeting (breaking bad
news) multidisciplinary team meeting (case
discussion)
To inform related professional team members
Patient Journey
Break Bad
News
1st Imaging
1st Treatment
Other Treatment
/ FUDiagnosis
Cancer Case ManagerNotify
Role of case manager (newly diagnosis stage)
To trace all the appointments and investigation reports
To arrange further investigation if needed: CT scan, MRI scan, PET scan, biopsy
To facilitate decision making and to prepare patient for operation
To control the time for operation
Patient education & counseling
To facilitate patient knowing her professional team
To help the patient to known herself To advocate on behalf of patient To provide relevance written information To offer social support and introduce the patient
support group (Yin Chun Club) To refer to other professional team for assessment
if indicated (medical social worker, clinical psychologist)
Clinical photos
Written information An outcome management flow
chart
Relevant information is
given according to different stages
Contact nurse and number
SOS!!!Where can I get help?
Discharge planning
where and how can I get help
after discharge ?
Role of case manager (early post-operative stage)
To enhance early recovery and wound healing of patient To educate patient on wound care and shoulder
mobilization exercise according to patient’s condition To refer to physiotherapist for difficult case To provide psychological support and encourage self care To trace the pathology report and arrange the post-op
collateral case conference for pathology disclosure To facilitate patient to understand and can make decision
on her adjuvant therapy To introduce the concept, side-effects of different adjuvant
therapy To arrange oncology consultation appointment if needed
Role of case manager (rehabilitation stage)
To follow patient’s coping ability and extended problems
To provide bra and prosthesis fitting if needed To arrange and confirm the appointment of
surgical and oncology To trace and monitor the progress of oncological
management plan of patient To check patient’s experience on adjuvant therapy To check problems patient encountered is under
professional care To educate patient on long term risk care
Role of case manager (extended care at home)
Problems encountered by patient at home
To arrange follow up in nurse clinic by appointment booking
Consultation Counselling Lymphoedema management Nipple areolar tattoo Post 5 years breast cancer patients
health screening clinic
Role of case manager for the patient
on neo-adjuvant treatment (patient with advanced condition, detours from the normal
pathway) To check the progress of the neo-adjuvant treatment
To arrange patient and her relatives to attend collateral case conference for the discussion of surgical intervention
To facilitate decision making (BCT vs mastectomy +/- reconstruction)
To prepare patient for operation To control the time and put on list for operation To arrange nurse clinic FU after operation
according to the protocol
Data collection and documentation (1)
Data collection and documentation (2)
Data collection and documentation (3)
Result and outcome (1) 1 April 2010 to 31 December 2010 239 patients (newly diagnosed breast cancer)
Age 56.9 (mean)29 – 97 (range)
Education level:• No formal education• Primary education• Secondary education• Tertiary education
3.3%27.8%63.3%5.6%
Total family income (monthly)• Less than $10,000• $10,001 - $20,000• $20,001 - $30,000• $30,001 - $40,000• Above $40,000
42.2%32.2%13.3%5.6%2.2%
Result and outcome (2)Total number of treatment interventions 246Number of multidisciplinary team meeting:
X-ray meeting: 87 Combined Breast Clinic: 26
113
Number of nurse clinic attendances: Counselling Pre-op education Post-op rehabilitation Wound / drain care Post adjuvant treatment management Phone counselling Others: prosthesis fitting, lymphoedema management, nipple
areolar tattoo etc.
1015
Result and outcome (3)
Mastectomy44%
Breastconservation
treatment26%
Other:chemotherapy /
refuse operation /to other hospitals
20%
Mastectomy withreconstruction
10%
Treatment interventions
Result and outcome (4)
Pre-op education11%
Wound / draincare34%
Phone counselling1%
Post adjuvanttreatment
management4%
Others8% Counselling
17%
Post-oprehabilitation
25%
The nature of nurse clinic attendances
Result and outcome (5)
Patient Journey
1st +ve Biopsy Date
Date of Treatment Decision
(Final)
1st Definitive Treatment Date
Average # of days Days from 1st +ve Bx to 1st definitive
treatment
12.4 25.9 38.3
Remarks:Only cases that followed the above pathway were included in the particular field of the above analyses
(Milestones in Care Pathway)
Result and outcome (6) Patient Satisfaction Questionnaire (PSQ)
Explanation provided by nurse:Very satisfied 44.4%
Satisfied 48.9%
OK 4.4%
Service provided by nurse:Very satisfied 45.6%
Satisfied 46.7%
OK 6.7%
Service improvement
Shorten the waiting time for investigation, operation, . . .
Streamline the clinical pathway
Multidisciplinary team meeting for every cases
Update knowledge
Acknowledgement Medical team
Dr. C M Chan Dr. W L Ying Dr. S W Sun Dr. C Y Lui Dr. L K Chan Dr. C Kwok
IT team Mr H Lee
Nursing team Ms Amy Or Ms M W Tsui Ms W M Cheung Ms N S Wong
Clerk Ms Y L Leung
