Transcript 16th Reach to Recovery International Breast Cancer Support Conference A pilot program of the implementation of Cancer Case Manager (breast) in Hong Kong in.

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 Chun
Advanced Practice Nurse
Department of Surgery
Kwong Wah Hospital
Hong Kong
11 November, 2011
Background
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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
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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
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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
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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
Neo-adjuvant
chemotherapy
Post-op rehab
(Post-op
D7-21)
New case of
breast cancer
(D1-10)
Breaking
bad news
(D10-14)
Operation
(W6-8)
Post-op
Pathology
disclosure
(Post-op
D20-27)
MDT
meeting
1st oncology
consultation
(Post-op
D30-37)
1st oncology
FU appt
(Post-op
W26-34)
1st surgical
FU appt
(Post-op
W26-34)
Newly diagnosis stage
Cancer Case Manager
Notify
Patient Journey
Diagnosis
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To initiate protocol
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To check and arrange
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Break
Bad
News
early baseline investigation (MMG)
collateral meeting (breaking bad
news)
multidisciplinary team meeting (case
discussion)
To inform related
professional team members
1st
Imaging
1st
Treatment
Other
Treatment
/ FU
Role of case manager
(newly diagnosis stage)
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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
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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
SOS!!!
Where can I get help?
Contact nurse and number
Discharge planning
where and how can
I get help after
discharge ?
Role of case manager
(early post-operative stage)
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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)
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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)
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Problems encountered by patient at home
To arrange follow up in nurse
clinic by appointment booking
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Consultation
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Counselling
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Lymphoedema management
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Nipple areolar tattoo
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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)
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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)
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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
246
Number of multidisciplinary team meeting:
113
X-ray meeting: 87
 Combined Breast Clinic: 26
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Number of nurse clinic attendances:
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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.
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1015
Result and outcome (3)
Treatment interventions
Mastectomy
44%
Breast
conservation
treatment
26%
Mastectomy with
reconstruction
10%
Other:
chemotherapy /
refuse operation /
to other hospitals
20%
Result and outcome (4)
Phone counselling
1%
Post adjuvant
treatment
management
4%
Others
8%
Counselling
17%
Pre-op education
11%
Wound / drain
care
34%
Post-op
rehabilitation
25%
The nature of nurse clinic attendances
Result and outcome (5)
(Milestones in Care Pathway)
Patient Journey
Date of
Treatment
Decision
(Final)
1st
+ve
Biopsy Date
1st Definitive
Treatment
Date
Average # of days
12.4
25.9
Days from 1st +ve
Bx to 1st definitive
treatment
38.3
Remarks:
Only cases that followed the above pathway were included in the particular field of the above analyses
Result and outcome (6)
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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
Streamline
the clinical
pathway
Shorten the
waiting time for
investigation,
operation, . . .
Update
knowledge
Multidisciplinary
team meeting for
every cases
Acknowledgement
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Medical team
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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
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Mr H Lee
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Nursing team
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Ms Amy Or
Ms M W Tsui
Ms W M Cheung
Ms N S Wong
Clerk
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Ms Y L Leung