Quality statement 7: Supportive care and rehabilitation

Quality statement

Adults with metastatic spinal cord compression (MSCC) have a management plan that includes an assessment of ongoing care and rehabilitation needs.

Rationale

It is important that personalised management planning for adults with MSCC starts on admission because rehabilitation and supportive care are integral to the promotion of independence and quality of life for adults with MSCC. Emphasis should be on an individualised, person-centred management planning process, led by a key worker, which takes into account care relating to all existing healthcare issues the person may have, including cancer. Communication between secondary, primary and tertiary care needs to ensure a seamless transfer between services and continuity of care for patients.

Quality measures

Structure

Evidence of local arrangements and written protocols to ensure that management planning for adults with MSCC includes an assessment of ongoing care and rehabilitation needs.

Data source: Local data collection.

Process

Proportion of adults with MSCC who are discharged from hospital with a management plan that includes an assessment of ongoing care and rehabilitation needs.

Numerator – the number of adults in the denominator who have a management plan on discharge.

Denominator – the number of adults with MSCC who are admitted to hospital.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that staff are trained on how to develop management plans, including how to undertake an assessment of ongoing care and rehabilitation needs for adults with MSCC, and have protocols in place for starting management planning on admission.

Healthcare professionals involve adults with MSCC in developing management plans that include an assessment of ongoing care and rehabilitation needs for adults with MSCC when they are admitted to hospital.

Commissioners ensure that they commission services that train their staff on how to develop management plans including how to undertake an assessment of ongoing care and rehabilitation needs for adults with MSCC, and have protocols in place for starting management planning on admission.

What the quality statement means for patients, service users and carers

Adults with MSCC have a plan of the ongoing care they agree they will receive after they have been discharged from hospital, which will include plans for rehabilitation.

Source guidance

  • Metastatic spinal cord compression (NICE clinical guideline 75), recommendation 1.6.5.4 (key priority for implementation).

Definitions of terms used in this quality statement

Management planning and ongoing care

For adults with MSCC, this should start on admission and it should involve: the patient; their families and carers with the patient's consent; their primary oncology site; surgical, specialist palliative care and rehabilitation teams and community support, including primary care, as needed. The management plan should address physical and psychological needs. Management planning should include, but not be limited to, consideration of: pressure ulcers, continence, maintenance of circulatory and respiratory functioning, psychological adjustment and location of care. [NICE clinical guideline 75 recommendation 1.6.5.4 and expert consensus]

Key worker

Person who, with the patient's consent and agreement, takes the leading role in coordinating the patient's care and promoting continuity, ensuring the patient knows who to access for information and advice, regardless of the patient's location. The role may be undertaken by the MSCC coordinator or by a different named individual. Different practitioners are likely to perform this function on behalf of individual patients over time. [Adapted from the full clinical guideline 75, appendix 6, glossary; NICE cancer service guidance on Supportive and palliative care, recommendation 1.29 and expert consensus]

Equality and diversity considerations

Survival times for adults with MSCC vary from just a few weeks to over a decade. MSCC is closely associated with the end of life because of its high incidence in the late stages of advanced malignancy. The timing of discussions about ongoing care and rehabilitation should be sensitive to the emotional adjustments that the patient and carer may be experiencing.

The person's age should not affect the content of the discharge plan or their access to rehabilitation services. Healthcare professionals should consider whether adults with MSCC who are experiencing the later stages of cancer may benefit more from readjustment rather than rehabilitation.