Shared learning database

Gateshead NHS foundation Trust
Published date:
October 2011

The team have developed a pre operative supportive care clinic for women with gynaecological cancer. The clinic allows patients the opportunity to discuss their concerns and address informational and supportive care needs. The clinic has improved communication across health care boundaries and enhanced the patient experience.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The aim of the initiative was to ensure that all patients who attended for surgical pre assessment were offered the opportunity to have a holistic assessment prior to surgery. Develop a supportive care plan which included information and supportive care interventions by the Clinical Nurse specialist. Improve communication across health care boundaries. Enhance the patient experience and identify and communicate their concerns. Involve stakeholders in the process of service re design to ensure it was responsive to patient need. Provide a supportive environment for patients to discuss their information and supportive care needs. Commence care planning earlier in the patient pathway.

Reasons for implementing your project

Best practice guidelines recommend all women with a suspected or confirmed diagnosis of gynaecological malignancy (except for early stage cancer) receive their surgical treatment in a specialist centre. Such centres are able to offer the woman detailed information about their condition, proposed treatment and active support and co-ordination throughout their care pathway. Ideally the Clinical Nurse Specialist (CNS) acts as a key worker who, with the patient's agreement, takes a key role in co-ordinating and promoting continuity in care. But as the CNS is not always involved at diagnosis, they are sometimes contacted for crisis intervention or when a patient is admitted to hospital for treatment, rather than taking a more pro-active approach. Such concerns prompted an evaluation of the current service provision by the project team and informed this service development. Focus groups informed the initial pilot and a post implementation focus group and questionnaire analysis showed an improvement in the serve and patient experience.

How did you implement the project

The supportive care clinic was developed in response to patient need and underpinned by national policy directive, but active support from trust board members and the willingness of the nursing and medical team to change was central to success. Barriers were minimal as the team adopted a practice development framework and involved the key stakeholders at all times to ensure the success of the project which is now embedded within practice and is part of the patient pathway. There was no initial cost to the project just a different way of working.

Key findings

The team evaluated the impact of the clinic and collected data about concerns patients identified and what interventions were carried out by the nurse specialists. Patient questionnaires and a focus group were used to evaluate the clinic. This allowed the concerns to be identified earlier in the patient pathway and it also enabled the nursing team to refer patients to other professional to ensure their needs were met across a complex health care boundary. Feedback from patients suggests that the supportive care clinic and holistic assessment enhanced the experience of the patients and prevented duplication of effort by other professionals.

Key learning points

The important part of the development for our team was involving our patients in the development of this clinic helped us to determine what was important for the patient at the time of diagnosis of cancer. Sometimes barriers are there but with the appropriate patient reported outcomes this can provide the vehicle for effective and improved patient care.

Contact details

Alison Guest
Macmillan Lead Nurse
Gateshead NHS foundation Trust

Secondary care
Is the example industry-sponsored in any way?

A grant was obtained from the Foundation of Nursing Studies to support the development and dissemination of the project.