Enhanced Supportive Care Royal Devon Exeter NHS Foundation

Enhanced Supportive Care Royal Devon & Exeter NHS Foundation Trust Niranjali Vijeratnam 28 th February 2019

Background • Enhanced Supportive Care = initiative to embed Supportive and Palliative Care earlier for advanced cancer patients • Growing evidence that this approach can improve outcomes for advanced cancer patients

ESC RDE • 2 year CQUIN - April 2017 • Oncology/haematology patients • Advanced liver disease patients • Daily clinics (joint assessments) • Working hours CNS mobile • Weekly MDT meetings/gaps (Consultant, CNS, OT, PT, DT - Psychologist to start)

April 17 - Nov 18 • 886 Oncology/Haematology Patients • 2438 contacts - 63% FTF, 37% Tel – 35 Advanced Liver Patients (108 contacts) Number of patients/Cancer sites 250 200 150 100 50 er Li v nc on -o ne N im Pr n ow nk n U Bo ar y ai n Br I G er Lo w rc om a k Sa ec N n H ea d/ Sk i al ct or e C ol G yn ae gy U ro lo m ae H ea st Br I G pp er U Lu ng 0

Patient examples Doing the right thing for the patient. 1. Palliative patient, MDT -> IPOS score reductions 2. Curative treatment – symptom control 3. Complex treatment decision – permission to decline Pembrolizumab

Onc/Haem Patient pathway • Stage of illness – 25% patients seen at point of diagnosis – 10% patients seen at recurrence diagnosis – 1% patients seen at End Of Life • Treatment intent – 14% patients having potentially curative treatment

Clinic feedback cards What went well… • I found the consultation to be very useful. I was treated with considerable empathy and respect. Well informed and I actually enjoyed the visit and am looking forward to seeing the team again. • Very supportive and assuring consultation. Good advice and hopefully some local support available. • It was so helpful to have someone to talk to that understands the whole situation and it is so nice to hear that there are options.

Even better if… • P If I had been seen much sooner / earlier in the process. Think would work better if the whole care system worked together and focussed on person centred care and co-ordinated services. • P A different venue, not Oncology • P I don’t see any way of improving. The system seems to work very well.

0, 00 Poor mobility Has s/he been feeling anxious or worried about his/her illness or treatment? Have any of his/her family or friends been anxious or worried about the patient? Do you think s/he felt depressed? Do you think s/he has felt at peace? Has the patient been able to share how s/he is feeling with his/her family or friends as much as s/hehad wanted? Has the patient as much Haveasany practical information s/he wanted? problems resulting from his/her illness been addressed? (such as financial or personal) Drowsiness Sore or dry mouth Constipation Poor appetite Vomiting Nausea Weakness or lack of Shortness of breath Pain IPOS Yr 2 Q 3 3, 50 3, 00 2, 50 2, 00 1, 50 1, 00 Total average 1 st attendance 0, 50 Total average 2 nd attendance

BTOG 2019 Poster

The future… • • • Ongoing funding for ESC Presentation to Ca Alliance E-IPOS Virtual clinics governance Non-malignant ESC CQUIN ? 2020

Questions Thank you