The Christie is one of the largest single site cancer centres in Europe treating more than 40,000 patients a year. The specialist supportive care team is an expanding service within the Trust, made up of medical and nursing professionals, with a background of pain and palliative care expertise. In addition to pain and palliative care, services include chaplaincy, psycho-oncology, dietetics, physiotherapy and pharmacy. The team’s enhanced supportive care (ESC) model is a new initiative aimed at patients with advancing progressive cancer and extending the excellent care patients receive at the end of life to include the whole continuum of cancer.
Due to advances in cancer treatment, there are now an increasing number of patients, at different stages of their illness, who are ‘living with cancer’. They may be actively receiving anticancer therapies (sometimes over many years), or be ‘off treatment’ – either in remission, cured (‘beyond cancer’), or living with advancing disease. Many will require the help of healthcare professionals who have expertise in managing a range of problems, whether these are associated with the cancer itself, or as a consequence of cancer treatment. ESC has developed through recognition of what specialist palliative care can offer, but also from recognition of the barriers to achieving earlier involvement of palliative care expertise within the cancer treatment continuum. These barriers may be largely due to the perception of palliative care by the public, patients and many health professionals – in particular the association with care at the end of life. The excellent care that is provided for patients who are nearing the end of life needs to be extended to support them much earlier on in the pathway.
The first objective was to implement five standards derived from national clinical guidelines, including documented evidence that the patient is identified as having advancing progressive disease and that the patient has been considered for entry on to the local supportive care register though GP communication. The second objective was to develop, deliver and evaluate an education programme around advance care planning (ACP) aimed at professionals working within the identified disease groups. The third objective was to undertake patient and carer interviews and questionnaires to measure the impact of ESC on quality of care and experience.
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