Boosting confidence after breast cancer in Salisbury

Case study summary

Breast cancer survivors feel more confident and less fatigued after enhanced support to live better after cancer.

The Salisbury stratified follow-up pathway includes a Holistic Needs Assessment (HNA) followed by a two-hour Moving Forward group. Hosted by a Consultant and a nurse, it addresses immediate health and wellbeing concerns. Offered to everyone on the patient initiated follow up, the average rating on session usefulness is 4.45 out of five. The average self-reported confidence score is 4.65. However the support does not stop there, patients identified as requiring more support are referred to the Cancer wellbeing group.

This group meets once a week for seven weeks. Hosted by a Clinical Psychologist and Gym Instructor qualified in rehabilitation, each two hour session starts with wellbeing advice, such as finance and benefits, diet or mindfulness and ends with a suitable rehabilitation exercise session. Group members unable to participate in group exercise receive a personal rehabilitation exercise programme. Members can also access weekly swimming sessions in the hospital pool. The average satisfaction rating for the group is 4.5 out of five, while on average, members report fatigue on daily life scores reduced by one third.

The service models

Stratified follow-up pathway

A new breast cancer stratified follow-up pathway, to increase the support given to breast cancer survivors, was rolled out at Salisbury Hospital in 2016.

Following breast surgery or completion of radiotherapy and chemotherapy, patients enter the stratified follow-up pathway. The patient will have a Holistic Needs Assessment (HNA), identifying their physical, practical, emotional, lifestyle and social needs to ensure these are met in a timely and appropriate way.

Everyone on the patient initiated follow-up pathway is referred to a two hour follow-up appointment – Moving Forward. Hosted by a Consultant and a nurse, this group session addresses immediate health and wellbeing concerns of breast cancer survivors. During the first hour the clinician and nurse address health and treatment concerns. This includes information about breast cancer, mammograms, advice on breast self-examination as well as advice on how to manage their follow-up care and when and how to contact their clinical team as required during their recovery. Patients with concerns about surgical aspects of their care, also speak to a surgeon. There is a short break to enable patients to ask questions in a relaxed setting and seek peer-to-peer support. After the break, the group discuss wellbeing and potential issues that might hinder their recovery including depression, poor sleep and difficulty accessing appropriate exercise. The aim of Moving Forward is to address immediate patient medical and wellbeing concerns, as well as preparing patients to have the confidence to manage their wellbeing. Patients identified as requiring ongoing support at this session are referred to the Cancer Wellbeing Group.

The Cancer Wellbeing Group

Run by a Clinical Psychologist and Gym Instructor qualified in rehabilitation, the group meets weekly for seven weeks, enabling all cancer survivors an opportunity to receive advice, supported exercise and peer-to-peer support in a relaxed and friendly atmosphere for a weekly over a period of seven weeks.

Each two hour session starts with a professional speaker offering wellbeing advice on a topic indicated as important by group members. Common topics include finance, benefits, diet, sleep and mindfulness. After a short break, group members return for a one hour exercise rehabilitation session. Members are also able to take advantage of a weekly swimming session in the hospital pool – this has been helpful in creating a safe and supportive environment in which patients can regain some of their confidence in the pool or in wearing swimwear.  For various reasons some members are unable to access group exercise. These patients receive a personal exercise rehabilitation programme following a one-to-one session with the instructor.

Results

  • The majority of breast cancer survivors are offered a HNA
  • The majority of patients access the Moving Forward session
    • The average rating on session usefulness is 4.45 out of five
    • The average self-reported confidence score is 4.65 out of five.
  • 600 cancer survivors attend the Wellbeing Group annually, of these:
    • An overall satisfaction score of 4.5 out of five is reported on completion of the group
    • Fatigue on daily life scores are reduced on average by 1/3 across participants

Quotes

The patient and clinical team make a joint decision about the best form of follow up. Tailoring care according to the severity and complexity of their medical and clinical needs, including their access to support in the community and need for peer-to-peer support”

Jessica Thomas, Cancer Specialist Nurse

The Wellbeing Group is an opportunity to give people the advice and support they need to live better after cancer. We are lucky to have a pool available and a qualified gym instructor who can help patients to regain their confidence to exercise appropriately after treatment that may have included invasive surgery.”

Kate Jenkins, Clinical Psychologist

Loved the session today, its already made me feel less isolated and that there is light at the end of the tunnel”

Patient feedback after attending the Cancer Wellbeing Group.

My stamina and balance increased, reduced my vulnerability in crowded places and feel more confident”

Top tips for implementation

  • Use depression scales questionnaires and previous HNAs to decide the session content
  • Build in time to enable members to ask questions within the group or on a one-to-one basis
  • Create an atmosphere and space that encourages peer-to-peer interaction so that patients feel less alone and have their feeling validated
  • Ensure patients are supported to participate in healthy behaviour such as rehabilitation exercise, healthy eating and smoking cessation.