Partnership in prostate cancer (ICARE-P): using digital technology to enable primary and specialist care integration

Conference:

SAPC ASM 2017 - Warwick

Talk Code:

EP1B.09

Presenter:

Rebecca Appleton

Co-authors:

Veronica Nanton, Jeremy Dale, Prashant Patel, Sam Ahmedzai, Theo Arvanitis, Douglas Badger, Thomas Hamborg, Nicholas James, Richard Mendelsohn, Omar Khan, Deepak Parashar, Julia Roscoe

Author institutions:

University of Warwick, University of Sheffield, University Hospital Birmingham NHS Foundation Trust, Birmingham South Central CCG, South Warwickshire Prostate Support Group

Problem

There are over 330,000 men living with a diagnosis of prostate cancer in the UK who have followed various treatment pathways and have differing needs. Many men experience concerns due to the physical or psychological consequences of treatment or living with cancer which cannot be addressed in a stretched secondary care service. Survival rates are increasing, therefore there is a need for urgent attention as to how follow-up care and monitoring can be best delivered. Evidence suggests that patients may benefit from follow-up care in General Practice.

Research has also shown the potential of technology to aid integration of care delivery systems, through enhanced communication between the patient and his care teams.

Approach

We have developed an online holistic needs assessment (CHAT-P), and this study will test the feasibility of carrying out a large scale trial to investigate whether the use of our intervention will improve patient outcomes. This is a two-phase study. Phase 1 comprised of interviews with healthcare professionals and patients. In Phase 2, patients in the intervention arm will complete the HNA three times at three-monthly intervals, followed by a consultation with a practice or research nurse to discuss any issues identified in the HNA. Nurses will direct men to other appropriate services if needed and a care plan will be agreed. All nurses are Macmillan trained and have received prostate cancer specific training provided by the study team, and have been linked with a clinical nurse specialist in secondary care to facilitate integrated care between services.

Participants in the control arm will receive usual care. Outcomes such as quality of life, prostate specific concerns, well-being and patient enablement will be measured three times over a nine month period.

Findings

Qualitative interviews in Phase 1 showed both patients and healthcare professionals were enthusiastic about our online intervention and proposed care plan. Recruitment to Phase 2 of the study will start in March 2017.

Consequences

This study is the first of its kind to trial an online HNA for prostate cancer patients, and a model of integrated care between services. We anticipate this system will provide important benefits for patients in terms of addressing unmet needs, identifying concerning symptoms and enabling self-management, and to the NHS in terms of effective use of resources.

Submitted by:

Rebecca Appleton

Funding acknowledgement:

National Institute of Health Research, Research for Patient Benefit funding stream. We would also like to thank Chameleon Information Management Systems and Prostate Cancer UK for their work in developing our online holistic needs assessment.