Phone follow up clinic for prostate cancer patients following radiation treatment Julia Hunter, Roya

By Adem Lewis / in , , , , , /

Hi, thank you, so my name is Julia
Hunter. I’m a cancer nurse coordinator at Royal North Shore and i’m going to talk about
fine follow-up clinic for prostate cancer patients following radiotherapy.
And so my presentation today is going to cover, creating a phone follow up
clinic. The logistics of how we did it, some of the patient feedback, and some of
the future projects that we’ve got and that we’re looking forward to. So our team
includes three doctors Thomas Eade, Andrew Kneebone and George Hruby, work with
different registrars and fellows, as well as the secretary who’s very vital in the
the process, and that’s Jan Bush and of course myself. Um, so the rationale.
The ideas sort of started when a couple years ago, when one of the doctors, Andrew,
decided to come up with the idea to start this phone follow-up clinic. And the
reason for that was that prostate cancer patients following the
radiotherapy, we were following them up for up to sort of 10 years, checking their
PSAs, checking their late side effects. So this in an increasing amount of prostate
cancer patients, especially with three doctors, so we wanted to reduce the amount of
patients that were coming to clinic and also at the time we did move to across
to a new hospital and so that previous to that, radiation oncology, medical
oncology and hematology were all very separate, so suddenly they were all
brought into one cancer center and also they’re all competing for the clinic
space so clinic space became a premium, also reducing the convenience,
inconvenience to the patients. A lot of our patients come from a long way away,
they’re driving couple of hours to get to us, they’re waiting in clinics all day and also
packing is an issue for these patients. We want to reduce the inconvenience to
them and also give them a choice of how they want to be followed up, and we’re
really hoping to decrease the number of patients lost to follow-up. So the
criteria for a phone follow-up was any patient who was 2 years post-treatment,
patients without metastatic disease, patients who preferred phone follow ups. So they had to to allocate phone follow-up patients with good English and of course
good hearing because we wanted them to be able to understand what we were
saying when they got the phone call. So the logistics of it: um, the patients
come into a clinic, and the doctor asked them whether they want to continue with
coming into the clinic or whether they would like to go on to phone follow-up. We’ve got a prostate cancer database where all the patients having radiotherapy for
prostate cancer are put onto the database and I’ve created a page on that database
specifically for the final follow-up and then the doctor could allocate whether
they were going on follow-up. If they were going that way, and there was a time period. If that, they put in whether it’s three months, six months 12 months for the next
follow-up and a date was generated when they would due. So every month the secretary printed out
a list of patients who were due that month for the phone follow-up and
letters to send out the patients, um with a PSA form, blood test form. A
popular pick up there as well, because we originally sent EPIC forms, but
which is a questionnaire for prostate cancer patients, but it’s 15 pages long, so it’s
quite cumbersome for the patients to have to fill out every time and send back. So
we sort of ditched that, and once we receive the PSA blood test back, the
patients booked into the following week for the phone follow-up and then
the doctors call them. So at first it didn’t actually work too well, and
there’s a number of reasons for this. The two doctors that we had working at
the time, Andrew and Tom are very different and wanted very different things, they, they
wanted to the clinic to run very differently. Um, they couldn’t decide on
where they actually wanted the patients booked into, and um, their
clinics were on sort of different days and Andrew saw patients on Monday afternoon and Tom
saw patients on Friday morning. That was sort of all over the place and at the
time the secretary was allocating a time for booking the patients into the
schedule, and then patients were ringing up and being told what time the doctor
would ring and then if the doctor didn’t ring at that specific time, they were
getting upset and taking it out on Jan. And so it sort of didn’t work at first
and we had no formal protocols. Patients weren’t at home when answering the phone
so it was quite difficult at first but we got it there in the end, and what
actually made it work and this is what made it work, that’s what usually
makes it work: hard work, teamwork, and good communication, and a second idea. And the second idea with the important part I think. And the second idea came from
Tom, who at the time George Hruby was coming over to join us, so we had three
doctors and what the idea was, was to bring the doctors and all the patients
that into one clinic and create a super clinic. So that’s what we’ve done every
Monday, we have a urology super clinic and um, so all the doctors know on Monday
they’re in the clinics. In the morning we see follow-up patients so we have quick
five minute appointments to start with, and then 10 minute appointments for
patients who needed to be seen because of a scan or they need treatment
organizing, so they’re the patients that come into the clinic. Then we have a bit
of a lunchtime break in the afternoon. We see new patients and then between four
and five we’ve got a scheduled time for phone
follow-ups and this is what made it sort of made it work, and patients are no
longer told a time that they that, the doctor’s gonna ring because if the
doctors are bit quieter in the morning, there not as many patients that ring
at any time during the day. So they’re told that on that Monday someone will
try and get in contact with them and when we started the super clinic, we
made sure we send out lots of letters to the patients and got lots of PSA backs,
so every single week we had 10 to 15 patients booked in for phone follow-ups,
and then we’d harass the doctors and make sure the doctors did the work, and
rang the patient and they were, and they started getting into the routine of it.
And that’s what I think really made the difference with a phone follow-up. So
currently we have 383 definitive radiotherapy patients and 232 post
prostatectomy radiotherapy patients but I think there is actually more than those
numbers. I think we’re following up with a lot more with phone follow-up, that are not
in those two categories. So each way, week without fail, the doctors called ten
to fifteen patients between, ah just some statistics for you. Between January and
during this year, we rang 252 patients. Unfortunately 66 patients dindn’t answer their phone which it really doesn’t help, and it gets quite frustrating because then they,
we have to put them on the next list and the patients unfortunately expect
the doctors to keep ringing until they get them, but there’s not time for that. So we had to sort of deal with that as
well, so the patients were actually happy with the way we’re doing things. We
got to a point where it was working for us, but were the patient’s happy? So about
a month ago I sent out some questionnaires in the mail to a 100 patients
and they were the last hundred patients have been rung for phone
follow-ups. So they had actually been successful in their phone follow-up. That’s
just some statistics and, then when the the patients that actually returned the
questionnaires, um were and so were they actually satisfied? On this graph, one is
extremely dissatisfied and five are extremely satisfied. So we had 40
patients come back and say that they were extremely satisfied with the final
follow-up, 21 were satisfied. So that was really good news to us. We’re really
happy about that. We had three patients say that they are uncertain and one say that he was extremely dissatisfied. Um, but then the next question was do they want to
stay on phone follow-up or do they want to go back to clinic, and if they chose
to go back to clinic, there was a number prompting them to make a phone call to
to book an appointment. And this is what we got back. So sixty-three
patients said that they wanted to keep going with a phone follow up and only two
patients said they wanted to go to clinic. One of those patients were, had
urinary symptoms, so he was luckily he put his name on the forms, because the forms,
the questionnaires didn’t have names on them, and he was quickly booked into the next
the next clinic appointment to have a chat to a doctor, and the other
gentleman is coming up and I think it’s next week, next year sorry. So his
clinic appointment, his follow-up is due, so hopefully he’ll contact us in the meantime. So there’s a couple of other
questions that I put on the questionnaire, um, and this one was about
whether the patient satis….how with the patient satisfaction with the
information that they received a phone call, and depending on who actually
rang them, and so I got the different colors there. So the blue is their
treating consultant, the red is a one of the other consultants, green is the
registrar, and actually I contacted one of the patients, and my patient was
satisfied that I talked to, so that was a good thing. But if you look at with with the
number five, with the patients are extremely satisfied, all the columns are
exactly the same, so it’s sort of showed us that no matter who, whether, whichever
doctor rang, whether it was their training consultant or someone else, they were
happy with the information that they were receiving in the phone call. So then
we looked a little bit deeper, and this was at the satisfaction of the timing of
the phone call. I think it probably needed a lot more questionnaires to go out to sort of really pinpoint whether they were happy and not, because a lot of patients even
if they were satisfied, they were satisfied with everything to do with the
phone follow up. They sort of didn’t differentiate too much, but I guess what
I took from this graph was that we were ringing a lot of patients over two
weeks after they had their PSA done. I don’t think that’s right, I think we
need to sort that out and we need to get on; if I’d had a PSA, I wouldn’t know
within two weeks so we’re really trying to improve that, and the reason I think
that this happened was because we were trying to catch up on all the patients
that we lost a little bit, so it was sort of a bit of a process for their over
them the last couple of months to get those patients PSAs and and phone
calls made. Um, but I think we really do need to improve on that, the timing of the
phone call. And there’s a bit where they could write comments about what they
thought about the phone follow-up clinic and I’m not going to go through all
these, but I sort of grouped them in comments that were the same. A lot of
patients mentioned that they were happy with the phone follow-up
because there was less travel involved, they didn’t have to drive an hour and a half get to the hospital and didn’t have to deal with parking and sitting
in clinics. So they were very happy about the convenience of it and it saved them
a lot of time and some some of our patients come from interstate as well, so
yeah, or they, they are at that age where they are retiring so they’re moving out to the
country, or moving interstate and they could still be followed up by our
doctors appropriately, and these were the comments were, I was really happy about
these sort of comments because a lot of patients were coming back and telling us
in the questionnaires, that that they knew that at this point in time their PSA was
stable, they didn’t have side effects, so they knew that phone follow-up was appropriate for
them, that that was all they needed this point, but they knew that if their PSA
went up, or that they started getting some side effects, that they could come
back into the clinic and it’s really good to know that the patient’s felt that at
this point we were appropriately managing them but if there was a problem
they could revert back to the clinic and we could sort of deal with them that way.
And I was really happy that a lot of them said they knew that that, that was the
case. These are the couple of comments we got
from patients who weren’t happy with the phone follow-up, and I think the
difference is these patients didn’t realize that and didn’t realize that
they could come back into clinic. So one patient said it would be good to speak
to Andrew Kneebone occasionally, although I know he’s busy. Unfortunately, I think that goes with the
fact that we changed, when we set up the the urology super clinic it went from patients always seeing the
consultant they were under and having quite a strong relationship with them to
them seeing any doctor. So we’ve seen that across the board, that patients, even
previous patients who have been with us a while were used to seeing the one doctor,
um, what yet now they sort of see the registrars, they see the consultants, so
we are seeing the patients getting a bit funny about that. Um, the a patient said that
he would want to be phoned after his PSA, not before. The patient had a PSA about three months
before and when he got the phone call and the doctor prompted him to have
another one. So that’s why he sort of made that comment that he’d hadn’t had the PSA
when he had the phone call. And one patient said they would prefer to speak
to someone in regards to some problems as said they he’s not realizing the can
come into the clinic at any time he can make us give us a phone call and come in
and they never received a phone call. The patient actually did receive one, that was a
couple months before so whether he had forgotten about it I’m not sure. So
the implications that we found from setting up this, the phone follow up. Um, we have had a reduction of numbers of patients in clinic, we’ve reduced the pressure on the
hospital resources, will do, we certainly have to decreased the number of patients
lost to follow-up, and I think from the questionnaires, they show that we have had a positive impact on patients well-being. So I think we’ve done what we set out to
do. Um, and so that the future where we want to go with this, I think when we
certainly need to reduce that waiting time between when they get their PSA
and when they have a phone call and I think now that we’re up to date with the
phone follow-ups, I think that’s going to be a lot easier and I see that
happening a lot more. We would like to give introduction packs to patients when they
first choose to go on to the phone follow-ups, just explaining and now that
we’ve sort of figured our slide of it, I think it’d be a lot easier and be able
to tell them what, what um, what their part of the bargain is and what’s going
to happen and possibly a nurse-led phone follow-up clinic in future that I could
do, um, we want to get together a formal protocol for the new registrars that
come along so they know they feel comfortable with the process and, and
what they’re meant to say, and when they’re meant to talk to their consultant about
a patient, or if the PSAs are going up, what they got side effects, what their part is in the the process. We will increase the numbers of patients actually
participating in these phone follow-up clinics, and of course with there’s
always further evaluation that needs to be done. I’d like to send out similar sort of questionnaires in six months
time, 12 months time and see if patients are sort of still as happy or if
they’ve got any ideas of how we can improve the system. Thank you.

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