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Improving supportive and palliative care for adults with cancer

  • Comment
Although many patients with cancer report positively on their experience of care, others claim they are not receiving the information and support they need at different stages of their care pathway. The national cancer patient survey (Department of Health, 2002), for example, showed wide variations in the quality of care delivered across the country.

Abstract

VOL: 99, ISSUE: 39, PAGE NO: 49

Alison Richardson, PhD, MSc, PGDipEd, BN, RN, RNT, is professor of cancer and palliative nursing care, Florence Nightingale School of Nursing and Midwifery, King’s College, London, and is lead of the Guidance Development Team

 

Although many patients with cancer report positively on their experience of care, others claim they are not receiving the information and support they need at different stages of their care pathway. The national cancer patient survey (Department of Health, 2002), for example, showed wide variations in the quality of care delivered across the country.

 


 

The evidence from this and other surveys (Commission for Health Improvement/Audit Commission, 2001; Cancerlink, 2000) clearly suggests that services should be providing:

 


 

- Better organisation, coordination and integration across cancer networks;

 


 

- Improved assessment of the individual needs of people with cancer, including their physical, psychological, social and spiritual care;

 


 

- Improved training for health and social care staff in supportive and palliative care;

 


 

- Enhanced provision of supportive and palliative care services to meet needs that are currently unmet and to reduce inequalities in service provision and access;

 


 

- Active promotion of self-help and support groups, recognising the large management role people with cancer have in their own care.

 


 

The guidance
The National Institute for Clinical Excellence (NICE) is currently producing guidance on supportive and palliative care services for patients with cancer, which will be published next year. The document will focus on the configuration of services.

 


 

The aim is to ensure that patients with cancer and their carers receive the support and care that they need to help them cope with cancer and its treatment, whatever the stage of their illness, and wherever they access services. Recommendations for action at national, regional and local level are at the core of the guidance.

 


 

All recommendations are evidence-based - reviewed by a team led by Professor Irene Higginson of King’s College, London - and have broad consensus among the professionals who run the services and the people who use them.

 


 

The recommendations are grouped into 12 action areas (Box 1). A significant theme has been the involvement of service users in the design, delivery and evaluation of services and two of the action areas focus exclusively on user, family and carer issues. All topic areas reflect the importance of the contribution made by the family and carers.

 


 

A final public consultation on the guidance is planned for October and November 2003.

 


 

Implications for nursing services
The guidance will have a significant impact on the design of nursing services, particularly in identifying additional roles and responsibilities, extending duties, developing the nursing workforce and providing education, training and ongoing support for nurses.

 


 

This is evident, for example, from the guidance’s recommendations for ensuring that patients who are dying at home have access to qualified nurses around the clock.

 


 

The guidance is relevant not only to nursing services in specialist cancer or palliative care teams, but also to those in key front-line generalist services in both primary and secondary care. It recognises that most supportive and palliative care services are likely to be supplied by generalist practitioners, with much being delivered in primary care settings.

 


 

Conclusion
The guidance sets out a framework for the design, delivery and evaluation of effective supportive and palliative care services, with recommendations to address areas of service most likely to make a difference to patients.

 


 

It is difficult to assess accurately the degree of change that will be required of individual services to implement the recommendations. Much will depend on the deficit between the priorities set out in the guidance and current configurations of services.

 


 

The document, it must be emphasised, offers guidance, not guidelines: it recommends the shape services should take, but it is for commissioners, providers and service users to determine how the recommendations should be enacted locally. The guidance will encourage the design and delivery of better services for all those affected by cancer.

 


 

FURTHER INFORMATION
- To view the latest draft of the guidance online, go to: www.nice.org.uk/pdf/supppalldraftmanual.pdf

 


 

- Individuals wishing to comment on the guidance must do so through a registered stakeholder. Further information is available at: www.nice.org.uk/pdf/guidelinedevelopmentstakeholdersfinal.pdf
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