commissioning chemotherapy services conference · evaluation –website analytics (1) 0 500 1000...
TRANSCRIPT
![Page 1: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/1.jpg)
Commissioning Chemotherapy Services Conference
Issues of consent in systemic therapy
Dr Janine MansiConsultant Medical Oncologist
28th November 2017
![Page 2: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/2.jpg)
Introduction
• Background and context
• What we have done
• What we have achieved to date
• Future plans
![Page 3: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/3.jpg)
Background and Context
• Consent for majority of systemic therapy is mandatory
• Pharmacists and specialist nurses will not dispense or give treatment unless the consent form has been signed
• Historically (and in some cases currently) a standard consent form is used for this function
![Page 4: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/4.jpg)
Standard Consent Forms
• Hand written!
• Variable side-effects included (or not)
• Quality dependent on clinician taking consent
• Can just write – ‘see patient information sheet’
• No accurate or permanent record of what has been discussed
![Page 5: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/5.jpg)
Standard Consent Form
![Page 6: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/6.jpg)
Standard consent forms
![Page 7: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/7.jpg)
Consent
• Consent is the principle that a person must give their permission before they receive any type of physical investigation, medical treatment, or personal care
• ‘…reflects the right of patients to determine what happens to their own bodies, and is a fundamental part of good practice.’1
![Page 8: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/8.jpg)
Consent Issues
• Valid consent – voluntary, informed, capacity
• Legal and ethical principles
• Procedural, NHS and organisational practice guidelines
![Page 9: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/9.jpg)
The Law and Ethics
The Bolam test (1957):
“If a doctor reaches the standard of a responsible body of medical opinion, he is not negligent”
![Page 10: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/10.jpg)
The Law and Ethics
Montgomery Case 2015
Montgomery v Lanarkshire:
a woman with diabetes and a small stature delivered her son vaginally; he experienced shoulder dystocia, resulting in hypoxic insult with consequent cerebral palsy
![Page 11: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/11.jpg)
The Law and EthicsAfter the Montgomery case, the Bolam test, which asks whether a doctor’s conduct would be supported by a responsible body of medical opinion, no longer applies to the issue of consent. The law now requires a doctor to take “reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments.”
![Page 12: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/12.jpg)
The Law and Ethics
“a patient should be told whatever they want to know, not what the doctor thinks they should be told”
“the most important UK judgement on informed consent in 30 years”
“supports patient autonomy over medical paternalism”
![Page 13: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/13.jpg)
Clinical Concerns and Ethical Arguments
Patients
• more stringent disclosure requirements would risk overwhelming patients
• may cause distress
• may make poor decisions
Doctors
• more lengthy explanations
• drain on healthcare resources
• defensive medicine
![Page 14: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/14.jpg)
Clinical Concerns and Ethical Arguments
• The clinician’s role is to ensure that relevant information is presented to enable the patient to use it meaningfully
• Today’s patients can expect a more active and informed role in treatment decisions
• Legally, consent law has been clarified and aligns with current GMC guidance
• Ethically, it clarifies the existing shift towards a more cooperative approach in the consultation room
» Chan et al, BMJ 2017;357:2224
![Page 15: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/15.jpg)
Consent for SACT – NCAG report7
• Recommendations relating to the whole of the chemotherapy pathway, including consent and information
![Page 16: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/16.jpg)
Consent for SACT – NCAG report• ‘Consent should be obtained and recorded in detail
in terms of the aims of treatment and both the common and serious side effects of treatment’
• Main proposed actions– ‘Standardised consent forms are used which include details of
the toxicities discussed and which identify whether a patient has been provided with written information.’
– Chemotherapy service providers should ‘provide written information to patients about the chemotherapy they will be receiving, the likely side effects and whom they should contact if problems arise (including out of hours). Delivery of such information should be documented.’
– ‘A copy of the consent form should be given to the patient as well as one being filed in the patient’s case record.’
![Page 17: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/17.jpg)
Consent for SACT – Peer review
• Manual for Cancer Services: Chemotherapy Measures 20148
![Page 18: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/18.jpg)
Consent forms at GSTT/SEL• South East London – supported project for
development (AW)
• Guy’s and St. Thomas’ NHS Foundation Trust (GSTT) developed a library of >250 chemotherapy regimen-specific consent forms in 2010-2012
• Benefits
– High quality standardised information from clinician to patient
– Consistent, i.e. no omissions
– Tool for teaching and training
![Page 19: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/19.jpg)
National project• Practice of consent for SACT varies in the UK
• Cancer Research UK (CRUK) awarded a grant to GSTT to host the project
• Project to develop a national library of SACT regimen-specific consent forms commenced in October 2015
• The UK Chemotherapy Board are the governing body for the project:
![Page 20: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/20.jpg)
Created the webpage• To host the forms and associated documents:
www.cruk.org/sact_consent
![Page 21: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/21.jpg)
Launch July 2016• Published and launched the guidance
document
• First regimen-specific forms for breast cancer, and the generic form in July 2016
– Emails to lead chemotherapy clinicians in the UK
– Communication to members of professional groups (ACP, RCP, RCR, RCPath, UKONS, BOPA)
– Cancer Research UK news report and tweets
![Page 22: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/22.jpg)
National Guidance
• Recommends the use of regimen-specific forms• Guidance for the introduction of the forms• Guidance for the process of consent• Audit recommendations
![Page 23: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/23.jpg)
SACT regimen-specific forms• By tumour group for oncology and
haematology SACT regimens
• Reference to SPC, PIL, CRUK and Macmillan drug information sheets
• Each form is independently checked by an oncology/haematology pharmacist, oncology/haematology consultant and member of the UK Chemotherapy Board
![Page 24: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/24.jpg)
National Forms
• 5-page form• Standard template
![Page 25: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/25.jpg)
Page 1• Hospital name
• Health professional details
• Patient details
• Regimen details
• Where treatment will be given
• The intended benefits
![Page 26: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/26.jpg)
Page 2• Regimen-specific risks and side effects
• Separated into common, occasional and rare and other issues
•Includes a statement that the treatment may be life threatening or even result in death
![Page 27: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/27.jpg)
Page 3• Space for other risks
• Statements confirming discussions
• Details of leaflets provided
• Clinician signature
• Interpreter signature (where appropriate)
![Page 28: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/28.jpg)
Page 4• Patient statement and confirmation of consent
• Further information for patients
• Whether copy accepted by patient or not
![Page 29: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/29.jpg)
Page 5• Guidance for health professionals
![Page 30: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/30.jpg)
Published forms• Breast – July 2016• Generic – July 2016 • Head and neck cancers – October 2016• Melanoma – November 2016• Generic immunotherapy – December 2016• Gynaecological cancers – January 2017• Lung cancers – March 2017• Supportive medicines – April 2017• Colorectal cancer – May 2017• Urology/Bladder cancer – July 2017• Thyroid cancer – September 2017• Oesophago-gastric and GIST – October 2017
![Page 31: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/31.jpg)
Communication and Queries• Communication
– Email updates when new forms published
– Emails to lead chemotherapy clinicians in the UK, UK Chemotherapy Board members, and project mailing list
• Queries
– Database of all user queries and our responses
– FAQ document published October 2016
– Used to inform development of forms and project
![Page 32: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/32.jpg)
Evaluation – Website analytics (1)
0
500
1000
1500
2000
2500
3000
Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17
Nu
mb
er
of
visi
ts
Month
Visits to consent form page by Country
UK
England
N. Ireland
Scotland
Wales
Unknown
Other
![Page 33: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/33.jpg)
Evaluation – Website analytics (2)
0
500
1000
1500
2000
2500
Nu
mb
er
of
Do
wn
load
s
Month
Downloads from consent form webpage (www.cruk.org/sact_consent)
Guidance document
Generic SACT form
Genericimmunotherapy formFAQ document
Breast forms
Head & neck forms
Melanoma forms
Gynaecological cancerformsCML forms
Lung forms
Supportive medicinesformsColorectal forms
Urology forms
Thyroid forms
Total
![Page 34: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/34.jpg)
January 2017: Evaluation – Survey (1)• Aims and objectives
– To evaluate the uptake of the national forms in England, N. Ireland, Scotland and Wales
– To obtain feedback on the forms
– To obtain feedback on the challenges related to introducing the forms
– To use feedback to inform future developments of the project
![Page 35: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/35.jpg)
Evaluation – Survey (2)• Method
– Survey built using SurveyMonkey®, piloted and emailed to lead chemotherapy clinicians within NHS hospitals/Trusts in the UK in January 2017
– Results analysed after 2 weeks
• Results
– 87 responses
– 87% of responses from hospitals/Trusts in England
– 92% aware of national consent forms
– 74% aware of guidance on consent for SACT
![Page 36: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/36.jpg)
Evaluation – Survey (3)• Results (cont….)
0
5
10
15
20
25
30
35
40
45
50
Dept. of Healthconsent form 1
Local hospital/Truststandard consent
form
Locally developedgeneric SACT consent
form
Locally developedSACT regimen-
specific consentforms
National generic SACTconsent form
National SACTregimen-specificconsent forms
Res
po
nse
per
cen
t %
Method used to consent adult patients to treatment with SACT in the hospital/Trust
Prior tolaunch ofnationalforms
Followinglaunch ofnationalforms
![Page 37: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/37.jpg)
Evaluation – Survey (4)• Results (cont…)
– 30 hospitals/Trusts using forms; 17 plan to use
– Reasons for not using forms included:o Prefer existing method o Resistance from key stakeholders
o Forms not approved in hospital/Trust
o Too much paper to give to patients
o Time and motivation to implement
o Awaiting regional steer on use of national forms
o Use of electronic systems and processes
o Queries regarding legality of forms
o Forms not available for all tumour groups
![Page 38: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/38.jpg)
Evaluation – Survey (5)• Conclusions
– Results give an indication of the awareness and uptake of forms
– Responses give insight into the benefits and challenges of using the forms
– Comments positive overall
– Constructive feedback
![Page 39: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/39.jpg)
Evaluation – Survey (6)• Recommendations
– Continue to publish forms
– Outline options for local processes
– Issue reminder regards national guidance document
– Continue to send regular updates and comms
– Legal review of the forms
– Develop and publish paediatric forms
– Scope feasibility of electronic forms
– Repeat survey in 1 year
![Page 40: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/40.jpg)
Iterative process
• Responding to comments
• Hearing about other practices
• Extravasation
• Peripheral neuropathy
• Haemato-oncology
![Page 41: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/41.jpg)
Next steps• Forms for the remaining tumour groups will be
published in 2017-2018
• A national steering group is being set up
• Project evaluation – repeat survey Jan/Feb ‘18
• Year 3
– Continued maintenance and update of form library
– Paediatric, TYA and Sarcoma
– Scope electronic forms
– Welsh translation of generic forms
![Page 42: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/42.jpg)
References• Reference guide to consent for examination or treatment: Second edition,
Department of Health, 2009.
• Consent: patients and doctors making decisions together, General Medical Council, 2008.
• Sokol D. Update on the UK law on consent. BMJ 2015; 350:h1481.
• Guidance on consent, General Pharmaceutical Council, 2012.
• The code for nurses and midwives, Nursing and Midwifery Council, 2015.
• Health and Social Care Act 2008 (Regulated Activities) Regulations Care Quality Commission, 2014.
• Chemotherapy Services in England: Ensuring quality and safety, National Chemotherapy Advisory Group, August 2009.
• Manual for Cancer Services Chemotherapy Measures: Version 1.0, National Peer Review Programme, NHS England, April 2014.
• Consent form 1, Department of Health, 2009.
![Page 43: Commissioning Chemotherapy Services Conference · Evaluation –Website analytics (1) 0 500 1000 1500 2000 2500 3000 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17](https://reader031.vdocuments.us/reader031/viewer/2022011908/5f5e823f857ac5107648c524/html5/thumbnails/43.jpg)
Acknowledgements• Acknowledgements:
– Rena Chauhan – highly specialist pharmacist
– Victoria Fashina – highly specialist pharmacist (June 2017)
– Jacky Turner – previous lead pharmacist (to 2015)
– Nisha Shaunak – Lead Oncology Pharmacist and Specialised Cancer Commissioning Pharmacist, NHS England (London region)
– Colleagues at GSTT and Cancer Research UK
– Members of the UK Chemotherapy Board
– Tumour–specific leads from the CSGs who will help drive the project forward (Steering Group)