Annex 8
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
(NICE)
Draft guidance: "Improving Supportive and
Palliative Care for Adults with Cancer"
THE KEY
RECOMMENDATIONS
Key Recommendation 1: Within each Cancer
Network, commissioners and providers (both statutory and voluntary)
of cancer and palliative care services, working with service users,
should oversee the development of services in line with the recommendations
of this Guidance. Key personnel will need to be identified to
take this forward.
Key Recommendation 2: Assessment and
discussion of patients' needs for physical, psychological, social
and spiritual support should be undertaken at key points in the
patient pathway (such as at diagnosis; at the end of treatment;
at relapse; and when death is approaching). Cancer networks should
ensure that a unified approach to the assessment and recording
of patients' needs is adopted.
Key Recommendation 3: Each multi-professional
team or service should implement processes to ensure effective
inter-professional communication within teams and with other service
providers with whom the patient has contact. Mechanisms should
be developed to promote continuity of care, including the nomination
of individuals to take on the role of "key worker" for
individual patients.
Key Recommendation 4: Mechanisms should
be in place to ensure the views of patients and carers are taken
into account in the development and evaluation of cancer and palliative
care services.
Key Recommendation 5: Communicating significant
news should normally be undertaken by a senior clinician who has
received advanced level training and is an effective communicator.
It is recognised, however, that this is not always practical;
all staff should therefore be able to respond appropriately in
the first instance before referring to a senior colleague.
Key Recommendation 6: The outcome of
consultations in which key information is imparted and discussed
should be recorded in the patient's notes and communicated to
other professionals involved in the patient's care. The patient
should be offered a permanent record of important points relating
to the consultation.
Key Recommendation 7: Policies should
be developed at local (network/provider organisation/team) level
detailing what information materials should routinely be offered
at different steps in the patient pathway for patients with particular
concerns. These policies should be based on the findings of mapping
exercises involving service users.
Key Recommendation 8: Provider organisations
should ensure that patients and carers have easy access to a range
of different information materials about cancer and about cancer
services. These information materials should be free at the point
of delivery and patients should be offered help to understand
them within the context of their own circumstances.
Key Recommendation 9: Commissioners and
providers of cancer services should work through cancer networks
to ensure that all patients undergo systematic psychological assessment
at key points in the patient pathway and have access to an appropriate
level of psychological support. A four-level model of professional
psychological assessment is the suggested model for achieving
this.
Key Recommendation 10: Explicit partnership
arrangements need to be agreed between local health and social
care services to ensure that the needs of patients with cancer
and their carers are met in a timely fashion and that the different
components of social support are accessible from all locations
(including hospital, home, care home and hospice).
Key Recommendation 11: Multi-professional
teams should have access to suitably qualified, authorised and
appointed spiritual care providers who act as a resource for patients,
carers and staff. They should also be aware of the local community
resources for spiritual care.
Key Recommendation 12: Mechanisms need
to be implemented within each locality to ensure medical and nursing
services are available 24 hours-a-day for patients with advanced
cancer, and that equipment can be provided without delay.
Key Recommendation 13: Primary care teams
should institute mechanisms to ensure that the needs of patients
with advanced cancer are assessed and communicated within the
team and with other professionals as appropriate. The Gold
Standards Framework 4,5 provides one mechanism for achieving
this.
Key Recommendation 14: In all locations,
the particular needs of patients who are dying from cancer should
be identified and addressed. The Liverpool Care Pathway for
the Dying Patient 6 provides one mechanism for achieving this.
Key Recommendation 15: Commissioners
and providers, working through cancer networks, should ensure
they have an appropriate range of specialist palliative care services
to meet the needs of the local population. These services should,
as a minimum, include specialist palliative care inpatient facilities
and hospital and community teams. Specialist palliative care advice
should be available 24 hours-a-day. Community teams should be
able to provide support to patients in their own homes, community
hospitals and care homes.
Key Recommendation 16: Commissioners
and providers, working through cancer networks, should institute
mechanisms to ensure that patients' needs for rehabilitation are
recognised and that comprehensive rehabilitation services are
available to patients in all locations. A four-level model for
rehabilitation services is the suggested model for achieving this.
Key Recommendation 17: Commissioners
and NHS and voluntary sector providers should work in partnership
across a cancer network to decide how best to meet the wishes
of patients for complementary therapy. At a minimum, information
should be made available to patients about complementary therapies
and services. If services are to be provided within NHS facilities,
guidelines should be developed and implemented relating to the
training, qualification and competence of practitioners.
Key Recommendation 18: Organisations
providing cancer services should nominate a lead person to oversee
the development and implementation of services that specifically
focus on the needs of families and carers, both during the patient's
life and in bereavement.
Key Recommendation 19: Cancer networks
should work closely with Workforce Development Confederations
(the Workforce Development Steering Group in Wales) to determine
and meet workforce requirements and to ensure education and training
programmes are available.
Key Recommendation 20: Provider organisations
should identify staff who may benefit from training and should
facilitate their participation in training and ongoing development.
Individual practitioners should ensure they have the knowledge
and skills required for the roles they undertake.
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