Personalised Care

OUR STORY

Personalised care is about finding out ‘what matters to you’.

Being diagnosed with a cancer can turn your life around and impacts people in so many ways.

However, these impacts do vary from person to person dependent on many factors like where the cancer is situated, the treatment you may be receiving an your general health. In addition worries and concerns about money, work, your family and your family responsibilities.

There are 6 main interventions connected to Personalised Care, that you may come across following your diagnosis and also into recovery post treatment.

These will be described in more detail below and involve both your acute and primary care teams.

Holistic Needs Assessments

A Holistic Needs Assessment can help your health care professional to identify and address your needs and concerns and then develop you a Personalised Care and Support Plan.

A Holistic Needs Assessment (HNA) is a simple questionnaire. It can be carried at any stage of your cancer pathway, on paper or electronically, to help you:

identify your patient’s concerns
start a conversation about your needs
develop a Personalised Care and Support Plan
share the right information, at the right times for you
signpost you to relevant services.

What happens at the assessment?

It takes only 10 minutes to complete and is often offered at key stages in your cancer journey. So grab a coffee and a comfy seat and think about your concerns and worries

A conversation to discuss the answers

This is an opportunity to talk about your needs and concerns. If you find it helpful this conversation maybe done on the telephone to make it easier for you.

Creating A Personalised Care and Support Plan

You will then create a care plan together which will reflect and address your concerns. To act as a reminder and reflection of your conversation with your health care team member and the agreed actions to help. The completed plan maybe posted out to you at a later date. It can include information to help you self-manage, along with contact details. If you have any queries once it arrives give the healthcare professional who did the assessment a call. Your GP will also be sent an electronic copy.

What is a Personalised Care and Support Plan? (PCSP)

A Personalised Care and Support Plan (PCSP) is aimed at helping you to take an active and empowered role in the way your care is planned and delivered. With interventions and care tailored around the things that matter most to you.

The care plan allows the sharing of this information with you in written form as a reflection of your conversation and the concerns you highlighted. Alongside the plans to help including signposting to appropriate services.

A Personalised Care and Support Plan ensures that your physical, practical, emotional, spiritual and social needs are identified and addressed at the earliest opportunity.

End of Treatment Summaries

A Treatment Summary is a document produced by the hospital clinician at the End of your initial treatment for cancer. It is designed to be shared with you and your GP.

The End of Treatment Summary usually contains:

An overview of any treatment you may have received
Details of any potential side effects of treatment
The signs and symptoms of cancer recurrence
Contact details to address any concerns.

Primary Care Cancer Care Reviews

They are offered at varied intervals. This can be 3 months from your initial diagnosis and then after you have received acute treatment (within 12 months). These times do vary so please ask your primary care team if you haven’t heard anything. You may find that they are performed by either your GP,Cancer Champion, Care Co-ordinator, Health and Wellbeing Coach or Nurse Practitioner.

Health and Well-being Information and Support

Health and Well Being is about taking care of you as a whole, whether it be physical, social, financial, practical, spiritual or emotional impacts.

By knowing what matters to you, the health care teams can sign post or provide advice with aspects that are impacting your life. For example, you may be worried about money or your children, you may want to know how to keep your body physically well or work maybe a concern. Advice about all these things can be provided at all stages of your cancer journey, as you will find your worries and concerns may constantly change

We know people who receive the right information at the right times, have a much better understanding of their cancer, as well as the confidence to make informed choices about their treatment. They will have a better knowledge of:

the signs and symptoms of cancer recurrence
the consequences of cancer treatment
how to deal with the physical and emotional impacts of cancer
what support is available and how to access it.

You can find more about this in the Health and Well Being section on this site.

Personalised Stratified Follow-Up (PSFU) or PIFU

PSFU = Patient or Personalised Stratified Follow-Up
PIFU=Patient Initiated Follow up

Follow up regimes may vary depending on your cancer, how it has impacted you and your general well-being.

You may be followed up routinely or a mixture of medical or self-care management.

The team caring for you will discuss with you the required follow-up that is best suited to your individual needs. The follow-up may be provided in person/or by telephone.

This may mean that you alert your health care or specialist team if there are any concerns. You will be given information to help you self-manage some of your follow-up.

You can also contact your GP/healthcare team for help if you need at any point.

It is natural to worry about what will happen following your cancer treatment, or the fear of it returning. If you are worried please speak to someone who could support you, such as your Practice staff, Pharmacist or specialist teams

Personalised Care