Block 9 - part 3 Flashcards
Conclusions of eurocare-II report
Despite limitations for the methodology, cancer survival in the UK in 1980s/90s was one of worst in Europe.
Expert advisory group formed to the chief medical officer in 1995, which generated the calman-hine report
What did the Calman-Hine report (1995) do
Examined cancer services in the UK and proposed a restructuring of cancer services to achieve a more equitable level of access to high levels of expertise throughout the country
6 consequences/aims of Calman-hine report
All pts have access to uniformly high qual of care
Public/professional education to recognise early cancer symptoms
Clear information about treatment options and outcomes for pts, families, carers
development of cancer services should be pt centred
Primary care central to cancer care
psychological needs of cancer sufferers and carers recognised
Calman-hine solutions
3 levels of care: primary, cancer units serving district hospitals, cancer centres
key to managing pts would be MDT
Role of cancer units
Treat common cancers, diagnostic procedures, common surgery, non-complex chemo
Role of cancer centres
Treat rare cancers, radiotherapy, complex chemo
National service framework
National standards, support program implementation, establish performance measures (progress within agreed timescales)
Main aims of NHS cancer plan (2000)
Save more lives
Ensure cancer pts get right professional support, care and treatments
Tackle health inequalities
Build for the future
NICE guidlines which followed the cancer plan (2000)
Manual of cancer (2000) and (2004)
6 key areas for action in the cancer reform strategy (2007)
Prevention Early diagnosis Better treatment Living with and beyond cancer Reducing cancer inequalities Appropriate care setting
Which cancers are screened for?
Cervical, breast, bowel
National cancer survivorship initiative
partnership with cancer charities, clinicians and patients, considered a range of approaches to improving services and support available for cancer survivors
Main outcomes for ‘improving outcomes: a strategy for cancer’ (2011)
Prevention and early diagnosis, quality of life and patient experience, better treatments, reducing inequalities
Some inequalities experiences amongst cancer patients
White pts report more positive experience
younger people least positive about experience
men generally more positive about care
non-hetero patients less positive experience
Patients with rarer forms of cancer poorer experience of treatment and care
Outcomes from the independent cancer taskforce (2015)
Spearhead radical upgrade in prevention and public health, drive national ambition to achieve earlier diagnosis, establish patient experience as being on par with clinical effectiveness and safety, transform approach to support people living with and beyond cancer
Necessary investments to deliver high quality services
Overhaul process for commissioning, accountability and provision
Body image
perceptions, thoughts and behaviours relating to ones appearance
biological disturbance
chronic illness leads to loss of confidence in the body, followed by loss of confidence in social interaction or self-identity
Examples of things which affect body image
scars, prosthetics, mastectomy, impact on sexuality, stoma, hairloss, weight loss/gain
Importance of hair
Important site for individual and group identity, symbol of femininity, stigma, loss of patient control of their status of sick
functions of the clinical record
Support patient care, improve future patient care, social purposes at request of patients, medico-legal document
What should be recorded in clinical record
presenting symptoms, relevant clinical findings, diagnosis/differentials, care/treatment options, risk/benefits of care and treatment, decisions about care/treatment, actions taken and outcomes
features of paper records
continuous, portable, writer identified, legibility issues, must be dated and signed
Electronic record features
Problem orientated, searchable, structured, safer prescribing, clinical decision support software
Use of records in audit, research and management
support clinical audit, facilitates clinical governance, facilitates risk management, support clinical research
duty of care
legal obligation imposed on an individual requiring adherence to a standard of reasonable care while performing any acts that could foreseeably harm others
negligence
failure to exercise the care that a reasonable prudent person would exercise in like circumstances
4 ethical principles
Beneficence, non-maleficence, autonomy, justice
3 ethical theories
consequentialism, deontology, virtue ethics
consequentialism
correct moral response is related to the outcome or consequence of the act
deontology
places value on the intentions of the individual and focuses on rules, obligations and duties
virtue ethics
right living is derived from the moral character of the agent
how do you evaluate an argument
get clear on logical form of the argument, query if valid and sound
reasons an argument may be invalid
different premises may express different concepts, confusing necessary with sufficient, insensitive to the way in which claims are qualified, argument begs the question
reasons an argument might be unsound
Argument is invalid, argument valid but one or more premise is false (false/controversial moral/empirical claim made)
what should be avoided in arguments
Straw man fallacy, ab hominems, appealing to emotion, begging the question, argument from fallacy
straw man fallacy
simply ignoring the person’s actual position and substituting it for a distorted, exaggerated or misrepresented version of that position
ab hominems
directed against a person rather than the position they are maintaining
argument from fallacy
conclusion must be false, because premises are false (non necessarily)
Moral argument
seek to support a moral claim of some kind, must provide supporting reasons for claim
deductive argument
purely logic, this means this, therefore this means this
inductive argument
making an argument based on observation, more probable conclusions (seeing is believing but you may not have seen anything)
Why are MDTs needed in cancer care
Modern management, delivery of care often fragmented over several hospital sites, probably better outcomes for patients managed in MDT
Core medical MDT staff
Physicians, surgeons, oncologist, radiologist, histopathologist, specialist nurses, MDT coordinator
Extended MDT staff
physio, dietician, palliative care, chaplin
Functions of MDT in cancer care
Discuss new diagnoses, decide on management plans, inform primary care of plan, designate key worker for patient, develop referral, diagnosis and treatment guidelines, audit
