End of Treatment Summary (EOTS)

A key recommendation from our TCAT pilot was the development and implementation of End of Treatment Summaries (EOTS).

What Is An EOTS?

An EOTS is a document developed at the end of treatment which is primarily for the patient but is also shared with their GP and placed in their case notes, which is useful for medical staff if the patient is admitted in an emergency after primary treatment is complete.

The EOTS provides important information including possible treatment toxicities, information about side effects and / or consequences of treatment, signs and symptoms of recurrence and any actions the GP needs to undertake.

The pupose of an EOTS is to help the patient improve their understanding of their condition and to provide a summary to share with other professionals and those of their choice.

The aim of an EOTS is to enable greater self management of care and provide the patient with the tools to know who to contact, when and for what.

Background
The National Cancer Survivorship Initiative identified End of Treatment Summaries (EOTS) for patients completing cancer treatment as one of the three most important steps to achieving good outcomes for people with cancer.

Findings from NHS Borders Phase One Transforming Care After Treatment (TCAT) Project supported this view. A questionnaire returned by 45 of 104 patients who had completed cancer treatment in the preceding two years indicated that the majority of contacts post treatment were with healthcare professionals and that there was an unawareness of non health based support services. Additional comments from focus groups and one to one interviews reinforced these findings.  The aim of this project was to develop and pilot an EOTS for patients completing day case Systemic Anti Cancer Therapy (SACT) at Borders General Hospital. A template was developed based on a validated Treatment Summary Template¹ and informed by patient feedback, discussions with local GP’s, oncologists, haematologists, pharmacy and staff within the unit. This generic template was then developed in partnership with the local Trakcare Team to allow the EOTS to be supported on the local hospital administration system. Standardised templates were made for each tumour group and SACT regime and these are individualised to patients when completed by both the nurse and the pharmacist. On completion of treatment the patient receives the EOTS which includes information about a Holistic Needs Assessment and next Health and Well Being Event as well as symptoms to expect post treatment and symptoms which require contact with a healthcare professional. A copy of this is sent to the GP, Consultant and Clinical Nurse Specialist or Cancer Information  and Support Service. A copy is filed in the local case notes. The EOTS was piloted across a range of different tumour groups (haematology and oncology) with 21 patients and 20 GPs sent a questionnaire to evaluate it.

Results
13 (62%) patients and 11 (55%) GPs returned the questionnaire with both groups evaluating the EOTS positively.

The majority of patients (92%) reported they found the information relevant, easy to understand and very useful for follow up and self management after treatment knowing who to contact for what and when. In addition 84% reported the EOTs helped them understand the aim of their treatment.  All 4 patients who had previously received treatment felt this was a positive addition to their care.

Of the 8 patients who didn’t return the questionnaire one reported back it was too much paperwork to fill in, two had developed disease progression and one recommenced treatment. 

80% of GPs said the summary was ‘useful’ or ‘very useful’. Over 50% felt it would make a difference to the way they managed patients and 90% wanted its use to continue.

Conclusion
Phase one TCAT work indicated people do not know what to expect after cancer treatment whether it be symptoms of cancer recurrence, or how to re-integrate into a healthy and financially stable lifestyle. They also are unaware of who to contact when and for what The implementation of EOTS is a significant step forward in addressing these unmet needs and improving communication with primary care. Further work will focus on continuing development of the EOTS and roll out across all treatment settings.