P186. A comparison of audits of a secondary breast cancer support group

S78 increased health issues this was certainly a challenge. Another difficult challenge was to ensure that all hospital personnel involved in the patient’s journey were dedicated to achieving this nationally set target. The date for completion of the implementation was December 2013. In April 2011 Pennine Acute Hospitals NHS Trust used a multidisciplinary approach to redesign and implement a new breast surgical pathway, to enhance recovery through early discharge, whilst continually striving to provide high levels of quality care and patient satisfaction. After introduction of the pathway the team aimed to evaluate the patient experience to guide us in improving patient care. Methods/data collection: Questionnaires were distributed for 3 months with a response rate of 97%. Stages of data collection included before surgery, during the hospital stay, before discharge and after discharge from surgery. Patients were asked to comment on their overall experience and provide detailed information of how we could improve their care. A five point Likert scale was used with free text sections to enable quantitative and qualitative data collection. Results: Overall it was identified that more than 90% of patients felt that the information, standard of care and level of support at diagnosis, admission and discharge was good or excellent. 50% of patients felt that the day case environment was unsuitable for purpose and this has now been addressed by the Trust. Future implications: Potential improvements were identified in relation to the giving of appropriate information literature to the patients and information booklets have now been developed. Implementation of the pathway has proved to be more successful than anticipated. On-going patient feedback has ensured that patient satisfaction is an integral part of further improving the patient experience. All improvements suggested are considered and if thought viable were piloted. http://dx.doi.org/10.1016/j.ejso.2015.03.221 P184. Surgical pathway pilot and audit Sue Green Maidstone & Tunbridge Wells NHS Trust, Kent, UK Introduction: In 2009, intradermal microbubbles injection and contrast-enhanced ultrasound/biopsy was introduced to increase the accuracy of pre-operative sentinel node identification. The technique successfully predicts node status and reduces the rate of completion axillary surgery, but the treatment pathway lengthens by up to 15 days, resulting in breaches. The pilot aimed to establish if pre-booking tests, appointments and admission dates would reduce breaches. Method: Patients at one Trust site were compared with a group from the other site. The Breast CNS and patients discussed and agreed appointments for the microbubbles test, results clinic and admission date at the biopsy results clinic. An e-diary was used to check available operating time. Radiology appointments were booked/cancelled and operation lists updated by the BCNs and team secretary as needed e.g. a positive microbubbles biopsy requiring ANC. Results: Pre-booking treatment pathways reduces the time within the 62day target by an average of 10 days, and within the 31-day target by an average of 7 days. Late cancellations of Nuclear Medicine appointments are rare and can be accommodated by the department, whilst the effect on operating lists is minimal; the time allocated for SNB or ANC being similar. Patients do not appear to be confused by the extra information and our observation is that they respond positively to knowing their treatment plan in advance. Conclusions: Pre-booking treatment pathways reduces the number of target breaches and enhances patient satisfaction. The principles can be used for planning more complicated pathways e.g. patients requiring pre-operative staging. http://dx.doi.org/10.1016/j.ejso.2015.03.222

ABSTRACTS P185. Family History Clinic: Establishing a nurse led NICE compliant service Lynne Horton, Kartikae Grover Hull and East Yorkshire Breast Care Unit, Cottingham, UK Introduction: Following publication of the National Institute for Health and Care Excellence (NICE) 2013 led to a change in local pathways. Regional genetic service only accepting high risk referrals from July 2014, prior to this they assessed all referrals. Our family history service is provided by a Nurse Practitioner: this outlines how the NP has coordinated the family history service development. Method: Arranged educational update for the breast service regarding implications of NICE guidance from regional clinical geneticist. Local referral framework agreed for referral from primary to secondary care and for referral from secondary to tertiary care in line with NICE (2013). Process mapping session with key professionals. NP triaging referrals, matching against NICE (2013) criteria Developed family history questionnaire to capture information for risk assessment prior to clinic visit. Screening staff devised computer programme for moderate risk surveillance, all family history patients put onto automatic recall systems. Referral form for surveillance imaging devised in consultation with Radiologist and Geneticist Meeting with commissioners to agree commissioned service and improved communication in collaboration with Lead Consultant Breast Surgeon. Worked with interface pharmacist and GPs to develop shared care framework for prescribing Tamoxifen. Results: Nurse led service established with key personnel having identified roles. Lead Consultant Breast Surgeon and NP are points of contact for primary care leading to improved communication. Developed close working relationships with Consultant Geneticist and genetic counsellors. Teamwork and coordination by NP has developed a NICE compliant service. http://dx.doi.org/10.1016/j.ejso.2015.03.237 P186. A comparison of audits of a secondary breast cancer support group Gillian Gray, Sarah Delfont, Sisse Olsen Royal Devon & Exeter NHS Foundation Trust, Exeter, UK Introduction: Evidence shows that professionally facilitated support groups enable women to cope more effectively with existential concerns, physical effects and treatment side effects following a diagnosis of secondary breast cancer. The secondary breast cancer support group at the Royal Devon & Exeter Hospital was set up in 2009 using the Supportive Expressive Model of David Spiegel. The aim of the studies was to assess the value of this group. Method: The audits were conducted against standards set in NICE Guidelines. 12 Questionnaires were sent to group members in July 2011 and 8 returned 11 sent in July 2014 and 10 returned. Results: Both groups thought attending the group helped them cope with having cancer 88% (2011) 99% (2014). Conclusions: Our audits demonstrate that the secondary breast cancer support group is a suitable venue to discuss difficult and distressing issues and that women find the group helpful in coping with a diagnosis of secondary breast cancer. http://dx.doi.org/10.1016/j.ejso.2015.03.238