How to provide cancer care in remote areas – Australia deals with the challenge
Prostate cancer is the most commonly diagnosed male cancer in Australia. Approximately 20,000 new cases are diagnosed each year. Australia is the sixth biggest country in the world with a population of 25 million. approximately 30% of the population live in regional or remote areas. Prostate cancer services span across both public and private sectors which are located mainly in metropolitan areas. For those affected by prostate cancer, navigating the healthcare system can be complex due to the treatment options and the care provided across different services.
Prostate cancer care in remote areas
Prostate cancer care in Australia for men from regional or remote areas is one of many disparities compared to their metropolitan counterparts. These include late diagnosis, poor access to treatment due to distance, financial implications and social isolation because of time spent away from work, partners and family while undergoing treatment. It is known that men in regional and remote areas are less likely to be diagnosed with prostate cancer, however, those diagnosed are more likely to die from their disease.
In 2012, the Prostate Cancer Foundation of Australia (the peak national body for prostate cancer) launched a programme which involved implementing dedicated Prostate Cancer Specialist Nurse’s (PCSN) across Australia in various health care settings. Initially, twelve PCSN positions were developed in conjunction with existing prostate cancer services. The PCSN’s operate through an agreed practice framework and according to national competency standards. The framework outlines the role and purpose which includes the coordination of care, education and support to those affected by prostate cancer. The programme has increased to 44 nurses across Australia with additional federal funding secured to further expand the programme in 2019.
Strong multidisciplinary team
Since 2012 I have held the position as PCSN within the urology department at the Mater Hospital Brisbane, Queensland. Our urology team has a strong multidisciplinary approach to care, with well-established networks with oncology and allied health services based in metropolitan and regional areas. Approximately 20% of our patients are from metropolitan Brisbane and 80% are from nominated regional and remote areas of Queensland. these regional and remote areas are without a local public urological service. Many challenges arise for men and their families when consultations or treatments are required at our department.
To attend our department, patients can be required to travel many hundreds of kilometres and regularly need overnight accommodation. Multidisciplinary consultations are incorporated where possible to assist men regarding treatment decision making. Telehealth specialist consultation is used where possible to avoid unnecessary travel.
A voice for prostate cancer patients
As the PCSN within our service, my aim is to ensure all men receive reliable, accurate information to allow them to understand their diagnosis and treatment options. Newly diagnosed men are prioritised, however, all men affected by prostate cancer can access the service throughout their cancer journey. Face to face consultations and telephone support is provided to men, their partners and family members. Men experience significant distress at the time of diagnosis. The role provides a point of contact, continuity of care and ease of access to advanced nursing knowledge of prostate cancer care. A key aspect of the role is advocating on behalf of men both within our multidisciplinary team and with external stakeholders; this gives men a voice and assists in tailoring treatment to individual needs. Coordination of care is provided to help men navigate the health care system, avoid delays in treatment and prevent men from getting lost in the system.
Safe and effective care
During and after treatment ongoing support is provided to help deal with the effects of treatment. Through patient assessment onward supportive care referrals are made when required. A PCSN-led telephone follow-up consultation is routine in the post-treatment setting, which results in a reduced need to travel to the urology department and continuity of care. Patients can easily access the PCSN service via telephone or a face to face consultation. As a member of the multidisciplinary team, the PCSN strives to contribute to the delivery of safe and effective care, regardless of the geographical location of the men affected by prostate cancer.
Recently, I joined the EAUN Special Interest Group Prostate Cancer. In this way, I hope to be able to share my experience with the EAUN members. Don’t hesitate to contact me if you have any queries or suggestions!
Deirdre Kiernan, Prostate Cancer Specialist Nurse, SIG Prostate Group Member, Mater Hospital, Brisbane (AU), firstname.lastname@example.org