Cancer Control in New Zealand

Supportive Care

Cancer Support Services Evaluation Summary

What are the three community cancer support pilots?
Evaluation of the support services
What information is being collected and how?
What are the interim findings?
What next?
Further Information?

What are the three community cancer support pilots?
In 2008, the Ministry of Health commissioned Health Outcomes International to evaluate three community cancer support pilots. The pilot projects are aimed at reducing inequalities in cancer access and outcomes for Māori and people living in rural areas, and are provided by:

Tamaki Healthcare, Auckland
Te Kahui Hauora Trust, Rotorua; and
West Coast PHO, West Coast

The services are based on international evidence suggesting that community-level cancer services may be effective in supporting more vulnerable populations to better understand, access and navigate the health system. They are built on a ‘patient navigator’ model of healthcare and aim to reduce barriers to cancer service access and care and to educate local communities about available health and social support services.

Although based on a common model of service provision including support, care and advocacy for patients and whānau, each of the providers works differently to deliver cancer support.

In the West Coast, the service is delivered by a project coordinator and three community workers. One of these has a Māori-specific role. Most of the service referrals are through the community or through primary care, and the service targets high needs patients living throughout the coast.

Through Rotorua Hospital, Te Kahui Hauora Trust delivers the cancer support as an extension of their Hunga Manaaki service. Initial referrals come mainly through the hospital where nurses work with cancer patients and their whānau. Once patients are out of hospital, they are referred on to Aroha Mai, a service that provides community-based cancer support.

Tamaki Healthcare provides an urban-focused service for the Auckland DHB catchment area. The service is provided by a mix of nurse and community workers, and receives referrals from a number of sources.

Evaluation of the support services
The Ministry of Health is funding both the delivery and evaluation of the pilots over a three-year period.

There are two streams to the evaluation:

An evaluation of the processes involved in implementing and operating the pilots (e.g., the effectiveness of: service structures; communication; referral processes; health promotion; continuing education; etc); and
An evaluation of the impacts, to review whether the pilots achieve their goals and objectives, and to measure the value added for service users, their families/whānau, health professionals, as well as for regional cancer programme development and utilisation.

What information is being collected and how?
The evaluation is based on annual cycles of quantitative and qualitative data collection.

Qualitative approaches include a review of providers’ narrative reports, and interviews, focus groups and workshops with service stakeholders including:

Patients/whānau;
Service Providers;
Health Professionals;
Local iwi groups; and
Relevant social service and non-government organisations (e.g., Cancer Society, Work and Income).

Quantitative data analysis includes a review of service provider data to examine patient characteristics (e.g. type and stage of cancer) and throughput as well as the type (e.g. advocacy) and extent of services provided.

What are the interim findings?
Overall, findings from the first year of the evaluation suggest that all three providers are on track in implementing and providing community cancer support. Moreover, stakeholders who have used the services applaud their aims and early impacts.

Specifically, results from the first year of the evaluation indicate that the pilots are having positive effects by:

Reducing barriers related to transport, finance, and by providing practical assistance to improve patient/whānau access to cancer service and care.

Connecting patients/whānau to other services such as those involved in home help, nutrition and education.

Raising community awareness of available supports and services through community education and service inter-promotion. For example, among other events, the West Coast PHO has hosted a Men’s health forum to raise awareness about health issues for men and promoted their services at various health huis hosted by other health providers. Te Kahui Hauora Trust has raised awareness of cancer through development and distribution of a calendar celebrating community members affected by cancer. Tamaki Healthcare has promoted and provided their services through local community centres and marae.

Assisting GPs and other health professionals by freeing up time that would otherwise by spent providing social and emotional supports and by providing confidence that there are services to help patients.

Providing social/emotional support to patients/whānau via reassurance and encouragement and by ‘being there’ when needed.

Advocating for patients and whānau to ensure that they understand their rights and receive appropriate care and supports.

These and other positive service actions were highlighted across sites and across stakeholder groups. Despite positive feedback, the challenges of implementing new services alongside pre-existing and sometimes similar support services, as well as different ideas about how care should be delivered have been noted.

As is common in the early stages of service implementation, there have been some challenges in fitting the cancer support pilots alongside existing services. Additionally, all three services have had the challenges of ‘finding their feet’ in defining, developing and delivering services new to the New Zealand context.

Stakeholders highlighted potential service improvements such as:

Ongoing professional development for support workers (e.g., grief work courses, cultural supervision);
Further specification and documentation of service delivery models (e.g., kaupapa Māori approach) and methods; and
Ongoing engagement with other relevant health and social support service providers.

Alongside these more immediate service improvements, stakeholders highlighted contextual issues affecting pilot project service delivery and their potential future utility. For example, some feedback suggested that:

Considering the need for services across chronic conditions and the fact that patients often have multiple chronic conditions, resources might be better spent on a chronic care navigator. Some felt that cancer as being over-serviced relative to other conditions. A chronic care navigator may provide a more holistic, integrated, and efficient service.
The cancer care pathway may be too complex to have just one navigator. Navigators may need to work and specialise in the primary, secondary and tertiary settings.
Services may need to be coordinated regionally.

Commentary on these and other findings may be found in the full interim report.

What next?
Over the next two years, the evaluation will document progress/changes in service delivery over time, the impacts and outcomes of these processes and the uniqueness of each of the services in achieving their aims.

In 2009, data collection described above will be complemented by a service journey mapping exercise aimed at examining the steps involved in and the flow of service delivery.

Interim reports will be delivered annually and the final report will be presented in 2011. Results of the evaluation will serve to inform development and implementation of models of cancer care service and support.

Further Information?
If you would like further information or a copy of the 2009 Interim Report, please contact Emma Hindson on 04 495 4413 or by email emma_hindson@moh.govt.nz

Website feedback
We welcome your feedback on this page.

Page last updated: 29 July 2009