Liz Happle, Research NurseHampshire Hospitals NHS Foundation Trust

HORIZONSHORIZONS in practice

The team at HHFT- Winchester and Basingstoke. Three cohorts, two hospitals

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• Wioletta Kowalczyk-Williams- Basingstoke• Liz Happle- WinchesterNHL

• Jackie Smith- Basingstoke• Julie Conti and Lesley Hollister- WinchesterBreast

• Liz Happle- Basingstoke • Lesley Hollister and Liz Happle- WinchesterGynae

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Patient pathways NHL

Diagnosis of DLBCL

NHL

(Pre-phase

steroids)

Start of curative intent

treatment

Few days

2 weeks

Maybe longer for

trial screening

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Approach for HORIZONS NHL

Diagnosis of DLBCL NHL

Start of curative intent

treatment

Few days

2 weeks

Maybe longer for

trial screening

Approach at

the next clinic

visit following

diagnosis

Consultant

clinic/ pre-

chemo

After diagnosis

on same

appointment as

next appt is

treatment

At first

chemo

visit

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Challenges to approach in NHL

Appointments not on

electronic system

Patients unwell at diagnosis

Short timeline between

diagnosis and treatment

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Patient pathways breastDiagnosis of breast cancer

(under 50)

Neoadjuvant Chemotherapy Surgery

2-4 weeks2-3 weeks

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Approach for HORIZONS breast

Diagnosis of breast cancer

(under 50)

Neoadjuvant Chemotherapy Surgery

Neoadjuvant

chemo appt with

oncologist

Pre-op

Breast Care Nurse

Postal

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Challenges to

approach in breast

Time constraints

Tracking patients (time consuming)

“Safeguarding” by clinicians

Not appropriate to approach at

diagnosis

Not all clinics on one site

Resources

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Patient pathways gynae

4 days

2 weeks

6 weeks

Diagnostic tests

• Scans• Biopsies

Diagnostic surgery

Curative intent

• Surgery• Chemotherapy • Radiotherapy

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Approach for HORIZONS gynae

4 days

2 weeks

6 weeks

Diagnostic tests

• Scans• Biopsies

Diagnostic surgery

Curative intent

• Surgery• Chemotherapy • Radiotherapy

After all

diagnostic investigations;

at consultant

clinic or

pre-op/ pre-chemo

At first visit following

Surgical diagnosis (oncologist or

Surgeon)

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Challenges to recruitment in

gynae

Biopsy diagnosis at

clinic

Imaging following diagnosis

Imaging results close to surgical

date

Patients referred

elsewhere for surgery

Follow up may or may

not be at surgical hospital

Surgery may be diagnostic

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General challenges

Full cohort approach

Short timeframe for approach

Missing patients

Involvement/ reliance on other staff

Competing studies and multi-study approach

Questionnaire is long

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Screen PostDiscuss and

consent

Approach

Consent

Take information

home

Approach and consent

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Patient response

Positive and willing

Opportunity to talk about QoL

issues

Chance to think about how they

might be affected in the

future

Hope improvements

in understanding

QoL lead to improvements

in care

Interesting concept and can

see value

Hope to benefit others

Happy to have opportunity to

express opinions

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Patient response

Mixed response if also asked to

take part in another study

with questionnaire-overwhelming

Response to diagnosis indicates

likelihood to take part

Too anxious to complete study

Questionnaires bulky and quite

a few

Focussed on treatment

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Time to discuss

wellbeing and QoL

CNS involved-introduce

study

MDT lists/ somersetdatabase

Leave PIS in medical

notes/ advice slip

for clinician

Opportunity to discuss further

(phone or in person)

Option to take

information home

Clinician to mention during

consultation

Communication between clinical

and research teams

Clinician to mention during

consultation

Flexibility of approach

fits with local

pathways

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