The month of November sees a particular awareness of male cancers and mental health in males and is a great way to get men talking. We spoke to Advanced Nurse Practitioner, Sandra Dyer, from Transforming Cancer Services Team for London about opportunities for primary care nurses to promote cancer awareness and support men living with cancer.
“In advanced practice roles, nurses can take a history, physically assess, make a diagnosis and prescribe medication – often fulfilling roles that doctors have filled in the past. As a nurse I have a holistic view of the healthcare I provide – I’m always thinking about the person in front of me and not just the health problems or concern. I think that’s a valuable skill that nurses bring to healthcare.
Making every contact count (MECC) is an evidence-based approach to improving people’s health and wellbeing by helping them change their behaviour. In the context of men’s health this might mean talking to men about smoking, physical activity, weight and safe alcohol consumption (all important for cancer prevention) or mentioning a bowel cancer screening whilst a person may have attended for another reason. These opportunistic interventions can really make difference – we know for example that a trusted healthcare professional recommending bowel screening improves the take up rate. I’m mindful of the health inequalities faced by men e.g. 1 man in 5 dies before the age of 65, that 2 men in 5 die before the age of 75 and that 3 out of 4 suicides are by men, and this informs my conversations with men about their health – taking their concerns seriously and providing evidenced health messages whenever possible.
Primary care nurses are experts in managing long term conditions, from diabetes to asthma, heart disease to hypertension. Many nurses (myself included) are also developing their knowledge about cancer and now offer holistic cancer care reviews to patients. Cancer care reviews are offered in the first six months after a cancer diagnosis but haven’t always been carried out in a holistic way – for example the clinician will often focus on the medical aspects of a cancer diagnosis. The yearly National Cancer Patient Experience Survey tells us that patients haven’t felt that their primary care team have supported them as effectively as they would have liked when they are diagnosed, as well as during and after cancer treatment. Having a good quality cancer care review can make a difference and we want people to feel more confident that they can go and see their Practice Nurse, Advanced Nurse Practitioner or GP if they have a concern or need more support.
As 70% of people with cancer have another long-term condition it’s very likely they will be seeing their primary care nurse regularly. The more nurses are knowledgeable about cancer and some of side effects that cancer and its treatment can cause, the better they are able to support patients. During the COVID pandemic a lot of primary healthcare has become remote in order to protect patients and staff. The pandemic and the message to stay home and protect the NHS has unfortunately resulted in some patients staying away and not seeking help when they need it. There is growing evidence that this is resulting in many missed or delayed cancer diagnosis. This means that even more people may be diagnosed with an advanced stage of cancer. Primary care nurses have continued to provide routine nursing care throughout the pandemic and are therefore extremely well placed identify a concern about a patient – such as ongoing cough, weight loss, or another worrying sign or symptom. For patients living with cancer – such as men with prostate cancer needing hormone injections, the face to face appointment with a nurse is an ideal time to check how he is, identify any concerns, signpost to support services or seek further advice from secondary care colleagues if there is a concern about progression of his cancer. The psychological impact of cancer is often overlooked – however patients report anxiety and low mood as a frequent concern when asked in holistic needs assessments. There is good evidence that men are less likely than women to seek help for their mental health and emotional well-being. Asking a simple question about how a man is feeling can be a useful way to starting a conversation and encouraging a man to talk about his emotional or psychological wellbeing. Cancer Care Map could then be used to signpost the man to supportive services locally.
As a Primary care nurse I’m often in a position of caring for whole families. Sometimes other family members or partners will seek help from me on behalf of a partner/spouse/son/sibling etc they are concerned about who is reluctant to seek healthcare. Without breaking patient confidentiality, it is possible to work together with families/partners to empower them to support the man to seek help when needed. In September 2020 I started a secondment to Transforming Cancer Services Team (TCST) for London as Primary Care Lead Nurse. In this new role I’m going to be working with nurses, healthcare leaders, educators and commissioners to ensure that primary care nurses in London can get training and education in cancer and are supported to develop their roles to support patients living with cancer. I believe this will help improve patient experience of their primary care after a cancer diagnosis ,and contribute to improvement in outcomes.”