HOPE Protocol [PDF, 420KB] - National Cancer Survivorship Initiative

Self-Management Programme for Survivors of Breast Cancer
Birmingham Service Improvement Project Protocol
National Cancer Survivorship Initiative, Macmillan Cancer Support
1. Background
1.1. Introduction
In the UK, there are an estimated two million cancer survivors, and this is expected to rise
annually by more than 3% (KCL, 2008). There are currently limited support services
available for people who have completed their primary treatment for cancer, and are living
with and beyond cancer. This includes not only patients in remission, but also patients who
may now live for many years with metastatic disease undergoing repeat cycles of treatment.
The Cancer Reform Strategy (Allberry, 2008) highlights the need to commission services to
support patients who may be dealing with the long-term consequences of cancer and the
enduring effects of cancer treatments.
The Self-Management Workstream of the National Cancer Survivorship Initiative (NCSI) has
agreed the development of national cancer survivorship follow-up models for pilot testing of
self-management support for survivors who will be at different stages of living with or beyond
a diagnosis of cancer. This will be achieved as part of an NHS Improvement test community
for new survivorship services within Birmingham East and North PCT, Good Hope Hospital,
and Pan Birmingham Cancer Network. The programme will be offered to patients who have
completed their treatment for primary breast cancer, as part of testing the redesign of the
pathway for cancer follow-up and support.
Self-management programmes are offering greater utility in the current climate of increased
numbers of people living with chronic long-term conditions. Indeed, chronic disease selfmanagement
has been shown in the US, Canada, and the UK to be effective on both a
patient and health service level (Lorig et al., 1999; Holroyd et al., 1986; Lorig, Mazonson,
and Holman, 1993; Watson et al., 1997).
1.2. Self-Management Programmes
The leading self-management programme is the USA-developed Chronic Disease Self-
Management Program (CDSMP), a community-based generic programme applicable to all
chronic conditions (Lorig et al., 1999). The CDSMP is designed around self-efficacy theory
(Sieving et al., 1997; O‘Leary, 1985), with confidence in one‘s abilities to perform specific
behaviours being one of the key factors in successful health behaviour change (O‘Leary,
1985). In a five-year research project, the CDSMP was found to improve healthy behaviours
(i.e. exercise, cognitive symptom management, coping, and communications with
physicians) and health status (i.e. self-reported health, fatigue, disability, social/role
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