The waiting can be unbearable for patients expecting a diagnosis of cancer. Lynne Greenwood describes how one clinic has eased the pain

Published: 11/4/2002, Volume II2, No. 5800 Page 18 19

Hard chairs, old magazines, worried faces, whispered conversations - these are familiar elements of a crowded hospital waiting room. It is never easy, but if it is the day of a diagnosis of cancer, followed by a wait to see a surgeon, it becomes almost unbearable.

Because many patients attend rapid-access clinics - where they undergo tests, receive a diagnosis, and see two clinicians on the same day - delays are inevitable.

'We knew that patients were waiting between appointments because we are co-ordinating two clinics, to save them having to return on another day, ' says Liz Darlison, respiratory nurse practitioner at the rapid-access lung clinic at Glenfield Hospital, part of University Hospitals of Leicester trust.

'If they have been diagnosed with cancer, they need a bit of space, a time to talk, a cup of tea.'

That freedom to escape the claustrophobia of the waiting room now comes courtesy of a pager.

Rose Dunphy, who has recovered from surgery for lung cancer, recalls her visit, accompanied by her husband and daughter. 'We were prepared for a long wait because I had to see two professionals, ' she says.

'And you dare not move out of earshot in case you are called. I was so surprised when the nurse told me to pop a pager in my pocket, and she would call me 20 minutes before my next appointment.'

Mrs Dunphy and her family headed off to the café for a coffee, studied an art exhibition in the hospital and went for a walk outside.

'The best part of it was that it stopped all three of us sitting there, not really able to talk, just worrying.You know that everybody else in the room has a similar problem, so you can hardly have a friendly chat, ' she says. 'Having a pager may sound like a small detail to people who have never been in that situation, but to us it meant so much.'

Ms Darlison says that patients are 'surprised but really grateful' for the chance to have half an hour away from the clinic, often to digest the diagnosis privately.

Some who know they have a longer wait even walk to the nearby shopping precinct.

The idea of the pagers arose from team discussions on how to improve the waiting time for patients following the cancer services collaborative 18-month pilot in Leicester, which focused on five types of cancer: lung, breast, ovarian, prostate and bowel. Its aim was to ensure that patients were treated as quickly as possible and that all their care was booked from start to finish.

Within six months, improvements became obvious, not as a result of major change but of smarter ways of working.

Dr Mick Peake, the national clinical lead for lung cancer within the collaborative and the lead lung cancer clinician in Leicester, says: 'We know that small changes can make a big difference. Some of them do not cost money, just the time to think about them.'

But Dr Peake, who says the collaborative methodology has been 'enormously influential' in allowing staff time to think and develop new ways of working, admits that not all changes can be made easily.

'We come across blocks and bottlenecks whose removal is dependent on people and resources, ' he says. 'But the collaborative technology is important in helping to identify problems in the health service and where money can best be spent. I can see enormous enthusiasm - and some scepticism - out there. I am hopeful that the collaboratives can make a big difference.'

In Leicester, the collaborative began with a process-mapping session with those involved in the cancer patient journey - including porters, managers and clinicians. 'A visual map made us appreciate what a long and potentially difficult journey it is, ' says Corinne Green, regional facilitator for the collaborative in Leicester.

They discussed the ideal patients' journey - imagining the patient as their mother, father or child - and were 'creative and demanding' about what they would expect.

'Everyone gained a better understanding of what others were doing instead of blaming a person up or down the ladder, ' she says.

Now a one-stop clinic gives anyone suspected of lung cancer a diagnosis on the same day - or within a week for more complex cases - instead of the previous wait of anything up to 30 weeks.