Quality standard

Quality statement 7: Supportive care and rehabilitation

Quality statement 7: Supportive care and rehabilitation

Quality statement

Adults with metastatic spinal cord compression (MSCC) have a management plan that includes an assessment of ongoing care and rehabilitation needs.

Rationale

It is important that personalised management planning for adults with MSCC starts on admission because rehabilitation and supportive care are integral to the promotion of independence and quality of life for adults with MSCC. Emphasis should be on an individualised, person-centred management planning process, led by a key worker, which takes into account care relating to all existing healthcare issues the person may have, including cancer. Communication between secondary, primary and tertiary care needs to ensure a seamless transfer between services and continuity of care for patients.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of adults with MSCC who are discharged from hospital with a management plan that includes an assessment of ongoing care and rehabilitation needs.

Numerator – the number of adults in the denominator who have a management plan on discharge.

Denominator – the number of adults with MSCC who are discharged from hospital.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers ensure that staff are trained on how to develop management plans, including how to undertake an assessment of ongoing care and rehabilitation needs for adults with MSCC, and have protocols in place for starting management planning on admission.

Healthcare professionals involve adults with MSCC in developing management plans, which include an assessment of ongoing care and rehabilitation needs, when they are admitted to hospital.

Commissioners ensure that they commission services that train their staff on how to develop management plans, including how to undertake an assessment of ongoing care and rehabilitation needs for adults with MSCC, and have protocols in place for starting management planning on admission.

Adults with MSCC have a plan of the ongoing care they agree to receive after they have been discharged from hospital, which will include plans for rehabilitation.

Source guidance

Spinal metastases and metastatic spinal cord compression. NICE guideline NG234 (2023), recommendations 1.12.1 to 1.12.3

Definitions of terms used in this quality statement

Management planning and ongoing care

For adults with MSCC, this should start at diagnosis. Rehabilitation should be focussed on the person's priorities and goals. These could include:

  • improving functional independence

  • participation in activities of daily life

  • improving quality of life.

[Adapted from NICE's guideline on spinal metastases and metastatic spinal cord compression, recommendation 1.12.2]

Equality and diversity considerations

Survival times for adults with MSCC vary from just a few weeks to over a decade. MSCC is closely associated with the end of life because of its high incidence in the late stages of advanced malignancy. The timing of discussions about ongoing care and rehabilitation should be sensitive to the emotional adjustments that the patient and carer may be experiencing.

The person's age should not affect the content of the discharge plan or their access to rehabilitation services. Healthcare professionals should consider whether adults with MSCC who are experiencing the later stages of cancer may benefit more from readjustment rather than rehabilitation.