Palliative and supportive care

The team are committed to improving your experience at all stages of your treatment and care. We aim to maximise your wellbeing, and to help you, and those important to you, cope with the impact of your illness and the treatment you are receiving.

One way to achieve this is through earlier involvement of specific members of our team, to help with various issues that may be affecting you or a family member.

This approach is called Enhanced Supportive Care, and may have been discussed by your specialist nurse or cancer doctor (oncologist).

We aim to:

• Provide practical advice and emotional support
• Help to improve or resolve troublesome symptoms
• Treat any pain problems caused by your cancer or cancer treatment

Enhanced Supportive Care provides a positive, individualised approach for patients who are living with cancer. Our focus is on achieving your 2 goals and keeping you well through cancer treatment, and after treatment has ended.

Enhanced Supportive Care is delivered by doctors, nurses, and other healthcare professionals, who are specifically trained to manage problems associated with cancer or cancer treatments. We will work alongside your cancer doctor to make sure you get the best possible care and support.

We can also talk to you about how you are coping, what is important to you when deciding on cancer treatments, and your goals and plans for the future.

Your cancer doctor or specialist nurse can discuss with you about when Enhanced Supportive Care is available to you during your treatment.

Will Enhanced Supportive Care affect treatments for my cancer?

No. Enhanced Supportive Care aims to work alongside chemotherapy, radiotherapy and immunotherapy so will not affect or interfere with your cancer treatment.

Who provides Enhanced Supportive Care?

At The Clatterbridge Cancer Centre, Enhanced Supportive Care is led by the Specialist Palliative Care Team, but delivered by the whole of the Supportive Care Team.

Enhanced Supportive Care means that you will be offered an appointment with a specialist palliative care doctor or nurse for an initial assessment.

This might include talking through any troublesome symptoms, and formulating a plan, which may include changing or building on existing medicines, to help alleviate your symptoms.

This discussion may also involve referring you to members of our team who may be helpful for other reasons.

Who might I get support from?

The additional help available could come from a range of healthcare professionals that make up our Supportive Care Team. At The Clatterbridge Cancer Centre, our Supportive Care Team consists of:

• Specialist Palliative Care Team for assessment and advice relating to troublesome symptoms
• Dietitians assess, diagnose and treat diet and nutrition-related problems with experience of working with cancer patients
• Pain management experts - if procedures are needed for complex and difficult pain control
• Psychological Medicine for assessment and management of psychological difficulties associated with cancer
• Occupational therapists use rehabilitation methods, advice and adaptive equipment to try and limit the effects of any type of disability and promote independence in all aspects of daily life
• Physiotherapists provide specialist assessments and intervention around managing potential symptoms such as breathlessness, fatigue, de-conditioning, muscle weakness and problems with mobility
• Social worker to assist with issues related to home circumstances and possible additional care and social support needs, including the needs of carers
• Welfare rights advisers to ensure that financial difficulties are addressed during a period of treatment for cancer
• Administrators / booking clerks to ensure appointments are coordinated as smoothly as possible, you will have telephone access to our care coordinators, who will work with you and members of the team to arrange appointment times that are as convenient as possible
• Lymphoedema nurse to help with problems associated with swollen limbs, as a result of cancer affecting lymph glands within the body
• Family support worker to help support family members affected by a cancer diagnosis
• Cancer Information and Support Centre offers information and support to anyone affected by cancer, and signposts to services in your local area
• Chaplaincy team to help provide ongoing religious support where faith is important to you and those closest to you
• Spiritual support recognising that some people do not have a religious faith but have important spiritual support needs

How long will Enhanced Supportive Care be available for me?

This will very much depend on what your needs are, and will be tailored to you as an individual.

It may be that if your symptoms are reduced or completely alleviated, your ongoing support will be provided by your GP and cancer doctor / specialist nurse. We will make sure that we always discuss any plans with you and those important to you. We will also communicate with the other healthcare professionals involved in your care so that they are aware of any additional support provided.

It may be appropriate to refer you to your local district nursing team to monitor your symptoms, or your local community specialist palliative care (Macmillan) team for further support. 

Dr Dan Monnery, Consultant in Palliative Medicine

Dan is a Consultant in Palliative Medicine and the clinical lead for palliative and supportive care at The Clatterbridge Cancer Centre. Dan is also the national clinical advisor for Enhanced Supportive Care (ESC) at NHS England and an honorary clinical lecturer at the University of Liverpool. He graduated from Keele University in 2010 and spent his early career working at The University Hospital of North Midlands before moving to Liverpool for specialty training. Since joining The Clatterbridge Cancer Centre in 2018, Dan has developed an interest in outcome measures to demonstrate impact for patients of supportive care services and enjoys an active role in delivering patient care and teaching others.

Dr Séamus Coyle, Consultant in Palliative Medicine

Séamus is a Consultant in Palliative Medicine, research lead for palliative and supportive care at The Clatterbridge Cancer Centre and an Honorary Senior Clinical Lecturer at the University of Liverpool.

Before studying medicine, he completed a BSc in biotechnology, a masters in medical sciences and a PhD. He studied medicine at the National University of Ireland Medical School in Galway and graduated in 2006. He moved to Liverpool to take up an academic clinical fellowship in August 2012 and completed consultant training in 2016.  He worked as a community palliative care consultant in St Helens and Knowsley from 2017 to 2020 before joining The Clatterbridge Cancer Centre in June 2020.

His main research area is the biology of dying, which he has been working on since 2012. He is also passionate about trying to improve treatments to control symptoms.

Dr Lexie McDougall, Consultant in Palliative Medicine

Lexie is a Consultant in Palliative Medicine. She graduated from Keele University in 2012 and spent her early career working in the West Midlands before moving to Liverpool for specialty training. Lexie joined The Clatterbridge Cancer Centre team in 2022 and enjoys an active role in delivering patient care and education. She is excited to start here in her first consultant post and looks forward to helping develop the service.

Heather Lee, Supportive and Palliative Care Team Coordinator

Heather started working at The Clatterbridge Cancer Centre in November 2004, initially within the Clinical Governance team as a secretary. In 2007 Heather joined the Specialist Palliative Care Team as a coordinator. In her role she coordinates the Specialist Palliative Care Team MDT (multidisciplinary team meting), provides an administration service to the consultants and CNSs, coordinates the enhanced supportive care (ESC) referrals and books appointments. She also manages clinics and deals with patients queries ensuring that patients' safety and wellbeing is a priority.

Pam Jones, Supportive and Palliative Care Team Clerk

Pam started working at The Clatterbridge Cancer Centre in January 2012, firstly within the Medical Records department as a clerk.  In July 2012 Pam joined the Specialist Palliative Care Team as a clerical assistant. In her role she prepares clinics for doctors and nurses in the palliative care and psychological medicine teams, provides support to the secretaries and deals with patient appointments and Envoy (text message service) queries ensuring that patients receive an excellent service and support.

Eva Allen, Supportive and Palliative Care Team Medical Secretary

Eva joined the Specialist Palliative Care Team as a medical secretary in July 2019, having previously supported the breast team at The Clatterbridge Cancer Centre. In her role she provides an administration service to the Specialist Palliative Care Team consultants and CNSs, coordinates the enhanced supportive care (ESC) referrals and books appointments. She also manages clinics and deals with patients queries ensuring that patients' safety and wellbeing is a priority.

Justine Kennedy - Cancer Support Worker

Justine has worked in the NHS since 2004, first within PALS and patient engagement, then with Cheshire and Merseyside Cancer Alliance from 2009.  

She was the coordinator of the iVan Cancer and Information Van which was a unique collaborative between NHS England and the Cancer Alliance to provide a mobile, clinically led, and community-based resource. Operating within the Greater Merseyside and West Cheshire regions, the iVan visited shopping centres, workplaces, faith buildings, community centres and in the centres of areas of deprivation, with a cancer clinical nurse specialist and coordinator on board. The team provided information and advice on cancer awareness, prevention and early diagnosis.

From 2018 she was the colorectal early diagnosis support worker at Liverpool University Hospitals. 

Ann Griffiths, Clinical Nurse Specialist and Lead Cancer Nurse for Radiation Services

Ann qualified as a nurse in September 2001 and initially started working on a diabetic and endocrinology ward in her local district general hospital, before moving to The Clatterbridge Cancer Centre in 2003 to start gaining experience in cancer care and palliative care.

Ann gained her qualifications in oncology nursing and chemotherapy administration and was ward manager on the inpatient chemotherapy unit before landing her dream job in palliative care in January 2011. Ann became the Macmillan Palliative Care Clinical Nurse Specialist and has been part of the team expanding and evolving.

Ann has recently been appointed as the Lead Cancer Nurse for Radiation Services and her time is divided working two days in management and three days in palliative care. Ann has a passion for meeting new people, improving services and ensuring patients and their families receive the best possible care.

Tracey Meyers, Clinical Nurse Specialist

Tracey qualified in 1996 working initially in the acute emergency and surgical setting then over the last 20 years has enjoyed a variety of clinical, educational and leadership roles within the cancer and palliative care setting.

Tracey joined the Clatterbridge team in June 2021 and has an ongoing passion for clinical education and staff support and is currently working towards her masters degree in cancer and palliative care.

Joy Boyd, Clinical Nurse Specialist

Joy started her nurse training in 1985. She joined the Palliative Care team at The Clatterbridge Cancer Centre in May 2020 and before this worked with the palliative care team at the Royal Liverpool University Hospital. She worked for 11 years at Wirral Hospice St John’s. Joy’s background in nursing before palliative care was mainly acute surgery. She has experience as a ward manager and as a specialist nurse in stoma care.

Joy enjoys working with the ward nurses and student nurses and is involved with teaching programmes and education, and has a particular interest in mouth care.

Jane Slack, Clinical Nurse Specialist

Jane qualified in 2001 and worked in the acute sector and ward-based cancer services in Leeds before moving into more specialist palliative care.

Jane has been part of the Palliative Care team at The Clatterbridge Cancer Centre since March 2019. Before this Jane, worked for 14 years in two hospices in Wirral and Leeds. There Jane had various roles, primarily in in-patient care, but also in daycare services and hospice at home.

Jane loves working with patients and families, especially in terms of advanced care planning. She also has a developing interest in education.

Amanda Watson, Clinical Nurse Specialist

Amanda has worked in palliative care for more than 25 years, working within the community and hospice settings and has been with the team at The Clatterbridge Cancer Centre since 2016.  She sees both inpatients and outpatients with their families for support with physical symptoms and for psychological and emotional support.  She also has an interest in audit and service improvement.

Emma Davey, Clinical Nurse Specialist

Emma came into palliative care early in her nursing career finding her love of the specialism whilst developing her skills and knowledge as a staff nurse at St Johns Hospice in Wirral. In 2003 Emma took up a Macmillan palliative care clinical nurse specialist post in Chester working into the community, supporting the holistic needs of both cancer and patients with non-malignancies and their families, before moving to an acute nurse specialist post in The Countess of Chester Hospital for four years.

Emma joined the team at The Clatterbridge Cancer Centre in 2021 and continues to further her professional development studying to compete her masters degree. She has a passion for HIV oncology, education and advance care planning.

Sinead Benson, Clinical Nurse Specialist

Sinead qualified as a nurse in 2002 and worked in acute medicine for 3 years. Following this she worked in Marie Curie Belfast for 3 years while completing a MSc in pain management. Since then Sinead has experience working in the community and acute trusts as a palliative care clinical nurse specialist before her employment here.

Sinead has a keen interest in research and audit, mainly in the area of continuous subcutaneous infusions (syringe driver / pumps). Her interest focuses on patient selection, communication and education of patients, those closest to them and healthcare professionals.

Malcolm Cooper, Clinical Nurse Specialist

Malcolm qualified as RGN in Southend General Hospital in 1989. Having completed an oncology certificate at The Royal Marsden in 1992, where he worked on the inpatient palliative care unit for several years, he has remained in the specialty of palliative care for almost 30 years. Since 1997, he has worked in various roles as a clinical nurse specialist, including community palliative care (St Christopher’s hospice team), and several hospital-based teams including general and specialist cancer NHS trusts.

He has had a special interest in improving access to palliative care for people with learning disabilities, and led an ongoing project during his last role within a busy inner city general hospital, which led to improved collaborative working with the community learning disability team. This work was published in the ‘Learning Disability Practice’ journal.

In his current post he has developed an interest in spiritual and psychological care, and led on development of spiritual and psychological care mandatory training, in conjunction with Wirral University Teaching Hospital's chaplaincy lead.

Jessy O'Farrell, Clinical Nurse Specialist

Jessy is a Clinical Nurse Specialist in Palliative Care and qualified as a nurse in September 2017 and working on Mersey Ward at Clatterbridge Cancer Centre - Wirral as a staff nurse until she was later promoted to deputy ward manager. During this time Jessy gained masters modules in cancer treatments and supportive interventions and also in the safe administration and care of systematic anti-cancer treatments.

Whilst working on the inpatient wards, Jessy developed an interest in palliative care and caring for Teenage and Young Adult patients. Jessy later went on to work as a clinical nurse specialist in palliative care in a local district general hospital for two years until she later returned to The Clatterbridge Cancer Centre in October 2022, joining the Specialist Palliative Care Team.

Jessy is currently developing her knowledge and skills within her role and hopes to complete further masters modules in the future.

Claire Cadwallader, Clinical Nurse Specialist

Claire qualified as a nurse in 2009 and spent 4 years working on the inpatient wards and as the nutritional nurse specialist before joining the palliative care team as a clinical nurse specialist in 2014. Claire is the advance care planning and AMBER care bundle project lead at The Clatterbridge Cancer Centre. Claire has a keen interest in education and advance care planning and continues to her professional development in these areas.

Jane Kean, Family Support Practitioner

Jane completed a health studies degree in 1992 and then undertook her social work training.

She has worked extensively since then in bereavement and palliative care, initially as a Macmillan social worker supporting families when a loved one was at end of life.

She has also supported families affected by the Alder Hey organ scandal, families impacted by the 'right to die' cases through the court system, families bereaved by suicide or murder and has provided training on bereavement to the education / schools system, hospices, NHS staff, voluntary organisations and child and adolescent mental health (CAMHS) team.

Jane joined the team at the end of 2022 and is developing resources for children and young people.

What does advance care planning involve?

Advance care planning involves anything about a person’s future care and wishes, including:

• How they would like to be looked after
• Where they would like to be looked after – preferred place of care and preferred place of death
• Any spiritual or religious belief they would like taking into account
• Who should know about their wishes and preferences
• Practical matters – the care of pets, finances or funeral arrangements
• What a person does not want to happen to them if they are unable to make decisions

Knowing about a person’s wishes can make it easier for family, friends and health care professionals.

How do you make an advance care plan?

A person can talk to a healthcare professional (GP, district nurse, specialist nurse, social worker and hospital doctor), family and friends.

They can write their wishes down, but don’t have to. Writing wishes down can make it easier for people to follow the plan in the future.

Or a person can choose to plan ahead in three ways:

• By making an Advance Care Plan of their preference and wishes for future care
• Creating a Lasting Power of Attorney (LPA) where a person is appointed to make decisions on their behalf
• Making an Advance Decision to Refuse Treatment (ADRT) where decisions are recorded about the treatments a person does not want to have in the future

Who should start the process of advance care planning?

Advance care planning can be started by anyone, at any time, by the person, their family, a carer or a health or social care professional.

It should be offered when a person is well enough to participate in the discussions and before any loss of mental capacity.

What are the benefits of advance care planning?

An ACP conversation allows everyone to develop an understanding of a person’s future needs and wishes.

Evidence suggests that having discussions in relation to future treatment and care results in:

• An increased sense of control for the person
• Opens up conversations about making a will and funeral planning
• Allows for proactive decision making and a reduction in the number of hospital admissions
• More people dying in their preferred place of care which improves end of life care
• Enables better communication between the patient, their family and health care professionals
• Helps families prepare for the death of a loved one

For example, if you have an illness that could not be cured and your condition suddenly got worse you may want to be cared for at home. If your family, friends and healthcare team do not know this and you became too unwell to tell them, you may be taken to hospital.

Starting a conversation about planning ahead can feel difficult so it is helpful to involve people who are close to you like family and friends. They may be able to help you think through some of the issues, so you can plan ahead better.

Useful information

We have provided links below to some blank templates which you may find helpful when you are discussing and documenting an advance care plan. They can be downloaded from these websites for use.

My Wishes

MyWishes’ goal is to ensure that everyone documents what they would like to happen to their physical estate, their digital estate, the care they may require in the future, and the care of any dependents they may have (children, pets etc).

Marie Curie

Planning ahead – thinking about your care and wishes ahead of time

The Gold Standards Framework

Advance Care Planning in 5 simple steps

Macmillan Cancer Support

Advance Care Planning information and documentation for:

• Planning ahead
• Your wishes for care
• Lasting power of attorney
• Advance directive
• Advance decision to refuse treatment

The Advance Care Planning facilitator at The Clatterbridge Cancer Centre is Claire Cadwallader, Palliative Care Clinical Nurse Specialist: Email Claire about advance care planning. The medical lead is Dr Dan Monnery, Consultant in Palliative Medicine.

It's important to us that we can talk with you and your family about your wishes and make plans. 

There are four steps to this:

1. We have a conversation with you and your family to explain our concerns about your condition and understand your preferences and wishes
2. We decide together how you will be cared for if your condition gets worse
3.  We make and record a medical plan
4. We agree on the plans about your treatment and care with all of the medical team looking after you

More information for health professionals

The AMBER care bundle is one of the tools mentioned in the NICE guidance on end of life care for adults: service delivery. This guidance covers situations where there is medical uncertainty. The aim is to make sure that patients and their carers are involved as much as they want in shared decision making.