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Category: Scheme best illustrating application of Evidence-Based Practice
Name: Christina Bailey
Job Title: Lead Nurse, Cancer Services
Organisation: Derby/Burton Cancer Network
Email: christina.bailey@burtonh-tr.wmids.nhs.uk
Telephone: 01283 566333 x 5314
Key team: Clinical Psychologist, Breast Care CNS and Sister, Chemotherapy Team, Psycho-Sexual CNS, Family Centred Children's Counsellor
Title: Patient post treatment support, rehabilitation and survivorship
The need for change within the oncology unit was identified by the results of research undertaken by the Lead Nurse of Cancer Services at Queens Hospital Burton.
The literature suggests it is common for psychological and physical problems to accompany cancer chemotherapy (Peters & Smith et al 1994). Krause (1991) reported that a great number of patients with cancer have feelings of shock, sense of unreality, anger, fear, sorrow and bitterness. Monahan (1988) argues all to often nursing and medical interventions focus only on those challenges of daily living related to physical care or disease status.
Following treatment, patients are initially relieved to have "finished" and are happy to see the Oncologist at a three-month follow up appointment. However, the researcher and oncology nurses noted, that from their shared professional experiences, that within weeks of completion, patients feelings of initial euphoria tended to subside and the abrupt lack of contact and support caused patient vulnerabilities to emerge. It was therefore thought that a post treatment support clinic may help.
A small investigative study was completed using semi-structured taped interviews with women to examine their personal experiences and to identify any similarities following a diagnosis of breast cancer and completion of chemotherapy. The study showed that all the participants experienced ongoing problems, which inhibited their recovery and adaptation to these life-changing experiences.
Service piloted in 1999/2000 and continues 2004. Education sessions were provided by the researcher, with the chemotherapy/breast care teams in liaison with Clinical Psychologist. A forum for clinical supervision - support of staff was established and continues. The clinic is now led by the Breast CNS and Breast Care Sister.
Patient satisfaction audits demonstrates nearly 100% attendance at the clinic, and conveys that there is therapeutic benefits for patients given the opportunity, time to reflect, discuss their experience of a cancer diagnosis, treatments, side effects, and the profound impact this also has on partners, children, other family members. This successful service continues to be implemented within other site-specific cancers within our cancer unit and cancer network.
- Time constraints of staff
- Case loads
- Limited space and appropriate environment
- Education of team, both in secondary, primary care.
- Education of patients/families
- Access to Clinical Psychologist experienced in cancer care
- Lack of clinical support from a clinical psychologist to educate team
- Negotiated funding and weekly session of Clinical Psychologist from our Cancer Centre - Derby Royal Infirmary
- Established a referral criteria, evidence based check-list tool and established a designated space for the clinic to be held.
- Provided education for the multi - disciplinary team members and patients regarding long-term side effects to treatments.
- Re-scheduled working week within the team and designated specific staff to lead the initiative.
- Developed closer working relationships between secondary and primary care.
- Developed a protocol within the clinic for referral of patients as required to other colleagues, i.e., Clinical Psychologist, Dietician, Aromatherapist, primary care colleagues or earlier appointment with oncologist.
This clinic has identified patients and families ongoing needs, in particular patient’s partners and their children.
Patients expressed concerns in regard to how they approached the subject of cancer with their children. In particular concerns with body image and parenting. The perceived uncertainties of the families’ future was highlighted. Some of
the women felt the opportunity to access skilled staff would support their children and enhance the service.
After a 6 month pilot the clinic was initially set up to run concurrent to the patients’ attendance for treatment, in reality patients did not readily access the service on the same day as the focus of attention was towards their chemotherapy treatment.
Therefore, this service is now based at St Giles Hospice and we have established a protocol for referral as required and have produced posters and information, which is displayed within the Oncology Unit. This has proved invaluable for some families and has educated the team about children’s support needs.
A library of appropriate children’s books to develop their cognitive skills is available within the unit for parents to access. This service continues in 2004.
The post treatment support clinic has also identified the need for some patients and their partners to have access to a trained psycho-sexual counsellor. The impact of body image changes, sexual function and loss of libido are all concerns and do add stress on relationships both initially and longer term.
To address the above we have obtained funding for a 6 month pilot project/clinic commenced November 2003. This is a nurse led andrology/psycho-sexual counselling clinic with experienced staff in this specialty. A protocol for referral from all the site-specific multi-professional teams is now in place to promote this added service.
This is being adopted by other site-specific cancer teams within the network.
Published in network newsletter.
Sharing good practice and submitting to service improvement team/ modernisation agency.
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