Summary
Rehabilitation is vitally important for patients living with and beyond cancer to enhance their quality of life and help them gain control and focus on areas of importance within their life. A two-year project by the Macmillan Therapy Team provides education for the local workforce in the delivery of rehabilitation across the patient pathway from diagnosis through to end of life care. It has enabled a specialist occupational therapist and physiotherapist to integrate within the specialist palliative care multidisciplinary team, in order to improve continuity of patient care, build strong links and adopt a holistic approach for patients within this specialist area.
Challenge
One of the biggest drivers for the project was the lack of specialist allied health professionals (AHPs) dedicated to the oncology and palliative care community service. This resulted in poor continuity, and disjointed practice between professionals. More importantly, the patient was not viewed in a holistic way therefore certain problems which were significant to the patient were not being identified and addressed. Resources were wasted and there were unnecessary admissions to hospital.
Objectives
To support other professionals and increase their knowledge and skills. To provide self-management support to patients and carers and to offer individual care plans to patients. To enhance the patient experience.
Solution
A patient and staff survey was designed and distributed to gather information re: skills, development needs and patient experience of therapy. An occupational therapist developed a complex caseload of patients, developing referral criteria, assessment paperwork and outcome measures. An audit system was created to collate outcome results, important dates (eg, referral and discharge) and demographic details. A mailbox was created to improve timeliness of referrals. A prioritisation criterion was developed, to ensure patients were assessed in a time frame cognisant with local and national practice for palliative care.
18 workshops were designed and delivered to staff consisting of topics such as fatigue management, vocational rehabilitation, activity in palliative care and motivational interviewing. A physiotherapist successfully completed a cancer rehabilitation course, and together with local clinical nurse specialists and the North Lincolnshire council, designed a 10 week rehabilitation programme for breast cancer survivors. Both therapists have delivered an education session to breast cancer survivors as part of a health and well-being programme which has contributed to other trust projects such as the Macmillan recovery package implementation.
Results
After year one key statistics showed 229 referrals received and 592 face to face therapy sessions completed. All urgent referrals are seen face-to-face within 24 hours and 97% of all referrals are contacted via telephone within the first 5 days of receipt. Meanwhile 84% of all referrals are contacted within the first 24 hours of referral receipt and 97% of patients are seen within their preferred place of care (home). We are able to say that although patients generally deteriorate and/or pass away, they are successfully achieving their goals and ambitions prior to these changes.
Learnings
Through attending the specialist palliative care MDT, we are able to emphasise the importance of holistic practice and open up opportunities for patients raising awareness of our skills and the benefits for the patient. From providing education and developing self-management resources, we hope patients can regain control of some of their symptoms resulting in reduced dependency on professionals to ‘direct’ care unnecessarily. The beauty of the project is that it can be shaped to meet patient need, and elements such as the workshops can be adapted to fulfil staff expectation and development need.Evaluation
Three outcome measures were used: the Elderly Mobility Scale (assessing physical ability eg, mobility and transfers), Modified Barthel Index (assessing daily activities) and a Goal Attainment Scale (assessing specific patient-centred goal achievement). From evaluating the initial patient survey, we implemented and shaped the project. For example, 61% of patients felt therapy was provided ‘too late’ therefore we completed meet-and-greets with healthcare professionals to present the benefit of early referral, resulting in us having intervention with patients for up to a year before deterioration/mortality. 72% of patients wished to be treated at home, therefore we accommodated this. 28% would like to be treated elsewhere, eg, hospital, therefore as we move to year two we have secured an ‘outpatient’ gym space to trial how this works for patients who wish to have rehabilitation outside their home environment. To add to patient experience evaluation, we have also received positive feedback from our colleagues within the hospice, Macmillan nurses, Community nursing team, therapy managers and Macmillan development managers. The project is monitored bimonthly by a steering group including a patient representative which helps guide the project’s future and allows progress sharing with multiple professionals.
