Paediatric radiotherapy – small team making big changes

Summary

Over the past four years the team at St James Institute of Oncology has restructured its methods of treatment preparation to help reduce the number of younger patients needing a general anaesthetic for treatment. This has been achieved through role play (offering the patient a chance to be a radiographer), creating a working model LINAC for patients to play with and by introducing new technology, such as iPads, as distraction methods. The team has secured funding to create a dedicated teenage and young adults’ waiting area within the radiotherapy department.

Challenge

The radiotherapy department at Leeds treats around 6,000 new patients each year, 70 of them children or young adults. Though a minority group in number, treatment is complex. Radiotherapy for children and young adults requires a multidisciplinary approach in order to prepare and support patients and families through what can be up to seven weeks of daily treatment. 

Historically this support was provided by a specialist nurse and play therapist, but it became clear that Leeds needed a paediatric specialist radiographer. In 2010 the radiotherapy department was successful in securing funding for such a post.

Objectives

The main objectives set by the team from the introduction of the paediatric radiographer were to improve treatment preparation, reduce the number of patients receiving GA for treatment, and develop a motorised miniature treatment machine for children. 

The team also hoped to improve awareness of paediatric services within radiotherapy to the trust and the general public, and to improve overall communication.

Solution

The treatment preparation programme was developed to help the child understand what is going on around them during treatment. Through play, the child was put in the position of the radiographer. A fully motorised model of a linear accelerator (Linac) was developed – children could practice setting up their favourite toy on the model. 

Another objective was to develop services for teenage and young adult patients. They now receive the same level of support as younger children. The team is to build a dedicated TYA area within the radiotherapy department. 

In 2012 the paediatric radiographer visited radiotherapy departments in New Zealand and Australia. This inspired the beads of courage programme. Communication has also improved, both between departments and with patients’ families.

Results

The number of GA patients has fallen. Although impossible to put a cost on this, it is clear that a non-GA patient does not need the resources a GA patient does. In three years the team has prevented nine children aged under five from needing GA. 

In 2012, 45 families were asked what they thought of the paediatric radiotherapy services. They said they were happy with the service but needed more information on the treatment. This was addressed through the introduction of treatment photo guides and the creation of the baby Linac. 

Improving communication to other team members and patients’ families helped reduce wasted appointment slots on the treatment machines. Easier communication, via email, has reduced the amount of missed appointments.

Learnings

The three-strong team found that by having high levels of team preparation before a patient and their family arrives in the department they could deliver an excellent service and prepare the child well for any procedures. 

They learnt that communicating with other members of staff within the radiotherapy department is key when preparing a child for radiotherapy treatment, as was the ability of staff to fully understand patients’ cancer experiences. 

The team has continued to review and push its services. Helping create better experiences for paediatric and teenage patients resulted in new ideas that can be transferred to adult services (for example, use of a baby Linac for anxious patients, photo guides to treatment preparation, and iPods for distraction during treatment).

Evaluation

Presenting at national and international conferences allowed the team to show other departments how the paediatric radiotherapy services within Leeds work. This has led to other health professionals visiting the department with a view to adopting some of its methods. 

The presentation of the baby Linac led to enquiries from other departments about having one made by the team’s in-house engineers. This is currently under discussion with the trust management.
QiC Oncology Highly Commended
Supporting people through a team approach
Paediatric radiotherapy - small team making big changes
by St James Institute of Oncology

Contacts

Lucy Hume
Job title: Paediatric radiographer
Place of work: St James Institute of Oncology
Email: Lucy.hume@leedsth.nhs.uk
Telephone: 0113 2067810