Lesley Taylor wanted to examine the lack of support for patients at the end of treatment, so the decision was made to explore the impact of a wellbeing clinic on care, Claire Read reports
They needed something more after treatment
When the results of the study came back, they confirmed what Lesley Taylor and her colleagues had long suspected. The patients for whom they cared were getting good support for their actual medical issues, but their post-treatment needs weren’t always being identified or met.
Ms Taylor is the Macmillan advanced oncology nurse specialist at NHS Tayside, as well as the head and neck cancer nurse specialist at the same organisation. It was on these patients which Ms Taylor’s study was focused.
“We could look down into their mouths and throats and say there was no evidence of any cancer, and that was great, they appreciated that. But what we didn’t have time to do in that medically-led clinic was look at things like dry mouth, and swallow, and the emotional aspects and the social aspects that come alongside what are often life-changing diagnoses and treatments,” she remembers.
“It became clear they needed something very much more at the end of treatment.” And so the decision was taken to instigate a nurse and allied health professional-led wellbeing clinic. The idea was to provide the sort of support that had been lacking; the holistic look at someone’s life in the immediate aftermath of the end of treatment.
The team worked together to reshuffle how they saw patients, and found a rare spot in the hospital in which they could hold appointments: a dental suite. The impact was soon felt. “The new cohort of patients that were coming through seemed to be getting better quicker,” according to Ms Taylor.
At the same time, there was the know-ledge that the service could be refined further. A priority was finding a non-hospital setting in which to hold the clinics. “We were aware there was this in-built anxiety about coming back to the hospital each time you had to be checked – there were all these reminders of what they’d been through and how that made them feel.”
It was felt a move into the community would make most sense, not least because, this is the main setting for individuals’ lives post-treatment. “We needed to rehabilitate them away from hospital and back to what was their own life, although it might be very different from what it was before.”
That became possible when a space was secured at a purpose-built health centre on the edges of Dundee. The shift to the new facility brought with it a shift in patient group. The service was opened up to colorectal and prostate cancer patients as well as those with head and neck cancers. In the longer run, the aim is to open the service to anyone who has been through any form of cancer treatment.
It means, staff hope, there is no longer the sense of abandonment some patients had reported feeling at the end of active treatment. “For head and neck cancer patients, they would have six weeks of daily treatment and then no contact – at a time when they were probably at the height of their treatment toxicity. So we now see them at two weeks, and we can see them earlier than that if there’s a problem.”
It is a major service design change. But ask Ms Taylor how she and her colleagues achieved it, and she is matter of fact: “We just thought: ‘We’ve got to do this’.”
And so they simply rearranged their diaries and made the new clinic work, not going down the route of trying to secure additional funding and the associated bureaucracy.
Ms Taylor argues there are virtues to that sort of evidence-based ‘get on and do it’ approach, but she also urges nurses who want to drive service redesign to pay attention to the effect their innovations have.
“Gather your information as you go, so that when somebody turns around and says to you: ‘Well, do you think you’ve made a difference?’, you don’t have to hack back through all this information, which is there but may not have been collated properly. Keep a strict eye on the data you’re producing, so that you can say – ‘Look at the difference we have made’.”
In the case of the clinics, there is now clear evidence of just such a difference. “It seems to be in this cohort of patients who’ve gone through these wellbeing clinics that they’ve gone from having their feeding tubes in for on average six months to having their feeding tubes in for an average of three months – a 50% reduction,” she reports. “So I just think it’s made a huge difference to the patients.”