Jenny Welford (specialist occupational therapist) and Kirstyn Borrowdale (occupational therapy technical instructor) have been piloting an innovative new service to support patients with lung cancer.
Issues commonly described by patients include fatigue, breathlessness, difficulty with psychological adjustment and changes to day-to-day function. This can have a major impact on a patient’s wellbeing and independence.
Jenny has set up a new service so that the occupational therapy team are involved at any point throughout the patient’s pathway, including at the point of diagnosis. This way, they can provide support and education to patients and their families in a timely manner.
Patients who are experiencing breathlessness can access CBT techniques for this specific symptom. “I introduce the concept of CBT techniques to support patients experiencing panic, anxiety and low mood linked to their breathlessness,” explains Jenny.
“Quite often these are symptoms patients have to adapt to live with and so upskilling them in self-management is of the utmost importance.”
Kirstyn’s skills in creative problem-solving, fatigue management and falls prevention has also been of great benefit to patients. She organises equipment to support patients in the community and provides patients and their families with helpful educational resources to refer to at home and ensures they have a direct line to the service.
Jenny takes the lead on serious illness conversations- “I talk to patients about what they may experience in the future and discuss what and who is important to them. I also explore their care and support preferences in detail and strive to achieve this wherever possible in partnership with the wider lung cancer team.
“These discussions have increased by 31% since the beginning of the pilot and any documentation regarding the wishes of our patients is shared with their consultant GP, district nurse, and anyone else involved in their care.”
“For me personally, this has been the most fulfilling aspect of my new role. It has been a privilege to provide a safe space for those we care for to have the confidence to talk openly, with support about their wishes.”
Occupational therapy is now an integral part of the lung cancer multidisciplinary team and the new service is now embedded in the respiratory and oncology teams, linking in with various services in the community including loan equipment, Newcastle’s palliative care team, and the Community Response and Rehabilitation Team.
In the first seven months, Jenny and Kirstyn saw 91 patients (467 patient contacts, delivering close to 500 interventions), and were able to avoid 14 unnecessary admissions to hospital, as well as delayed discharges home for social reasons.
Anonymous feedback from patients has been very positive with 100% patients ‘strongly agreeing’ that their initial assessment covered all aspects of their function. Patients reported feeling informed and involved in deciding what support they needed, and felt more confident at home as a result. They also received positive feedback from their colleagues in the lung cancer multidisciplinary team.
Jenny and Kirstyn would like to see similar services available for patients with other cancers and to develop a decision support clinic involving occupational therapy, physiotherapy, oncology, palliative care and clinical nurse specialists in order to reach the best possible decisions for patients in line with their wishes.
Jenny, who has submitted her findings to the Society of International Geriatric Oncology and British Thoracic Oncology Group, presented their wider frailty work at the European Society of Medical Oncology annual congress, and has also been involved in writing a book chapter on the importance of physical performance and function in cancer.
She says: “My vision is for all patients facing a diagnosis of cancer to have access to high quality occupational therapy, no matter where they live nationally, in order to promote quality of life.”