Understanding and meeting the needs of rural and regional radiotherapy patients with educational multimedia

Ms Jacinta Krstic1Ms Amelia WanEmily Whillance,1 Adrian Mendoza,1 Jane Honey,1 Richard Oates.

1Radiation Therapist at the Peter Maccallum Cancer Centre, Bendigo campus

Abstract

Aims

Studies show that cancer patients fear radiation therapy due to a limited understanding of its purpose and its accompanying side effects, even after consultation with a Radiation Oncologist and a simulation session with a Radiation Therapist.  This project aims to address the need for rural and regional patients to be informed of their treatment plan and processes prior to commencing radiotherapy.

Methods

Patients were given Patient Education Satisfaction Survey 1 during the course of radiotherapy treatment to identify education needs.  Using this information, videos were created for distribution to patients prior to commencing radiotherapy. The videos included footage of the radiotherapy department and team, as well as footage of a virtual radiotherapy environment with enhanced visualisation from commercially available software. Patient Education Satisfaction Survey 2 was conducted subsequently to evaluate the videos.

Results

Fifty patients completed survey 1 and their education needs were identified.  Four videos were created which focussed on palliative/general radiotherapy, breast, prostate and upper gastrointestinal tumours. Fifty patients completed survey 2 to evaluate the videos and provided feedback on their content.

Discussion

This project enabled the production of patient education materials which aimed to meet patient education needs and allowed for patient feedback in their development. These videos will provide improved understanding of the radiotherapy process and may help to reduce patient fears.  Final versions of the videos will be distributed via DVD and online to the relevant patient groups and their families who may not be able to attend the department.

Biography

Jacinta Krstic is a Radiation Therapist at the Peter MacCallum Cancer Centre in Bendigo. She completed a Bachelor of Applied Science in Radiation Therapy at RMIT and has been working as a qualified radiation therapist for 2 years. She is currently working on a project funded by LMICS to develop patient and GP radiation therapy education videos to promote increased awareness about radiation therapy in the regional and rural environment.

Cleft management in the Northern Territory: a review of the past 17 years (2000 – 2017)

Celina Lai1, Mr Mark  Moore1, Dr Gurmeet Singh1

1Royal Darwin Hospital, Darwin, Australia

Abstract:

About one infant in 700 live births is born with a cleft lip and/or palate (CL±P).  The prevalence of CL±P occurring in indigenous Australian population is reported to be higher when compared to the non-indigenous Australian population1.  The Northern Territory (NT) is the third largest state/territory in Australia and home to approximately 212 000 people of which 26.8% are Indigenous2.

In the “top end” of the NT, children born with CL±P are referred to the Royal Darwin Hospital (RDH) Cleft Lip and Palate Clinic for assessment, review and long term case management.  The RDH cleft clinic, made up of a multidisciplinary team of medical and allied health professionals, meet three times a year providing case management to children and young adults with a cleft condition.

Approximately 40% of active clients identify as Aboriginal or Torres Strait Islander.  Of this group, nearly 70% live in a remote or rural location (population <5000 to <100000).  For this group, the challenges to providing optimal cleft care are substantial, when you consider language and cultural barriers to understanding western health practices, cultural variations in processes for decision making, limited access to allied health services in remote NT and the tyranny of distance.

Cleft management is a long journey where children are followed up into their early adult years.  Continual review of the way services are delivered is imperative to ensure children with CL±P living in rural and remote NT, receive a service equitable to those living in metropolitan areas.


Biography:

Coming Soon.

Changing inpatient rehabilitation ward to an enriched environment for rural patients

Mrs Bronwyn Connelly1

1Northeast Health Wangaratta, Wangaratta, Australia, 2Victoria Stroke Clinical Network, Melbourne, Australia

Abstract:

Central to the goal of stroke rehabilitation is the aim to reduce the level of impairment experienced by increasing participation in therapy and meaningful activities. Inpatient rehabilitation forms an integral step for patients to regain function following a stroke. Inpatient rehabilitation environments are often not conducive to maximising recovery despite recent innovations and increased knowledge. Research indicates stroke clients spend up to 50% of their day in their room alone and inactive.

Environment enrichment is an emerging concept within stroke rehabilitation that aims to provide a stimulating environment to maximise clients’ recovery but to date has tended to a metropolitan based service change. The enriched environment model was implemented in January 2017 to address reduced activity levels, and to maximise recovery and function within a rural inpatient rehabilitation setting. This innovative concept includes increasing levels of activity and increasing opportunities for stimulating, enjoyable activities for inpatient stroke patients seven days a week.

Underpinning the changes was the guiding principle of improvement in service delivery to offer a comprehensive, truly team based approach to maximise patient recovery and improve quality of life. This model created an approach to facilitate social interaction and stimulation by creating an environment to respond to individual needs and goals without increased funds or staffing.

This presentation will also outline how the model has been successfully sustained and extended for all rehabilitation patients.


Biography:

Bronwyn Connelly is a senior occupational therapist at Northeast Health, where she specialises in the management of complex neurological clients. Bronwyn has a special interest in developing models of care which incorporate research into evidence based rural clinical practice.

Adjusting for ACEs: services for rural children with Adverse Childhood Experiences

Ms Margaret Burgess1, Ms Jessica McGrath1, Dagney Hopp1

1Royal Far West, Manly, Australia

Abstract:

Studies have demonstrated a strong link between exposure to Adverse Childhood Experiences (ACEs) and poor health outcomes in adulthood. While there is growing evidence about the consequences of ACEs and the need for intervention, there is a need for further evidence on the prevalence of ACEs in rural and remote areas, including in Australia, and how interventions can be adapted for these rural and remote contexts.

Royal Far West (RFW) is an Australian charity based in Manly, New South Wales that has been providing paediatric and allied health services for children in rural and remote NSW for 94 years.

In 2017 RFW began a formal process of reorientating the organisation towards delivering care for families that recognizes the role of ACEs and traumatic experiences in child development. This process has included establishing an active working group to understand the prevalence of ACEs in our client population and to research and recommend ways to adjust practices within the organisation.

This work is now being used to inform RFW services and is also contributing to Royal Far West’s advocacy for increased investment nationally in understanding and reducing the impact of ACEs in rural and remote Australia.

Presenters will describe how learning more about this important area and the unique client population has led to key service changes and will share learnings about the change process.


Biography:

Margaret Burgess is a Speech Pathologist working part time at the Royal Far West in Manly. She also works at the Dalwood Spilstead Service, an organisation providing intervention for children who have experienced early childhood trauma. Margaret studied at the National University of Ireland Galway and the University of Auckland before commencing work in Sydney in 2011. She has a strong focus on optimising the life outcomes of children who have experienced early childhood trauma. She is a member of the Northern Beaches Complex Trauma Network and is the Chair of the Royal Far West Trauma Working Party.

The changing landscape of palliative care and implications for allied health clinicians

Dr Deidre Morgan1, Ms  Deb Rawlings1, Ms Lizzie Button1, Professor Jennifer Tieman1

1Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia

Abstract:

Introduction:Allied Health (AH) clinicians are seeing increasing numbers of palliative care patients in generalist settings due to an ageing population and improved medical care of life limiting illnesses. This study sought to identify AH perspectives about palliative care given the implications for AH clinical practice, education and professional development. We present survey responses to a single open-ended question from the larger survey: “Please describe what you think palliative care involves for patients, families and the health practitioner.”

Methods:This survey was distributed to AH via email lists from a range of organisations including the CareSearch (an online palliative care resource) Allied Health Hub, and Allied Health Professions Australia. Data was analysed using descriptive statistics and content analysis of free text responses. Ethics approval was received.

Results:Two hundred and seventeen AH responded to the survey. Analysis was undertaken of 187 useable responses to Question 1 and four themes were identified. 1. Palliative care employs a client-centred model of care, 2. Acknowledgement of living whilst dying, 3. Interdisciplinary palliative care interventions provide active care in a range of domains and 4. Characteristics of palliative care teams and settings.

Discussion:Allied Health have an active role to play in the physical, social, emotional and spiritual care of palliative care patients and caregivers. Given the increasing number of these patients seen in non-specialist palliative care settings, there is an imperative for AH, including those in rural and remote settings, to develop skills and competencies in order to provide optimal care.


Biography:

Deidre is an Occupational Therapist with a clinical background in acute care, rehabilitation and 13 years in specialist palliative care. Deidre’s research interests focus on the role of allied health in optimising function of people with advanced disease and implications for education and professional development. She has an active research interest in the relationship between dependence with intimate hygiene and dignity at the end-of-life and the physical impact of caring on informal caregivers. Deidre works as a researcher and lecturer in Palliative and Supportive Services, Flinders University and is the inaugural chair of Australian Allied Health in Palliative Care.

Collaborative Approach for Implementing Cognitive and Delirium Care in the Top End

Ms Deidre Widdall, Ms Debbie Roe

1Royal Darwin Hospital, Leanyer, Australia

Abstract:

In 2016 Top End Health Service (TEHS) Cognitive and Delirium Care in Hospital Project (CDCP) commenced a formal cognitive and delirium care pathway. This bought together a range of expertise over several clinical disciplines including Occupational Therapists. The project focused on adults only, though in a culturally and linguistically diverse population group with a high proportion of Aboriginal patients.

Delirium is a common medical emergency with a high mortality but unless specifically screened for can be under recognised, and in our hospital there was no formal guideline or pathway to help clinicians detect or treat.
The project highlights an all hospital approach aiming to develop a guideline for cognitive care, improving the safety and quality care while also developing culturally relevant protocols for our diverse and unique patient cohort in the Top End.

This presentation will outline the role of the Occupational Therapy Service at RDH in the collaborative working with the project officer and will focus on area where therapists have participated with the implementation of the pathway.

Areas will be highlighted that show the importance of Occupational Therapy had provided on our reference group, reviewing the screening tool on the pathway with other formal assessments. Also look at the protocol as an education resource and examine the effect of participating in a cognitive care workshop and what it entails to train ‘champions’

Lastly it will detail opportunities that the project has bought for therapists working alongside the project officer and to work at other sites within TEHS


Biography:

Deidre has had a varied clinical background in the NT and SA mainly in rehabilitation and community nursing. With post graduate qualifications in stoma, wound and continence care and a Masters by research in Clinical Rehabilitation. Deidre is currently working as the project officer for the Top End Health Service Cognitive Care and Delirium Care Hospital Project

Debbie is a Senior Occupational Therapist currently working in for Royal Darwin Hospital in the Acute Medical Wards. Debbie has had a varied clinical background however her passion is better care for the older person.

Burns Occupational Therapy —providing burn rehabilitation to remote Indigenous patients in the Top End.

Mrs Jennifer O’Neill1

1Royal Darwin Hospital, Tiwi, Australia

Abstract:

The Royal Darwin Hospital Burns Unit has been committed to providing burn treatment and education across the Top End since its formation after the Bali Bombings in 2002. The Burns Unit caters to adult and paediatric inpatients and outpatients with minor to major burn injuries, and supports patients through their recovery from acute treatment to long term scar management.

The Burns Unit Scar Management Clinic delivers a high standard of care in accordance with evidence based practice guidelines in Burn Trauma Rehabilitation. The primary role of the Burns OT is to provide specialist scar education, treatment and management to prevent problematic scarring, contractures and skin breakdown post a burn, while maintaining joint function and improving overall cosmetic appearance and quality of life.

A significant proportion of the unit’s acute admissions are people from remote Aboriginal communities. The unique issues and challenges presented by this patient group demand adaptations to standard approaches to practice. Working with remote dwelling Aboriginal people offers opportunities to develop specific educational resources and interventions to meet the demand for culturally responsive care, and address the geographical and environmental challenges that come with living in the Top End.

Providing an effective scar management service to remote dwelling Aboriginal people is challenging, however the RDH Burns Unit continues to strive for best practice, utilising resources such as telehealth, adapting educational tools, and coordinating with community clinics.


Biography:

Jennifer O’Neill is an Occupational Therapist at the Royal Darwin Hospital (RDH). After graduating from the University of Queensland, Jennifer has spent the last 6 and a half years working in a wide variety of general and specialist areas at RDH, including caseloads in medical, surgical, neurology, oncology, orthopaedic, paediatric and the Emergency Department.
For the last four years Jennifer has been working in an outpatient caseload , specialising in hand therapy. She was the RDH lymphoedema therapist for two years until July 2017, when she moved into the speciality Burns caseload as the primary Burns Occupational Therapist.

TEHS Renal Service Occupational Therapy Role

Mrs Joan Crombie1

1TEHS Renal Service, Darwin, Australia, 2Occupational Therapy Acute Service Royal Darwin Hospital, Darwin, Australia, 3Occupational Therapy Australia , Fitzroy, Australia

Abstract:

Lightning Presentation ( visual message )

Representing OT Goals current activities and projects
– to provide inpatient acute service whist also addressing the
outpatient suburban , rural and remote population across
diverse cultural backgrounds and languages for CKD and ESRF
clients
– to ensure clients with renal disease continue to utilise the most
appropriate services for their specific issue including Remote
Services, GP’s Include existing services
– to support patients in their renal journey to be actively engage in
their own health care journey through meaningful dialogue,
through activity and with mutual respect through the Pathways
to My Home Program.


Biography:

An Occupational Therapist , British Diploma in Occupational Therapy 1977 ( Trained in Edinburgh Scotland)
Practised mainly in Australia ( Vic, WA, NT) across Acute inpatient Services, inpatient rehabilitation , domiciliary services, Community Health and within home based Enablement Programs. As a volunteer in India over extended periods I used my OT practices to empower and enable children and adults towards healthy living and healthy futures. Opportunities within Royal Darwin Hospital since 2013 in a senior rotational clinical role have led me to this exciting new OT position within the Top End Renal Service.

Exploration of a transdisciplinary children service model delivered by rural generalists.

Ms Hannah Christensen1

1South West Hospital And Health Service, Roma, Australia

Abstract:

Background:This study evaluated the implementation of transdisciplinary child development service for a rural context delivered by rural generalists. The model included a centralised, coordinated intake and delivery of care process which was compared to the previous silo discipline approach.

Methods:This study was a comparison of outcomes on service efficiencies, economic analysis, family and staff perception of a transdisciplinary model for children 0 – 18 years presenting with questions surrounding their development. One month of clinical data for the different models of care were collected and compared including the families’ perception of whether the care delivered met their needs.

Results:The new model of care was measured against National Health Performance Framework indicators. This included; change in wait times, number of clients discharged from specialist (Paediatrician) wait list, changes in number of steps in patient journey and improved family satisfaction with care delivery.

Discussion and recommendations: A transdisciplinary model of care involving a centralised intake process will provide an efficient service which will be consistent with evidence based understanding of child development along the continuum of care.


Biography:

Hannah is a Physiotherapist who has worked in various project and leadership roles within Queensland Health across both metropolitan tertiary hospitals and rural settings. She has investigated models of care in which allied health clinicians work in an expanded scope of practice role to deliver services to communities in rural settings.

An evaluation of service outcomes, costs, and consumer engagement following implementation of telepractice services for the clinical assessment of dysphagia.

Dr Clare Burns1, Professor  Liz  Ward2, Ms  Brooke Cowie3, Dr  Robyn Saxon4, Ms  Amy  Gray5, Ms  Lisa  Baker6, Ms  Sarah Bignell7, Ms  Jodie  Turvey8, Ms  Natalie  Winter9, Ms  Rukmani  Rusch9, Associate Professor Tracy  Comans10

1Speech Pathology & Audiology Department, Royal Brisbane & Women’s Hospital , Herston , Australia, 2Centre for Functioning and Health Research, Metro South HHS  , Woolloongabba , Australia, 3Speech Pathology Department, Caboolture Hospital , Caboolture , Australia, 4Speech Pathology Department, Sunshine Coast University Hospital , Kawana , Australia, 5Speech Pathology Department, Gayndah Community Health, Gayndah, Australia, 6Speech Pathology Department, Wide Bay Rural Allied Health and Community Health Service , Gayndah, Australia, 7Speech Pathology Department, Charleville Hospital , Charleville , Australia, 8Safety and Quality Department, St George Hospital , St George , Australia, 9Speech Pathology Department, Cairns Hospital , Cairns , Australia, 10Metro North Hospital and Health Service , Herston, Australia

Abstract:

Purpose: The delivery of dysphagia services is impacted by travel distance; a geographically disperse population; and access to a skilled local workforce. These issues may be alleviated with telepractice. This study examined the service outcomes, costs, and consumer satisfaction of a telepractice service model for conducting clinical swallow examinations (CSEs) implemented across 5 public health services.

Method(s): Forty CSE sessions were conducted via videoconferencing, linking the assessing speech pathologists (n=8) with 30 patients in distant health facilities. Telepractice sessions followed published methodology with patient-end support provided by a trained local health support worker (HSW). Data was collected on waiting times, clinical and session outcomes, service costs and consumer satisfaction. Outcomes were compared to existing standard care,
which involved scheduled/on-demand clinician visits to remote services or patients travelling to face-to-face assessments.

Result(s): Telepractice services enabled a reduction in patient waiting times (mean=2 days); saved clinical time through avoided clinician travel (mean=2½ hours); and cost savings (mean=$229/session). Swallow safety and oral intake was optimized for 62% of patients who required diet/fluid changes post assessment. The HSW role was vital in providing patient support. Despite some technical issues, all sessions were completed successfully. Patient and
clinician satisfaction was high.

Conclusions: Telepractice can enable remote facilities to access CSEs in a more efficient manner, optimizing patient safety, and enhancing service, and cost efficiencies.


Biography:

Lisa Baker BSpPath 2001, GradCertRemote HlthPrac 2004, MRemoteHlth, 2009.

Lisa is the Rural Allied and Community Health team leader with the Wide Bay Hospital and Health Service, based at Gayndah Community Health and servicing multiple rural communities in Queensland’s Wide Bay region. Lisa has been actively involved in rural speech pathology and allied health service provision since 2002.

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