Download NECN – Holistic Assessment Pilot

Kathryn Almond. MSc, BAcC, IFPA, BSCAH, CNHC.
Chair north of England Cancer Network Complementary Therapy Group
Complementary Therapy Service
Mowbray Suite
Friarage Hospital
Northallerton
DL6 1JG
Complementary Therapy Service
Telephone:
e-mail:
01609 762676
[email protected]
Complementary therapy service:
a pilot exploration utilising the
north of england cancer network
holistic assessment tool.
March to April 2011
Kathryn Almond
Complementary Therapy Service
Oncolology & Haematology
Friarage Hospital, Northallerton
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Contents
Introduction
3
Drivers
3-4
Aims
4
Definition
4
Materials and Methods
5
Results
5-8
Conclusion
8
References
9
Appendix 1 – Adapted Holistic Assessment Tool
10
Appendix 2 – Consent form
11
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NECN – Holistic Assessment Pilot
Introduction
NECN would like to adopt a unified approach to the assessment and recording of
patients needs. The assessment tool that the NECN has chosen to adopt is the
distress thermometer developed by the National Comprehensive Cancer Network
2005. January 2007 saw the publication of the Holistic Common Assessment
(HCA) of Supportive and Palliative care Needs for Adults with Cancer. This
holistic assessment tool is aimed to encourage professionals and patients to
explore current problems and issues that may be affecting patients’ physical,
psychological, social and spiritual well-being.
This pilot exploration aims to measure the effect of complementary therapy
treatments by using an adapted version of the tool to record the patients own
assessment before and after their complementary therapy treatment.
The complementary therapy service aspires to contribute to a better
understanding of the demand for therapies and their effects on patient-centred
outcomes among patients with cancer. The service is focused upon therapies as
an adjunct to conventional forms of treatment and in palliative / supportive care,
by providing both psychological care through relaxation and promotion of well
being along with specific treatments to address symptom management during
chemotherapy and radiotherapy.
The data is shown as 122 episodes of care over 1 month, equating to 20
days of service delivery.
Drivers
The drive for improvement in patient assessments stems from the National
Institute of Clinical Excellence (NICE) 2004, ‘Guidance in Improving Supportive
and Palliative Care for Adults with Cancer’. This report highlighted the nature of
the care that should be provided to ensure that patients and their families are
supported and their needs addressed when coping with cancer and its treatment.
There is increasing public interest in, and use of, complementary and alternative
medicine (CAM); particularly among patients with cancer, surveys indicate that
one-third of patients with cancer sought and received some form of
complementary and alternative medicine treatment (Department of Health, 2008).
As far back as 2000 the House of Lords Select Committee 3 called for more
evidence to support the use of complementary therapy which was echoed by
NICE guidelines, improving supportive and palliative care for adults with
cancer (2004) 5
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
11.18 Evaluative research is needed into the cost effectiveness and
safety and efficacy of different complementary therapies

11.19 Research is needed to determine the best way to provide and
deliver information about complementary therapies
The Cancer Reform Strategy (2009) 6 announced the establishment of the
National Survivorship Initiative to deliver services and support to those living
beyond cancer and states that complementary therapies may have a role in
filling service gaps.
The complementary therapy (safeguarding practice) measures 1 for the
manual of cancer services (2009) support the quality assurance and act as a
driver for quality improvement in the commissioning and delivering of
service.
Aims
By piloting the use of the Holistic Common Assessment tool within the context of
complementary therapy treatment it is hoped to capture data to:

Identify the characteristics of service that are likely to have a significant
impact on health outcomes.

Give support to planning, commissioning and organising complementary
therapy services and to identify gaps in provision, ensuring the
appropriateness and quality of the existing service.
Definition
Participants were asked to verbally assess their own perceived level of stress
and anxiety before and after their complementary therapy treatment.
The National Institute of Health and Clinical Excellence (2009)4 define
‘complementary therapy’ as:
“Complementary therapies are used alongside orthodox treatments with the
aim of providing psychological and emotional support through the relief of
symptoms.”
And by the Manual of Cancer Services (2010) 2 as:
“a range of specific therapies, which are offered to patients with cancer, as
having potential benefit, but which are not offered as an alternative tumour
reduction (cancer reduction, tumour ablation or removal) method to any of the
conventional treatments offered by the network (surgery, radiotherapy,
chemotherapy, endocrine therapy or biological therapy)”.
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Materials & Methods
Please identify the number (1-10) that best describes how stressed
you were before treatment and again after treatment. If “0” is no
stress and “10” is high levels of stress or anxiety.
The holistic assessment tool is divided into five domains; background, physical,
social, psychological and spiritual by utilising an adapted version we aim to get a
snapshot of the patients self assessed wellbeing.
Snapshot assessment of wellbeing takes minimal time although varied at certain
points in the patients pathway.
Consent must be obtained prior to undertaking the assessment
Complementary therapy service at the Friarage is ideally placed as patients are
referred at every stage of the pathway and across all tumour sites
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Results
self assessed scores pre and post episode of care
holistic assessment (0-10)
6
5
4
3
2
1
0
pre treatment
post treatment
5.35
3.03
average scores

Comparing the mean average scores pre and post treatment demonstrates a
reduction of 43.36%
Completion
12%
0%
answered
81%
19%
forgot
not appropriate
7%


During the pilot there were 23 treatment interventions without scores because
the question was overlooked, on reviewing the data this was much more
prevalent at the beginning of the study showing that the tool was used more
as it became part of the clinical routine.
There were a further 15 episodes of care in which it was judged inappropriate
to ask. On examining the feedback in all cases this was due to the patient
being too emotional to ask, whether they had received bad news in clinic or
were struggling it was felt that the use of the tool would not have been helpful
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
in that situation. There may be an argument that this would have been
especially useful data to collect however, there are equally as strong case
against pressing patients for information. Perhaps further training and
support in using the tool would be useful.
For the 99 interventions that were recorded the information was given freely.
holistic assessment (0-10)
treatment comparison
8
6
4
2
0
auricular
acupuncture
acupuncture
aromatherapy
combination
pre
4.57
5.29
7.05
5.23
post
2.14
3.36
4.91
2.77
The data was also used to investigate the different effects of each intervention,
there was not a significant difference between the treatments however a
combination of both acupuncture and massage seemed to provide the biggest
reduction of 2.46 from pre to post scores.
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site specific group comparison
8
hloistic assessment (0-10)
7
6
5
4
3
2
1
0
pre
post
pre
post
pre
breast
2.69
bowel
1
carer
post
pre
post
pre
post
pre
2.4 gynaecology 2 haematology1.84
post
lung
pre
post
prostate
2.2
pre
post
staff
By comparing the effects of treatments on each site specific group the largest
movement of self assessed score is from breast with a reduction of 2.69. To
draw any further conclusions about the impact of complementary therapy
treatments it would also be useful to explore data from different stages of the
cancer pathway.
Conclusion
Assessment forms an integral part of patient care and should be seen as
continuous exercise, the continual modification of the service to adapt and
develop the best service for patients.
This exploration into using the holistic assessment tool has demonstrated:

Has been a useful tool to support the day to day appraisal of individuals
needs and inform service developments.

A way to support patients to reflect and assess their own feelings as well as
indicating services and resources that may help to resolve other concerns
and needs.

Demonstrate active and equal membership of the multidisciplinary team
within the north east cancer network and nationally. Contributing towards the
development of standardised; practice, research and audit, information and
service delivery.
However, we strive to adapt, and modify the service to accommodate as
many patients as possible ensuring an integrated approach to care by
combining the best of conventional cancer treatments with the timely
application of complementary therapy treatments. Over the past ten years
we have continued to analyse, reflect and adjust service delivery to ensure
clinical and cost effectiveness.
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References
1. National Cancer Peer Review Programme. (2009) Manual for Cancer
Services 2008: Complementary Therapy (Safeguarding Practice) Measures.
Gateway No. 12532 National Cancer Action Team
2. National Institute for Clinical Excellence (2004) Guidance on Cancer
Services, Improving Supportive and Palliative Care for Adults with Cancer.
London NICE.
3. House of Lords Select Committee on Science and Technology. (2000) 6th
report: Complementary and alternative medicine. London: The Stationary
Office.
4. Department of Health (2008) Research on the role of complementary and
alternative medicine (CAM) in the care of patients with cancer. London DoH.
5. National Institute for Clinical Excellence (2004) Guidance on Cancer
Services, Improving Supportive and Palliative Care for Adults with Cancer.
London NICE.
6. Department of Health (2007) The Cancer Reform Strategy. London DoH. .
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Appendix 1
Kathryn Almond. MSc, BAcC, IFPA, BSCAH, CNHC.
Complementary Therapy Service
Mowbray Suite
Friarage Hospital
Northallerton
DL6 1JG
Telephone:
e-mail:
01609 762676
[email protected]
Complementary Therapy Service
Holistic Assessment Pilot
Please would you contribute to piloting this assessment tool? We would like to record
your own assessment of your stress before and after you complementary therapy
treatment.
This screening tool is aimed to encourage professionals and patients to explore current
problems and issues that may be affecting patients’ physical, psychological, social and
spiritual well-being.
Please identify the number (1-10) that best describes how stressed you were before
treatment and again after treatment. If “0” is no stress and “10” is high levels of stress
or anxiety.
If you do not wish to contribute to this particular project, please just let us know. Please
be reassured that your treatment will not be affected in any way.
Thank you.
version: 1
date:
feb 2011
adapted from the NECN Holistic Assessment of Concerns Tool revised v2 26.09.08
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Appendix 2
Consent to Complementary Therapy Treatment
Introduction
Everything we do has to be evaluated. We would like to be able to use information you have given us to investigate
what effects, if any, complementary therapy treatments may have. Your experience is what we would like to explore.
We hope to share our findings with other healthcare professionals by presenting the outcomes at meetings and
publishing scientific articles that describe the study and results. If you would like to be informed of any projects then
please let us know, and we will be happy to forward information to you. Please read the following information and
share it with your family and friends if you wish. We are happy to provide alternative explanations or additional
information if you have any questions.
confidentiality
Your anonymity and confidentiality will be respected and any information will be subject to the Data Protection Act
(1998). Your practitioner is bound by the confidentially policy of South Tees Foundation Trust and their professional
code of ethics. All personal details and your anonymity will be respected at all times.
Complaints
If you are dissatisfied or wish to complain about any treatment or information you have received please contact:
Patient Advise and Liaison Service (PALS) on free phone: 0800 0282462
Side Effects and risks:
Generally Complementary Therapies are very safe. Serious side effects occur in less than 1 in 10,000 treatments.
You need to be aware that …
Acupuncture

drowsiness can occur after a treatment, and if affected you will be advised to stay and recover before driving or
advised not to drive if seriously affected.

fainting can occur following a treatment in a very small number of patients.

your blood sugar levels may fall so it is advised that you eat a light meal or snack before a treatment.

symptoms can exacerbate for a short while following a treatment; you should tell your practitioner if this occurs,
but is usually seen as a good response

minor bleeding or bruising can occur (approximately 3% of treatments)

pain occurs in 1% of patients during a treatment.
Aromatherapy

should you have any reaction to the oils, wash the area with cool milk, preferably full cream. Milk is a natural
emulsifier and will reduce any soreness or inflammation. Do not use soaps or creams. It is unlikely that you will
have any long term reaction but please call for advice if anything lasts for more than 2 hours.

drink plenty of water, as this aids the body to dispel toxins and waste products that have been encouraged into
the bloodstream by the treatment.

If there are any particular risks that apply in your case, your Practitioner will discuss these with you.
STATEMENT OF CONSENT
I confirm that I have read and understood the above information and I consent to having Complementary
Therapies. I understand I can refuse treatment at any time.
I understand that complementary therapy is not an alternative method of tumour reduction and this treatment
does not promise a particular benefit or cure
I understand the information will be stored in accordance with the principles of the Data Protection Act (1998)
and may be used for audit and research purposes.
Signed ………………………………………………………...……… Date ……………………............................
author:
issue:
review date:
Kathryn Almond
kathryn almond
3 (April 2011)
April 2013
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