Cancer survivorship

Watching the Olympics over the weekend has been inspiring, but also fascinating. Behind the scenes our athletes work hard with their coaches in preparation for their events and this behind the scenes view can be as interesting TV as the sprint finish or rugby sevens. What has been thought-provoking is that athletes have teams of coaches and supporters and this preparation is now seen as essential for a good team. The athletes themselves understand their bodies, know what makes them perform at their best, what to eat and how to prepare both physically and mentally. This sports science and coaching approach is now a substantive science but could we learn from this approach for health care? Why is it we don’t do the same preparation when people have a major illness or survive cancer which is a much harder race. Is our focus less holistic than that for our athletes? Traditionally in healthcare we have tended to focus on the medicine rather than what the person can do for themselves or what support we can add to maximise performance. Cost and pressure of work is often the response from hard stretched services with limited rehabilitation provision, but the consequences of cancer treatment and the subsequent symptoms can be costlier if not addressed. Maybe healthcare professionals need to become more like coaches and address this health challenge from a preventative stance just like the athletes.

We know that improving physical activity, changing behaviours and lifestyle can be as important as medicine in some diseases, but how do we get this as part of the preparation and recovery? In last week’s report from Macmillan about cancer survivorship which compared the needs of survivors to those in the 1970s to 2016, the chief executive stressed how different things are to 40 years ago. A bit like sports we have become better at what we do, improving diagnosis and treatment so we have more winners. Furthermore, getting beyond the treatment is not the end of the race, it’s gone from a 100-meter sprint to a marathon, as more than 60% of cancer suffers live 10 years or more and for some 80% survival is the norm. The intractable nature of some long-term health problems, a life time of maintenance therapy suggests the need for a more personalised approach. We want as nurses patients to live as good a life as possible after cancer, but once we finish supporting them through the treatment, we often leave it up to the patient to find the best road to recovery. The True NTH exercise and diet research team at Surrey have found that there is a real appetite from the public about getting fitter after cancer treatment. Taking a leaf out of sports and exercise science approach we are working with men with prostate cancer to provide a personalised exercise and diet package provided through community pharmacies. Changes to the body after cancer treatment can leave individuals feeling fat and frail but this can be reversed. We know that physical activity and changes in weight can reduce risks from cancer recurrence and improve health overall but activity also improves how people feel. What we don’t know is how best to get men to make these changes and improve their fitness. Let’s hope the Olympic spirit will prevail and we will be able to improve men’s physical health and fitness through this intervention, so subsequently improve men’s lives. In our own small way, we are the supporters and coaches that cheer on the athletes, the men with prostate cancer need this support.

Professor Sara Faithfull and one of her patients, John Marshall were recently interviewed about this study for Eagle radio, hear what they had to say during these 4 brief clips:

 

 

 

Why Research is Important in the Ambulance Service

I was giving a lecture recently to a group of student paramedics about prehospital research – why it’s an exciting, developing area to work in and why it’s so important for patients that we do it.

At the time of my lecture, Care at the scene, a themed review published by the National Institute for Health Research (NIHR) Dissemination Centre (@NIHR_DC) hadn’t been released yet, but would have demonstrated this point perfectly.

Their themed review brings together recent research evidence on urgent and emergency care, focussed on the ambulance service. They organised almost 40 NIHR funded studies into three main areas – understanding system and population factors that affect ambulance services; decision-making by patients, ambulance staff and services, workforce and patient experience; and clinical interventions in prehospital care(http://www.dc.nihr.ac.uk/highlights-and-reviews/pre-hospital-care).

The role of ambulance service staff and the care they provide for patients has seen a paradigm shift in the last couple of decades. From historically adhering to the ‘load-and-go’ ethos of ‘ambulance drivers’, to now delivering high levels of care and sophisticated interventions on scene. Not only has the level of acute-care advanced, but the ambulance service is now considered part of the wider system of urgent and emergency care services. We are treating more and more patients with complex health and social needs, long-term and chronic conditions.

Not only this, but with emergency departments under such relentless demand, the ambulance service has a part to play in ensuring patients are being seen and treated at the most appropriate place; whether that be at home, minor injury units or GP surgeries. Staff are undertaking more training to gain specialist skills and new approaches to managing patients at scene.

As the landscape of what we do as an ambulance service changes, we also need the research and evidence to show that the care we provide is effective, beneficial, safe and cost-effective. As a clinician, this review has highlighted important studies that can influence my practice and make sure I’m providing evidence-based care for the patients I see.

As a paramedic involved in research, I’m so encouraged to read about the variety of great studies that have happened and are ongoing. It shows how research plays such an important role in improving ambulance services and the care patients receive. It’s great to see that a range of well conducted research is being undertaken covering the different aspects involved in prehospital care, from large randomised controlled trials focussing on cardiac arrest, to qualitative studies looking at decision-making and safety in ambulance service transitions. And while it’s encouraging to see this research being done, it also highlights the fact that more research is still needed.

The review was launched at Sheffield University with a selection of presentations from some of the investigators involved in the research included in the review, as well as lay representatives and commissioners. It was great to hear the researchers talk about the results of their studies, as well as providing insights into the challenges and opportunities of conducting research in the prehospital setting that they found along the way. There was a passionate talk followed by a lively discussion by Derek Prentice, who chairs the lay group for the Royal College of Emergency Medicine, on whether the NHS truly does provide patient-centred care. The event also provided a great opportunity to (though, I loathe the saying) ‘network’ and meet others involved or interested in prehospital research from around the country. A gathering of like-minded folk to discuss common interests, potential collaborations and share ideas. Sometimes I can feel quite isolated whilst working on my research, but I came away from this event with renewed encouragement from meeting others that are also interested in research that is going to improve the care provided to patients.

I think that this is an important document for front-line clinicians who are providing out-of-hospital care to read, to help make them aware them of some of the existing evidence that can help inform their practice. The review also provides recommendations on how ambulance services can make better use of evidence and support research to drive improvement. It’s also important that chief executives, medical directors, those involved in policy-making, commissioners and opinion leaders understand the impact and potential that research has for helping adapt the ambulance service in the changing healthcare care landscape.

Scott Munro
Postgraduate Researcher | School of Health Sciences: PhD
Twitter: @ScottFSMunro

The Spending Review – what about the students?

I’ve recently attended several meetings and workshops exploring the spending review and its impact. There’s more meetings this week, I’m on a train on my way to one now. What I’m wondering is, what will the impact be on those who are currently considering healthcare in a few years time. Will they never know it was funded? Is it the norm to pay your university fees? I suppose you don’t know what you don’t know! So then I started to wonder, what about us, the educational staff? We know what has been, what will be coming and all are mostly unsure of the actual impact it will have.
I’ve been discussing the future with Directors of Nursing in our local healthcare organisations. There are some solutions, but they all vary. Will this make it difficult for students, trying to cherry pick the best deal? So I thought I’d give you a list of the solutions so far and see if you have a view:

– give students a contract as a health care assistant throughout their training of at least one day per week to guarantee them some income. This is good, we need to ensure that they work in areas where they are not placed as students, our experience tells us that this otherwise blurs their identity.

– refund tuition fees (up to 50%) if they remain in the organisation for a fixed period of time post qualifying. I guess this depends on who you are, are tuition fees just another (acceptable) tax and therefore not the main issue?

– in organisations that have capacity, provide low rent or possibly free accommodation for the duration of their programme. This is difficult, not everywhere has available accommodation. Would this put certain providers above others when students as customers may have a greater right to choose where they undertake the clinical elements of their programme?

– provide funding for a post graduate qualification if you remain in the organisation for a minimum of 18 months / 2 years post qualification.

So all of the above have legs, but I wonder, how do we make it fair across our provider partners? It feels to me that we need a combination of these offerings for all areas. If not, then how can we evenly spread the student numbers. They will be our customers, our culture has to shift. We do of course have to maintain our selection process to ensure we continue to recruit the highest calibre of student at Surrey to be the future health care workforce.

I’m interested to hear your thoughts?

Melaine Coward

Head of School
School of Health Sciences

Dementia Care & Media Engagement – Time to Focus on Solutions

On the eve of Dementia Awareness week (15th to 21st May), it is timely to take stock of progress made, to agree priorities for professional education and research and to consider how we can communicate innovations to best effect.

There have been positive developments in the treatment of dementia. Dr Dennis Gillings who recently stepped down as chair of the World Dementia Council expressed optimism that treatments to remove plaques in the brain, combined with brain training, could stop or reverse dementia symptoms. Interventions to ‘untangle some neural tangles’ could lead to regeneration. Dr Gillings raised the question of the accessibility of treatments when they become available as the NHS may not agree to fund them (http://www.telegraph.co.uk/news/health/elder/12174547/Dementia-cure-may-be-just-five-years-away-says-world-expert.html ).

Resource allocation in the NHS raises ethical issue such as: Who gets what and why? Which treatments should be provided and which should be withheld? And how can we justify prioritising treatments for one group of patients over another? These are important questions that require public and expert engagement. However, they are not the only ethical questions relating to the experience of people with dementia and their families.

We would do well to remember a fundamental question posed by Mary Warnock in 1984: What kind of society can we praise and admire? Media attention to dementia treatment innovations, the quest for cure and the aspiration to ‘fight’ and ‘defeat’ dementia are appropriate. However, they are not and should not be the whole story.

Enabling people with dementia to live as well as possible requires care. Good care requires engagement with a different set of ethical questions: How do we ensure that people with dementia are meaningfully involved in everyday decisions that relate to, for example, activities, dressing, food, drinks and intimate care? How do we work well with families and friends so they get the support and help they need? And, at the same time, ensure the interests of the person with dementia come first? How should care workers allocate their time when resources are constrained? And what form of ethics education needs to be in place to enable care workers to develop ethical sensitivity and to feel confident to advocate for older people in their care?

The society we can praise and admire is one in which attention is paid to initiatives that illuminate ethical aspects of dementia care and aim to create cultures of home and residential care that enable people with dementia and their families to have the best lives possible. Too often, care workers report that they see only relentless attention to negative aspects of care which is demoralising. They ask ‘Why don’t journalists report good news stories?’

The development of Solutions Journalism (SoJo) appears to offer an opportunity to have more positive engagement with the media (http://www.solutionsjournalism.org/). This has been described as investigating and explaining ‘in a critical and clear-eyed way, examples of people working towards solutions. It focuses not just on what may be working, but how and why it appears to be working, or alternatively, why it may be stumbling’.

Research and education activities in our own School of Health Sciences relating to dementia – and the care of older people more generally – are the kinds of initiatives that are worthy of SoJo attention. Four projects in particular engage with the what, how and why of the ethical care of older people:

  • The RIPE (Researching Interventions that Promote Ethics in social care) project tests three different approaches to ethics education for care workers in residential care for older people (see https://workspace.cimediacloud.com/r/92fLer );
  • Time for Dementia is a four year collaborative project led by Professor Sube Banergee, involving students from the University of Surrey and Brighton Medical School. The project aims to provide nursing, paramedic and medical students with longitudinal (three years) experience of visiting people with dementia and their carers at home. The overarching principle of dementia care should be supporting people with dementia to maintain or improve their quality of life. The aim is to personalise education by focusing on the experiences of people with dementia, rather than their diagnosis and to ensure they have a voice (See http://www.sussexpartnership.nhs.uk/whats-new/time-dementia-2 );
  • The Technology Integrated Healthcare Management (TIHM) Project aims to evaluate the impact of a combination of connected supportive care eHealth technologies on the outcomes of people with dementia and their carers. The study will also measure the costs associated with using this combined intervention and its impact on care delivery and the workforce See (https://www.england.nhs.uk/ourwork/innovation/test-beds/tihm ).
  • TiME (This is ME) is a co participatory research project that aims to explore and evaluate the feasibility and acceptability of a digital story based solution (ICT system product) to assist communication between formal (professional care home staff) and informal carers (family/friends) and people with dementia living in residential care home settings. This project is a collaboration between the School of Health and Digital World Research Centre in the University of Surrey but also involves key stakeholders from the dementia care research and policy world.

So there is then much opportunity to draw attention to initiatives that enable people with dementia and their families to have the best care and support possible. There is an opportunity also to better understand and reflect on the everyday ethical issues that arise in   care. Care research offers the opportunity to find out what works and why and how in one of the most important and complex areas of practice in our society.

In the months and years to come, we will look forward to engaging with those committed to Solutions Journalism. Together we can have a greater impact on current and future dementia care so can have a society we can praise and admire.

Ann Gallagher
Professor of Ethics and Care & Colleagues in the School of Health Sciences, University of Surrey
Contact: a.gallagher@surrey.ac.uk

Welcome from our Head of School

Hi everyone, we are starting a blog which I’m very proud to say we are launching in this momentous nurses week! There is a lot going on in the world of health at the moment, things to explore, things to ponder, things to react to. I look forward to the posts that follow and the thinking they will provoke for us all. Finally, let’s not forget the celebrations for what we all achieve which impacts on the people who matter, service users and carers.

Best wishes,

Melaine Coward

Head of School

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