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In 2009, the dietetic team at NHS Ayrshire and Arran set out to ensure that cancer care professionals have the knowledge, skills and confidence to deliver good nutritional care to people living with and beyond cancer.
A training needs analysis from 2006 had identified a gap in this area. The training was also motivated by the knowledge that cancer incidence continues to increase, and that around 40-45%1 of all cancers diagnosed in the UK could be avoided if people made appropriate lifestyle choices.
The risk of cancer recurrence could also be reduced through post-diagnosis weight management programmes.2
With support from Macmillan, the team developed an education programme with two main products:
- An e-learning programme entitled Nutritional Care of People Affected by Cancer: An Education Programme
- A virtual classroom lecture series, delivered live and then recorded as podcasts.
- A scoping exercise with staff, literature search and review, and consultation with key stakeholders guided the development of the e-learning programme’s content.
From this, an introduction and five modules were created. These were:
- Therapeutic, complementary and alternative diets
- Medications and treatments
- Provision of information
- Body image.
Patient and carer stories were also embedded within the e-learning programme to re-enforce key educational messages, and encourage reflection on current working practices.
The virtual classroom lecture series was developed to explore some areas of the programme in more detail, and to encourage discussion and peer assisted learning. Topics included: current science; information and support; nutritional issues for people with breast cancer; and cancer rehabilitation and survivorship.
Promotional presentations were delivered to multi-professional groups at a local and national level, and abstracts were presented as posters at national conferences. Articles about the e-learning package and podcasts were also published in relevant publications.
In 2011, the project was awarded with an AHP Advancing Healthcare Award| for Achieving Excellence in Learning and Development. As a result, the project featured heavily in Dietetics Today| and a motion was passed by the Scottish Parliament congratulating the team.
Between May 2011 and June 2012, 1,417 people from 22 different countries had enrolled on the e-learning programme. A team at the University of Glasgow was recruited to carry out an evaluation.
At a six month follow-up, 88% of those questioned agreed that the course fulfilled their expectations and around half of the participants said they had changed their practice as a result of the course. An increase in confidence about their knowledge on complementary and therapeutic diets (58%) and on fad diets (55%) was reported. However, knowledge about nutritional screening was not retained by the majority of participants. Overall the education programme was well received. It is available on Learn Zone|.
The inclusion of patient and carer stories and their impact on the effectiveness of the education programme was evaluated:
- 79% of respondents felt the stories increased their knowledge.
- 85% noted an increased ability to empathise with patients and families.
- 89% were encouraged to reflect on their own clinical practice.
- 89% had a greater understanding of the messages relayed in the e-learning. package due to the inclusion of stories.
- 100% of respondents felt the stories helped them understand how the application of the programme’s key messages in clinical practice could improve patient care and the healthcare experience.
Despite wide-spread advertisement and frequent attempts to engage local staff, the project team had difficulty recruiting staff to the virtual classroom. Several staff members from outside NHS Ayrshire and Arran also found that their local IT systems prevented them from participating.
However, those who did engage responded well to the sessions. Many felt that it was a great way to learn and that their knowledge and understanding of nutritional care in cancer had improved.
Some also stated they couldn’t have attended a lecture delivered in a traditional way due to travel and costs.
Each classroom session was recorded and posted as a podcast on cancernursing.org| Around 1,500 people have accessed these to date.
The project and its products have been well-received locally and nationally. Evaluation results show that staff have improved knowledge, skills and confidence levels, and it is hoped and believed that this will positively impact on patient care.
This piece of work has begun to look at the promotion of health within the cancer survivor population, however it has also highlighted where further work is needed. We must continue to work in partnership with staff to embed changes to further improve nutritional care. In particular, it is recommended that:
- the local dietetic department continues to support developments in the cancer pathway that provide opportunities to improve nutritional care
- certain areas of the cancer pathway, and the nutritional interventions at these points, need to be strengthened
- nutritional screening is firmly embedded and management strategies are universally applied across all inpatient wards
- the role of allied health professionals (AHPs) within cancer services is promoted and AHPs continue to work together to improve services, collect evidence and achieve patient-led outcomes
- IT systems are reviewed to support blended approaches to teaching and learning. Staff should also be encouraged to use and develop intranet resources to improve communication and access to information.
Macmillan and NHS Ayrshire and Arran have developed another proposal that builds on progress so far. Over the next two years a project team will work to embed changes in practice and strengthen nutritional care pathways. They will develop models of supported selfmanagement, improving access to dietetic services and improving the range of services available to cancer survivors and those receiving palliative care.
Email Debbie Provan|, Macmillan Project Lead Dietitian and National AHP Lead for Cancer Rehabilitation, Kirklandside Hospital, Kilmarnock.
We have information about eating well| for people affected by cancer..
1. Parkin D.M, Boyd L and Walker L.C. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010: Summary and conclusions|. British Journal of Cancer. 2011. 105, S77–S81.
2. Kroenke C, Chen W, Rosner B, et al. Weight, weight gain, and survival after breast cancer diagnosis|. Journal of Clinical Oncology. 2005. 23: 1370–1378
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