Tuesday 16th December 2014
Mac Voice, the magazine for Macmillan professionals: Winter 2014
Debbie Provan, Macmillan Project Lead Dietitian for NHS Ayrshire and Arran, on improving nutritional care for people with cancer
In 2009, I set out to ensure cancer care professionals had the knowledge, skills and confidence to deliver good nutritional care, through the development and delivery of an education programme. Over the first three years, this overall aim was achieved. However, the project also resulted in a number of recommendations, based on:
- political drivers
- the changing profile and needs of the population
- data obtained through the evaluation process
- the inability of the dietetic service to meet the demand produced by increased cancer incidence.
As a result, phase two of the Macmillan Nutrition Project was funded from June 2012–September 2015. This phase aims to improve outcomes across Ayrshire and Arran by developing a tiered approach to nutritional care.
The tiers listed below have been developed concurrently and together will improve access to high-quality and equitable nutrition services.
Aim: To have supported, empowered and proactive staff. They should be able to raise, discuss and deal with concerns about nutrition. They should also be able to embed nutritional care into their day-to-day work.
Method: Develop, deliver and promote available education. Improve communication with, and links to, specialist dietetic support.
Aim: Develop supported self-management strategies for people affected by cancer. These strategies should make them feel supported, enabled and empowered to take an active role in their nutritional care.
Method: Introduce self-management tools and Macmillan Dietetic Assistant Practitioners at ward level. Macmillan Dietetic Assistant Practitioners introduce themselves and a nutritional care booklet to patients as they begin chemotherapy. The patient and staff member then work collaboratively throughout treatment to proactively manage any nutritional consequences.
Aim: Develop specialist dietetic interventions for those who are most in need or unable to self-manage.
Method: Develop, deliver and promote education aimed at dietetic staff. Introduce self-referral pathways, and develop patient information that meets the needs of service users and prospective users.
Aim: Develop and deliver health promotion activities that focus on primary and secondary prevention strategies. Support people to live well beyond cancer.
Method: Make use of existing partnerships and resources. For example, partnerships with Boots and Ayrshire Cancer Support. Make use of resources produced by the local weight management team, Macmillan Cancer Support, Cancer Research UK and the World Cancer Research Fund. Develop input into the local cancer rehabilitation programme and health and well-being events.
Sustaining the tiered model
This model can be sustained through its use of existing patient pathways. It can also be sustained by appropriately using staff skills and specialist interventions to facilitate the approach.
To date, a substantial amount of activity has occurred:
- The education programme developed during phase one has been updated and remains available through Macmillan’s Learn Zone (learnzone.org.uk).
- Traditional training – focusing on primary and secondary prevention, and nutritional care during treatment and in palliative care – has also been offered. This training has been delivered to multi-professional staff and volunteers working across a variety of settings.
- Macmillan Dietetic Assistant Practitioners have been working in the day-case chemotherapy ward at a local hospital since November 2013. While this is still under evaluation, positive feedback has been received from staff and service users.
- A semi-structured weight management programme has been on offer since January 2013. To date, 31 people have enrolled.
- Access to information and support has improved. This has been achieved by producing written resources and online materials. The service also now accepts self-referrals.
The impact of these changes is being evaluated and will be reported in 2015.
Macmillan Project Lead Dietitian
Kirklandside Hospital, Kilmarnock