Transcript No Slide Title

FACET - European Journal of Cancer Care
December 2002
Measuring cancer rehabilitation outcomes:
using a multidisciplinary tool
LOWRIE, D1,. HOFFMAN, C. & VAN DER MOLEN, B.
Slide One
What is the purpose of
rehabilitation programmes?
• They help cancer patients cope both
physically and psychologically with
problems that may develop as a result
of their cancer or its treatment.
• Rehabilitation teams typically include
the following disciplines:
• Nurses
• Doctors
• Occupational
therapists
• Physiotherapists
• Speech and
language therapists
• Dietitians
• Complementary
therapists
Slide Two
Why is it important to measure
the outcomes of rehabilitation
programmes?
• Outcome measures determine the
effectiveness of rehabilitation
interventions.
• They should be able to show change
in a patient’s status over time.
• Measuring rehabilitation outcomes is
integral to effective practice.
Notes
Rehabilitation is an integral part of cancer care.
Cancer rehabilitation programmes can help
patients maximize their independence and improve
their quality of life, regardless of life expectancy.
Patients are assessed for their rehabilitation needs,
which can include physical, emotional, spiritual and
social concerns. A multi-professional team of
therapists and specialists working together
provides individualised cancer rehabilitation
programmes.
Consider what your organisation offer in terms of
a rehabilitation programme. Are inpatient
rehabilitation programmes provided in a specialist
setting or as part of care on a general ward?
The number of different professional disciplines
you work with will, of course, depend on the type
of cancer treated and treatment modalities
available in your centre.
Notes
An outcome measures tool serves several
purposes:
•
It can provide information to the patient
and ensure clarity with patient goals and
patient satisfaction.
•
It can can be used to evaluate the impact of
an intervention, or treatment.
•
It can be used to establish contracts for
rehabilitation programmes with patients
and agree their length of stay.
•
It can evaluate care through quantifying
patient outcomes.
•
It can indicate areas where service
developments are required or additional
services deployed.
•
It can indicate an effective use of health
care resources.
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2002
Measuring cancer rehabilitation outcomes:
using a multidisciplinary tool (continued)
Slide Three
How do you select an
instrument to measure
outcomes?
Choose an instrument that is relevant to
your intervention.
The instrument should be:
Notes
While it is clearly acknowledged that there is a
need to measure outcome in rehabilitation, how to
do it is less obvious. There are a variety of
measurement tools available that have been
developed in different settings. The key to selecting
an appropriate tool is to be clear about the issues
you wish to measure.
For a measurement tool to be effective in a clinical
setting, consider the following points:
•
How can you introduce the use of
outcome measures into routine clinical
practice?
•
What educational initiatives will be needed
to help members of the rehabilitation team
implement the measurement tool?
•
How will you analyse the results?
•
How will the results be used to change
practice?
• Reliable
• Valid
• Responsive to change
• Useful in the clinical setting
• Practical to use
Example: a rehabilitation ward
in a UK cancer centre
Slide Four
Markus Ward is the new rehabilitation
inpatient area at the Royal Marsden
Notes
Markus Ward provides inpatient facilities, with
specialist nurses and rehabilitation therapists to
provide support in dealing with the physical and the
psychological effects of cancer.
Markus Ward currently takes up to ten patients
every five-day week. The Nurse Consultant or
ward sister assesses each patient to make sure that
they would benefit from admission.
Hospital, London that opened in
November 2001. The ward provides a
welcoming, relaxing and informal
environment that is a step between
hospital and home.
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2002
Measuring cancer rehabilitation outcomes:
using a multidisciplinary tool (continued)
Markus Ward rehabilitation
programmes
Slide Five
Patients are assessed individually for their
rehabilitation needs, which can include
physical, emotional and spiritual concerns.
Patients staying on Markus Ward follow
individualised cancer rehabilitation
programmes provided by staff from the
Notes
Patients are assessed individually for their
rehabilitation needs. Programmes are then planned
to help patients make the most of their functional
ability following problems that may develop as a
result of their cancer or its treatment.
The aims of the programmes are to help patients
return home better able to cope with the ongoing
challenges of living with cancer. In addition to
interventions from therapists such as
physiotherapists, occupational therapists, dietitians
and speech and language therapists, patients may
also be offered therapies such as relaxation,
massage, art therapy, and psychological and
spiritual support. Some patients may also be
offered strategies to cope with cancer and be
taught self-help techniques.
multidisciplinary rehabilitation team.
Choosing an outcome measure
for Markus Ward
Slide Six
There was a need for a validated and
reliable tool that could address:
• Physical concerns and functional ability
• Emotional well-being and psychological
functioning
• Social and occupational functioning
• Spirituality, sexuality and altered body
image
• Family well-being and financial concerns
• Treatment satisfaction
• Future plans
Notes
The rehabilitation team considered various quality
of life issues when selecting a tool for use in cancer
rehabilitation. In addition, the tool needed to be
validated and reliable.
Using outcome measures in your practice is a way
of evaluating the care you are providing for your
patients. What instrument, if any, are you currently
using to measure outcomes? How effectively does
it measure the outcomes of your rehabilitation
interventions? If you are not using an outcome
measure, think about how it could enhance your
practice. Consider a number of tools that could be
appropriate in your setting. You will then need to
examine them to see if they fit your criteria.
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2002
Measuring cancer rehabilitation outcomes:
using a multidisciplinary tool (continued)
Slide Seven
Choice of outcome measure
for Markus Ward
• A number of outcome measures
were reviewed for use on Markus
Ward including a variety of nursing
assessment tools.
• The Canadian Occupational
Performance Measure (COPM) was
chosen for its client centred quality
and holistic parameters.
Slide Eight
Canadian Occupational
Performance Measure
(COPM)
• It enables clients to specify functional
goals that are important to them.
• Following the rehabilitation process, it
measures clients’ perceptions of the
changes in their performance in and
satisfaction with their chosen functional
tasks.
Notes
The perfect tool to measure outcomes probably
does not exist and you will need to consider the
specific needs of your own rehabilitation unit.
The staff on Markus Ward decided that the
Canadian Occupational Performance Measure
(COPM) would best capture the breadth of
possible rehabilitation outcomes. It is a reliable and
validated patient centred outcome measure. It
measures only the problem areas considered by
the patient to be worth examining in the areas of
self-care, productivity and leisure i.e. issues of
lifestyle.
COPM is not restricted to specific age groups,
disabilities or cognitive levels. It is sensitive enough
to detect change in performance and it considers
the subjective data of patient satisfaction.
Notes
COPM2 was developed as a result of discussions
between the Canadian Association of Occupational
Therapists and the Department of National Health
and Welfare in Ottawa in 1980. It is now used by
multidisciplinary teams in many countries and has
been translated into a number of different
languages.
It is a patient-centred measure which detects
change in a patient’s self-perception of task
performance over time.
COPM is administered in a five step process using a
semi-structured interview conducted by the health
professional together with the patient and/or
caregiver. The five steps of administration are:
•
Problem identification
•
Problem weighting
•
Scoring
•
Re-assessment
•
Follow-up
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2002
Measuring cancer rehabilitation outcomes:
using a multidisciplinary tool (continued)
Slide Nine
Using COPM
• Self-care
– Personal care
– Functional mobility
– Community management
• Productivity
– Paid/unpaid work
– Household management
– Play/school
• Leisure
– Quiet recreation
– Active recreation
– Socialisation
Slide Ten
How COPM was implemented
on Markus Ward
• Two additional categories were
added to ensure that COPM could
be used effectively by the whole
rehabilitation team.
• The Occupational Therapy team
designed and implemented an
education programme to promote
awareness of the measure amongst
the rehabilitation team and train the
Rehabilitation Nurses to use it.
Notes
Using the COPM as an initial assessment
establishes the therapeutic relationship between
the patient and the health professional. It can help
focus on the issues that the patient feels are
important which in turn, helps to establish
appropriate interventions.
The health professional interviews the patient
about daily activities in self-care, productivity and
leisure. The patient is first asked what daily
activities they wish to do or need to do. They are
then asked to identify which of these activities they
find difficult to do to their satisfaction. The five
most important problems are recorded and rated
for performance and satisfaction using scoring
cards.
Re-assessment occurs at a time agreed between
the assessor and the patient, when the patient is
asked to rate each problem on performance and
satisfaction again.
Notes
While the COPM is designed for use by
occupational therapists, some multidisciplinary
teams have used the COPM as an assessment tool
to identify the patient’s concerns when other
members of the rehabilitation team need to be
involved.
The rehabilitation team was granted permission to
use the copyrighted COPM by its chief author.
Although the original COPM form cannot be
altered, by using an additional sheet of paper, other
areas of care relating to the different disciplines can
be explored and scored in the same way. These
areas can be identified by the various professional
disciplines wishing to use the tool. The
rehabilitation team on Markus Ward added two
further categories, Mobility & Transfers and
Communication.
The occupational therapists implemented teaching
sessions for all members of the multidisciplinary
team. Team members initially joined the
occupational therapists when assessments were
performed, in order to gain confidence and
competency in using the tool.
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2002
Measuring cancer rehabilitation outcomes:
using a multidisciplinary tool (continued)
Slide Eleven
Review of rehabilitation
outcomes on Markus Ward
• An interim review of rehabilitation
outcomes took place after three
months.
• Clinically significant positive changes in
performance and satisfaction were
achieved in areas of self-care or
functional mobility and transfers.
Notes
The COPM is being used for a trial period of six
months before being formally reviewed.
An interim review of rehabilitation outcomes took
place after three months. Out of the review came
recommendations for the future. These included
the need to:
•
Maximise rehabilitation resources to
improve performance outcomes.
•
Improve patients’ therapeutic goals.
•
Improve co-ordination and communication.
•
Increase completion rate of and clarity of
information from the COPM.
•
Monitor progress frequently.
• Outcomes need to be improved with
regard to productivity and leisure
goals.
Conclusions: selecting a tool to
measure rehabilitation outcomes
Slide Twelve
• Decide on what you want to measure.
• Identify what tools may be appropriate
to your clinical setting.
• Agree on an outcome measurement
tool.
• Decide on how will you implement the
tool.
• Review the use of the tool after an
agreed period of time.
Notes
Initially a variety of tools were considered including
the Enderby Therapy Outcome Measure, the
COPM and other nursing assessment tools. The
nursing assessment tools were not felt to
adequately meet the breadth of perspective from
the multi-professional team.
The COPM was chosen because of its holistic,
patient focus. In addition, it had been validated and
was proven to be a reliable tool.
A timetable was set for further education of staff
and further in-depth training for members of staff
using the tool.
The tool will be audited after six months, to
evaluate appropriateness, the benefits to patients’
rehabilitation and the perceptions of patients and
staff.
• Decide on a strategy for using the
results to change practice.
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2002
Measuring cancer rehabilitation outcomes:
using a multidisciplinary tool (continued)
Literature and other information sources
•
•
•
•
Doyle, D., Hanks, GWC. & MacDonald, N. (1983) Oxford Textbook of Palliative Medicine OUP, Oxford.
Enderby, P. (1998) Therapy Outcomes Measures Singular Publishing Group, London
Law, M., Baptiste, S., Carswell, A. et al (1994) Canadian Occupational Performance Measure (2nd Ed.) Canadian
Association of Occupational Therapists, Toronto.
Law, M., Baptiste, S., Carswell, A. et al (1990) Canadian Occupational Performance Measure: An outcome
measure for occupational therapy. Canadian Journal of Occupational Therapy. 57(3): 82-87.
Footnotes
1 Dan
Lowrie is a Senior Occupational Therapist working in the Markus Centre, The Royal Marsden NHS Trust,
London, UK.
Caroline Hoffman is the Nurse Consultant in Cancer Rehabilitation at The Royal Marsden NHS Trust, London,
UK.
Beverley van der Molen is the Patient Information Services Manager at The Royal Marsden NHS Trust, London,
UK.
Correspondence address: [email protected]
Further information about the Canadian Occupational Performance Measure (COPM) can be found at
www.caot.ca/copm/
2
slides available at: www.blackwellpublishing.com/journals/ecc