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The Trinity Holistic Centre:Delivering Complementary Therapies in
an Integrated NHS Setting
Heather McLean & Kathryn Almond
NHS Outcomes framework (DoH, 2011/12)
Drivers • Consumer use and demand
• National Institute for Clinical Excellence (2004)
• Survivorship initiative (2010)
• Peer review - Cancer Reform Strategy (2010)
• UK Clinical Research Collaboration
• Department of Health (2010)
• NCRI Complementary Therapies Clinical Studies Development Group
• Target time to treatment
South Tees position
• South Tees Trust incidence rate (442.5 per 100,000) English average
(398.1 per 100,000)
• Late presentation and mortality rates
• Bed occupation of cancer patients
• Economic challenge
• Regional Cancer Centre 4,000 patients per year at JCUH
• Complementary therapies not directly NHS funded
• 2500 patients seen per year. quadrupled our contact in last 2 ½ years
over 50% patients
Definition: • British Medical Association (1993):
• Complementary therapies are those that ‘work alongside or in conjunction with orthodox medical treatment’
• Alternative therapies are those that ‘are given in place of orthodox medical treatment’
• The National Institute of Health and Clinical Excellence (2009) :“Complementary therapies are used alongside orthodox treatments with the aim of providing psychological and emotional support through the relief of symptoms.”
• Manual of Cancer Services (2010) :“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)”.
What holistic support is!
• About the persons’ non clinical needs (& their family too)
• Supportive care
• Integrated with clinical colleagues
• Risk averse
• Aiming to support families every step of the way
Service model
Supporting patients, carers and staff
Complementary therapy
Emotional
&
psychological support
Wellbeing
(physical activity & diet)
Safe space & wellbeing support hub
Access to the purpose built centre and gardens and trained staff volunteers
Opportunities to adapt, develop and deliver new and person centred initiatives
Every step of the wayDiagnosis & Treatment-Counselling and complementary therapies offered within Holistic Centre, on chemotherapy day units (2 locations) & all wards.--No max for complementary therapy sessions. Free for all patients and their family-Look Good Feel Better sessions-Hair loss clinic-Headstrong service-Group relaxation sessions-Targeted support for head & neck radiotherapy patients-Hair & beauty service for inpatients-Referral into all local Macmillan information centres-Guided mindfulness (June 2015)-Movie sessions (June 2015)-Sensory room experience sessions (June 2015)
End of life-Counselling and complementary therapies offered within Holistic Centre and all wards -Free for patients and their family-Available after bereavement for family
Survivorship• Auricular acupuncture for Hot flushes –
all patients• Targeted evaluation tools for hot
flushes and peripheral neuropathy• Breast, bowel and lymphoma cancer
support group• Monthly drop in afternoon teas – open
to all• Host multi disciplinary health and
wellbeing clinics: generic & cancer specific
• Physical activity support: Tai chi, healthwalks, running group, gardening
• Healthy eating support: Eat well feel good programme
• My Viewpoint programme• Returning to your new normal
programme• Choir• Guided mindfulness (June 2015)
Prevention-Host & deliver health promotion activities for awareness campaigns-Staff team trained (RSPH 2)to talk about cancer awareness & prevention – family influence. ‘Make every contact count’.-Working with genetics team for future model of support for high risk patients.
Centre environment: refurbished rooms & garden. Trained staff & volunteers for ‘listening ear’
Children & young people-Counselling service for cyp affected by a cancer diagnosis-Family days for support and signposting-Young adult movie and music sessions (July 2015)
Evaluation: Specific tools for pain, peripheral neuropathy & hot flushes. Wellbeing star in
development.
Pathway: 1 referral, triage and regular review ‘open door’
Wig fitting service to help you keep the day job …
A ‘safe space’ amidst the clinical environment
Haven for the whole family
Help in celebrating special times
Patient
• Patient preferences & involvement
• Bio psychosocial model
• Demand led
• Demographics
• Complex
• Identify & prioritise
• Opportunities
Why patients access & why staff refer …
• Relaxation
• To be able to offer ‘more’ to patients
• Time … we have it!
• Not to be poked and prodded.
• To feel ‘normal’
• 62% of patients
• All MDT areas refer in
Demand & use 2015
Patient numbers seen based on actual Jan-Oct & forecast Nov- Dec 2015
• Average 524 people accessing the centre per week (excluding inpatient support)• Use by 4 active support group (bowel cancer, lymphoma, breast & crohns/ colitis)• Host Look Good Feel Better (132), Hair loss clinic (493) , headstrong (144), provide headscarves all conditions (32) • From 2016 hosting teenager cancer trust youth support worker and targeted services • Sensory space developed from input by LD acute liaison nurse• Well used (avg 80 ppm) by therapeutic care team as distracting and calm environment for distressed patients
Safe space & support hub
Total patients seen 2475 Host clinical psychologist (cancer services) 5 ½ days pw Trinity green fingers 304Carers seen 294 Host Relate Eat well feel good Inpatients seen 587 Adult counselling Service 53 Take a strollWard locations 23 Children & Young People & families (pilot july –Oct) Tai chi Services provided: Enrich Running clubGroup relaxation Mindfulness My viewpointHair & Beauty Big noiseClinical hypnotherapy CraftsMassage South Tees singers Acupuncture Look Good Feel BetterAuricular Acupuncture Wig service reiki Headstrong
The plan
Training & Good Governance • Therapists, MDT & Medical Students
• Support clinical care pathway
• Knowledge, Expertise & Support
• Empowered & Accountable
• Policies & Protocols
• Competency based frameworks
Evidence
• Clinical & Cost
• Evidence based
• Demand led
• Therapists, MDT, Partners
• Consistency & Quality
• Highlight good practice
Measuring Impact – the challenge!• Pain scores (Acupuncture)• Hot flush daily interference scale (auricular acupuncture)• Peripheral neuropathy• CORE scores (Counselling)• Warwick-Edinburgh (all) – Jan 2016 onwards• Qualitative: Focus groups & patient experience questionnaires
Examples:
58/39% CORE score reduction (1:1 counselling/ Group activity)
100% of those accessing the centre and gardens would recommend to families and friends.
98.5% of those accessing any of our services (across locations) would recommend to families and friends.
Testimonials:“I didn’t know where to start to explain to our young daughter about my cancer and the treatment that I was going to have. Jo (CYP counsellor) worked with each of us as individuals and as a whole family at our own pace, I feel more confident in both tackling the treatment but also knowing how to ensure my daughter understands what is happening and that she can ask us questions. Jo helped us keep talking.” Patient Sept 2015
A little recognition
• Patient Safety Awards – finalist in cancer care 2015
• Macmillan Quality Environment Mark – 2015
• South Tees STAR awards
Hear from those we work with …
http://southtees.nhs.uk/services/trinity-holistic-centre/users/
Questions & Contact
Heather McLean Business [email protected]
Kathryn AlmondHead of Complementary [email protected]
01642 854839
Reference Material
DiagnosisStage Symptom
Emotion
Complementary
Therapy
Evidence base Comments
Finding out that something is wrong
Diagnosis
Fear/ Anxiety
Worry/ Grief
Acupuncture
Aromatherapy
Reflexology
Self Help techniques
Taylor et al (2004) Kim.SG et al (2007)
Costello et al (2004) Molastossis (2005)
Must not overload patient with information
Access and signposting to appropriate information sources
Surgery Stage Symptom
Emotion
Complementary
Therapy
Evidence base Comments
Going through
treatment
Surgery
Fear/ Anxiety
Worry/ Grief
Acupuncture
Auricular Acupuncture
Auricular seeds
Aromatherapy
Reflexology
Self Help techniques
Homeopathy
Kim KB (2007)
Walling (2006)
Shu Ming Wang (2001)
Knarndal (1998)
Haker (2000)
Karst (2007)
Mora (2007)
Billhult & Dahlbergh(2001)
Morrell et al (1997)
Corner (2006)
There is no literature on the efficacy of homeopathy pre op but some patients have found it beneficial
Aromatherapy not recommended on same day as anaesthetic
Chemotherapy Stage Symptom
Emotion Complementary Therapy Evidence base Comments
Going through treatment Situational anxietyFlight or Fight
FAST TRACK ACCESS TO COMPLEMENATRY THERAPY TEAM
Harris & Almond Service evaluation (2007)Corner (2006)
Chemotherapy Anticipatory Nausea/ Nausea
Fatigue
Acupuncture/AuricularAcupuncture/Auricular ear seedTeach specific use of Acupressure points
Suggest Sea BandsReflexology
AromatherapyReflexology
Walling (2006) Dundee (1990)Shin (2004) Roscoe (2002)
Grealish (2002)
Wilkie (200) Sloman (1995)Grealish (2002)
Poor peripheral circulation Peripheral neuropathy
Hair loss
Constipation, loss of appetite
Acupuncture Reflexology
Self help with homeopathy/ Bach flowers and breathing/
Visualisation/ relaxation emotional/ moral support
Grealish (2002)Harris & Almond (2007) service evaluationHammar (1999)
Radiotherapy Stage Symptom
Emotion Complementary Therapy Evidence
BaseComments
Radiotherapy
Considerfamily/supporters
Fatigue
Site specific symptoms discussed in service relevant pathway
EgXerostimaConstipationPain
Acupuncture/Auricular Acupuncture/ Auricular ear seed
Aromatherapy/ReflexologySelf help suggest and breathing/ visualisation strategies
Visualisation/ relaxation emotional/ moral support
Acupuncture
Walling (2006)
Wells(2001) Sloman (1995)Grealish (2002)Gilliard (1995)Wilkie (2002)
Payne (2002) Filshie (2001)
Patients Choice and tolerance
Avoid Site entry and exit
Living with consequences Stage
SymptomEmotion
Complementary Therapy Evidence Base Comments
Living with the consequences of cancer
Anxiety Stress Depression
Pain
Neuropathy
Hot Flushes Night Sweats
Relaxation
Acupuncture
Reflexology Massage
Reiki
Reflexology
Aromatherapy
Auricular Acupuncture
Sloman (1995)Payne (2002)Walling (2006)
Harris & Almond service evaluation (2007)Knarndal (1998)Haker (2000)
Hodgson (2000) Pan (2002) Wilkie (2000)
Oleson (2003)
Stephenson (2003)
Grealish (2002)
Soden (2004) Corner(2006) Hammar (1999)
De Valois (2007)Harding Harris & Chadwick (2008) in press
Survivorship Stage
SymptomEmotion
Complementary Therapy Evidence Base
Survivorship
Living with consequences of treatment
Anxiety / stress worry Pain Chemotherapy induced peripheral Neuropathy Hot Flushes Fatigue Altered Body Image
Acupuncture Aromatherapy Reflexology ReikiAuricular Acupuncture Touch therapies
Ernst et all, 1998. Ferrell-Tory & Glick, 1992.
Dossey et al, 1995. Corner et al, 1995. Van de Riet, 2000. Manasse, 2001. Hadfield, 2001. Grealish, 2002. Gambles, Crooke & Wilkinson, 2002) Fellows, Gambles, Lockheart, Wood, Wilkinson, 2003. Gillard,
1995. Stephenson, 1996. Botting, 1997.hills & Taylor, 2002. Wardell & Engerretson, 2001Filshie, 1990.
Alimi et al, 2000. Johnstone et al, 2002. Leng, 1999 ) Keller & Bzdek, 1986. Gorden et al, 1998. Neate & Neate, 2001.
Benor, 2001. Hills & Taylor, 2002Miligan, 2002. Stephenson, 2000. Hodgkinson, 2001 Ferrell-Tory & Glick, 1992. Smith, 1994. Wilkinson, 1995. Field,
1998. Byas, 1999. Van de Riet, 2000. Wilkie, 2000. Grealish, 2002South tees Gynaecology – 3x arms single blind placebo controlled
trail (Teesside university, Harris & Almond) Audit dataHarding, Harris, 2008. service evaluation south tees, Harris &
Almond, 2004-2012. Wyon et al, 1994. Cummins, 2000. Hammar, 1999 Oleson & Flocco, 1993. Gould & Macpherson, 2001 Fellows, Barnes & Wilkinson, 2003 Bredin, 1999. Van der Riet, 1999
Palliative Care & End of Life
Stage
SymptomEmotion
Complementary Therapy
Evidence Base Comments
Dying End of life care
Anxiety
Pain
Breathlessness Anxiety
Pain
Relaxation
Reiki
Reflexology
Aromatherapy
Reflexology
Acupuncture
Sloman (1995)Payne (2002)
Oleson (2003)
Milligan (2002) Stephenson (2003) Hodgkinson (2001)
Wilkie (2000)Kyle (2006)
Soden (2004)Pan (2000) Hodgson (2000)
Dillon (1999) Walling (2006) Filshie (2001)Knarndal (1998)Haker (2000) Oleson (2002)
Commissioning Intentions Health and Wellbeing strategies• http://www.redcar-cleveland.gov.uk/partnership-
rcbc.nsf/198533b51589d3778025786b003d08b5/$File/HealthWellbeingStrategy_web.pdf• http://www.middlesbrough.gov.uk/CHttpHandler.ashx?id=6380&p=0• http://www.nypartnerships.org.uk/CHttpHandler.ashx?id=21125&p=0• http://www.stockton.gov.uk/documents/839159/jointhealthandwellb.pdf• http://www.hartlepoolpartnership.co.uk/partnership/site/scripts/documents.php?categoryID=3• http://www.darlington.gov.uk/PublicMinutes/Cabinet/October%209%202012/Item%207a%20-
%20Appendix%201.pdf
CCG Commissioning intentions (most recent publication at Feb 14)
• http://www.southteesccg.nhs.uk/includes/documents/Commissioning%20Intentions%20South%20Tees%20CCG.pdf
• https://www3.northyorks.gov.uk/n3cabinet_healthandwb/reports_/20130925_/05ahwbstrategyc/05ahwbstrategyc.pdf
• http://www.hartlepoolandstocktonccg.nhs.uk/wp-content/uploads/2014/01/HaST-CCG-Public-GB-pack-28-01-14-REVISED.pdf (p39-45)
• http://www.darlingtonccg.nhs.uk/publications/