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What matters to a person is key to their care

A Prehabilitation Project Manager considers how Macmillan is incorporating personalised care to form a wealthier conversation with people post cancer diagnosis, empowering them to become involved in their care plan and enabling more tailored and individual support.

Occupational therapists (OTs) have always taken a client-centred approach, which is consistent with the principles and practice of personalisation.

What matters to a patient is core for an OT and our work centres around the person, their occupations and their environment, helping people fulfil their potential to the best of their ability.

Getting to know people is really important; it makes the job so much more interesting and makes you feel you’re really having an impact on their life.

As an occupational therapist in my new role as Macmillan Prehabilitation Project Manager I have been able to use this approach and introduce practical methods of how colleagues can apply this approach too. My new role is to determine the feasibility of providing prehabilitation to cancer patients to improve their health and wellbeing to better prepare them for their cancer journey, whether that be curative or palliative.

What matters to a person is key and more often than not services are developed without this in mind. The NHS Long Term Plan drives personalised care to ensure we get a better understanding of what matters to patients and thus develop services with them at the centre.

It doesn’t always feel easy getting an understanding of how to place patients at the centre of their care and asking them hasn’t always ensured this happens. With the introduction of the six personalised care questions and the Patient Activation Measure (PAM) this now feels achievable.

Supported by colleagues at NHS England I have added the PAM and the six personalised care questions to the prehab assessment process. This has proven very practical and allows me to identify levels of activation to help provide individualised support plans which help people to engage with prehabilitation interventions.

For example, we now have pathways for patients to access a variety of physical activity interventions prior to their cancer treatment and to ensure I know which intervention and how much support they need, I use their activation level to help gauge this.

The interventions are also tailored around what matters to a patient and meaningful occupations. It has also been instrumental in understanding why, at times patients may struggle to engage in interventions and services and the support offered to them. With the PAM, it helps me identify if knowledge, skill or confidence is affected and enables me and my colleagues to tailor interventions and levels of support to meet their needs and activation levels at that point in time.

I will also use the PAM when evaluating the Prehab project using it as an outcome measure to determine if patients have improved levels of activation and the potential cause of this.

It was felt these tools would benefit all patients diagnosed with cancer, and not just those involved in the prehab project. In response to patient feedback about volume and timing of information I have been involved in establishing an ‘on diagnosis’ health and well-being event called ‘First Steps’, which, provides information, education and support and is accessible to all newly diagnosed cancer patients.

At the very start and within these sessions, we introduce the personalised care questions; to get patients thinking about themselves, and to acknowledge they play a huge role in decisions about their treatment.  This enables us to better inform and support them when they do make these decisions; which also provides the clinician with insight into what matters to the individual. I also intend to introduce the PAM at these sessions in the future.

Not all patients can access the sessions due to the timeframe between diagnosis and treatment, which means they can miss out on essential information. However, as more people now have access to digital technology I’m working together with a company, connected by NHS England, to develop a digital platform where patients and their families / carers will be able to access pertinent information and education, at the touch of a button, when they require it. The use of digital technology will enable us to support our patients more effectively, give our patients tools for how to support themselves better and make them feel more inclusive.

I feel very passionate about personalised care as a way of health professionals establishing what is important to patients rather than important for patients.

It forms the basis of a wealthier conversation with patients to really establish what matters to them and how interventions can be tailored to meet their needs.

As an occupational therapist it has felt empowering to be able to support and incorporate this into my new role. Being able to give patients a tool to use to reflect and think about what is important to them, will help them have confidence in making decisions that empower and enable them to continue and achieve what is important.

It also allows health professionals to see and understand a patient for who they are rather than what they are being medically treated for.

Nikky Hill

Nikky Hill qualified as an Occupational Therapist in 1998 after completing her degree at Brunel University.

She started her career in Surrey and London and has always worked in the acute hospital setting.

For the past 14 years she has worked at Calderdale & Huddersfield NHS Foundation Trust.

In April 2019, she moved into her new role as Macmillan Prehabilitation Project Manager to look at the feasibility of developing and delivering a model of prehabilitation with the aim of improving patient’s health and wellbeing before, during and after primary cancer treatment.

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