| MUHC
Lymphedema pilot project
Proposal for a multidisciplinary
Lymphedema services at the MUHC: A pilot project
Sponsors
of the MUHC Lymphedema Pilot Project
February 2008
Dr.
Anna Towers
MUHC Lymphedema Clinic
EXECUTIVE SUMMMARY
Our
vision is for adequate and well-timed lymphedema services
to be available in Quebec and for these services and
rehabilitation aids to be covered by Medicare. This
requires the awareness and the support that will lead
to the creation of multidisciplinary clinics and services
that provide prevention and treatment services as outlined
in the International Consensus Document recently published
on Best Practices (1). This present project focuses
on developing appropriate services for cancer care at
the MUHC, however its outcomes are transferable to other
cancer centres.
In
addition to prevention and clinical services, there
is significant training of health professionals that
needs to occur, in particular for:
| 1. |
Physicians
who will assess lymphedema cases and offer medical
follow-up, and |
| 2. |
Therapists
and nurses who will offer prevention information
to all cancer patients at risk, and who will provide
treatment services to those in the palliative phase
and to those who require home care. |
This
pilot project outlines the first phase of a five-year
project that aims to introduce a multidisciplinary service
at the MUHC for prevention and treatment services, to
evaluate this service, and to advocate for buy-in and
involvement at the levels of the MUHC, the Regional
Agency and the Ministry of Health. The eventual outcome
would be appropriate and well-timed information and
services to the cancer population, and blueprints that
would enable the creation of services for the primary
lymphedema population.
(1)Lymphoedema
Framework: Best Practice for the Management of Lymphoedema.
International Consensus. London MEP Ltd, 2006. ISBN
0-9547669-4-6. Dr. Towers was a member of the international
advisory board that drafted these practice guidelines.
STATEMENT OF NEEDS
The
MUHC Lymphedema clinic has been in operation since 1994.
Since 1999 its home has been in the Palliative Care
Day Hospital of the MUHC, where there is support for
clerical services and room to house the 700 charts of
the population followed there. Dr. Towers has training
in Lymphedema Therapy (Casley Smith) and has been active
in education and research on cancer-related lymphedema
since 1995. Despite continuing advocacy work, this clinic
is not supported by the multidisciplinary team of adequately
trained professionals that it requires to provide even
basic clinical services. There are also important needs
at the provincial and at the Canadian level for model
clinics that provide integrated medical and support
services as well as an active educational program for
prevention.
There
is an urgent need for training of hospital personnel.
Lymphedema patients in hospitals are being treated by
health professionals who have no awareness of this condition.
This is particularly true for patients in the palliative
phase of their illness who also have lymphedema, and
for those with primary lymphedema. This is also the
case for patients in these categories who are at home
and under the care of CLSC personnel. Specifically,
there are no training programs for nurses that will
enable them to take charge of these populations.
A
model MUHC clinic and training program, in collaboration
with the MUHC Cancer Care Mission and the Lymphedema
Association of Quebec, may help address some of these
issues.
PROJECT OBJECTIVES
| 1. |
Involve the MUHC Cancer Care Mission and the Lymphedema
Association of Quebec (LAQ) in partnership with
the MUHC Lymphedema Clinic to enhance services to
lymphedema patients. |
| 2. |
Introduce
multidisciplinary lymphedema prevention and treatment
services at the MUHC and ensure evaluation of this
service. |
| 3. |
Increase
awareness at the level of the Regional Agency and
the Ministry of Health about the needs of lymphedema
patients. |
| 4. |
Disseminate
information about this project to help advocate
for appropriate and well-timed information and services
to the cancer population throughout Quebec, Canada
and beyond. |
PROJECT PLAN
Phase
I- 18 months
| 1. |
| Establish
an interdisciplinary team at the MUHC Lymphedema
clinic through the addition of a Lymphedema
Therapist one day per week. This therapist
will: |
| a. |
Give
preventive advice and help monitor treatment
results on an average of 10 patients per clinic. |
| b. |
Coordinate
lymphedema volunteer services for this clinic
for the purposes of ensuring that educational
materials and support are available. |
| c. |
Help
develop and give sessions on prevention to
patients in the breast cancer clinics.
|
|
| 2. |
Evaluate
this project though the development and administration
of qualitative and quantitative questionnaires that
measure extent and impact of the service and satisfaction
with the service. These questionnaires will be administered
to patients, their family members, and health professionals
in various departments of the hospital, including
Oncology Clinics. |
EXPECTED OUTCOMES AND BENEFITS
PHASE
I
| 1. |
Increased
awareness on the part of hospitals providing cancer
care of the importance of adequate lymphedema services,
and the provision of support for such services,
as measured by hospital financial support for a
multidisciplinary service. |
| 2. |
Increased access to prevention, as measured by numbers
of cancer patients attending individual or group
information sessions. |
| 3. |
Increased access to care, as measured by increasing
numbers of lymphedema patients receiving services
at MUHC. |
| 4. |
Increasing quality of care as measured by MUHC quality
assurance instruments. |
|
