Case Study - Supporting a man with learning difficulties to receive radiotherapy

Abstract

Keywords: Prostate cancer, radiotherapy, learning disabilities, mental capacity, advocate, support, reasonable adjustments Introduction: ‘Joe’, a man in his sixties with a learning disability was diagnosed with Stage 3a Prostate cancer. The only suitable treatment option was radiotherapy. Following a review by an independent mental capacity advocate it was established that Joe had no understanding of his medical condition or capacity to make decisions regarding treatment. Concerns were raised regarding whether Joe would be able to co-operate sufficiently to safely deliver the radiotherapy. It was assumed Joe would not be able to comply satisfactorily to receive radiotherapy. Method and Materials: Evaluation and preparation for the radiotherapy team was enabled to deliver personalised care. Radiographers ascertained Joe’s likes/dislikes, stress triggers, and capacity to understand instructions to ensure his safety, with communication of his needs to the radiotherapy team and wider MDT. A trial run was undertaken at the first clinic appointment to evaluate viability of treatment delivery. Results: Joe successfully completed his course of 20 treatments daily over four weeks. Conclusion and Discussion: Communication across the MDT meant the team were prepared to adapt care for Joe and his needs before his first appointment. Use of ‘my care passport’ [1] enabled the radiographers to get to know Joe and understand his requirements before they met him. A named radiographer guided Joe through his appointments. Treatment was delivered at a Satellite Centre, close to where Joe lived. This facilitated a personal experience in a less intimidating and calmer environment, and coupled with continuity of staff from Joe’s care home ensured a smooth and consistent experience. The familiarity of the care home staff with the radiotherapy procedure helped Joe maintain a routine with appointments at the same time each day Consideration of Joe’s dignity and toileting independence meant removing the need for Joe to use daily micro-enemas and simplifying the normal bladder filling routine. Small, simple adjustments to the standard care pathway enabled Joe to successfully receive curative treatment. Numerical References [1] Surrey Health Action (2013). This is me: My Care Passport. Retrieved from: http://www.surreyhealthaction.org/assets/files/My%20care%20passport%20-%20enabled%20adobe%20reader%202.pdf