ABSTRACT
In this chapter, via engagement with existential-phenomenological ideas and concepts, Dr Cleo Hanaway-Oakley reflects upon being pregnant, and giving birth, during the Covid-19 pandemic. She looks to Merleau-Ponty's ideas on intersubjectivity, and de Beauvoir's thoughts on uncertainty and ambiguity, to describe her lived experience. This chapter presents a first-person viewpoint but is interwoven with allusions to several of the literary texts that Hanaway-Oakley engages with in her job as an English lecturer: works by Beckett, Woolf and Plath. © 2023 selection and editorial matter, Monica Hanaway;individual chapters, the contributors.
ABSTRACT
Background: Healthcare professional (HCPs) consultations/ education provision to oral SACT patients can vary. This can impact on adherence leaving patients/ carers often feeling overwhelmed when managing oral SACT.1 Driven by significant growth in oral SACT activity for solid tumours since 20163 and capacity in outpatient clinics, a Joint Working Project was set up between Guy's and St Thomas' NHS Foundation Trust (GSTT) and Novartis. The project was led by a full time senior oncology pharmacist and nurse over 18 months (September 2019-June 2021). Aims: To pilot a dedicated oral SACT clinic for new patients, to provide support patients adherence and safety. Objectives • To undertake (pre- & post-pilot) patient surveys/focus groups and/or patient interviews to assess: • Patients' satisfaction. • Acute Oncology Services (AOS) awareness/support. • Adherence and confidence in taking oral SACT. • Confidence in managing/recognising side effects. • To develop a consistent multi-professional clinic protocol and training package Method: A project plan with defined milestones and metrics for the project were agreed. The initial focus was on breast, melanoma and renal cell carcinoma (RCC) as these represented higher patient numbers. A multi-disciplinary steering group with patient membership was set up with terms of reference and reporting arrangements to the SACT governance committees. A baseline patients' satisfaction and adherence survey, developed by the Steering Group, was distributed in January 2020. A patient focus group was conducted in June 2020. The data from both was used to define the oral SACT clinic pathway, which included: • A telephone pre-treatment consultations (PTCs) within 24-48hours of initiating treatment. • Mid-cycle treatment reviews for first 2 cycles (if applicable) • Telephone reviews for 2 cycles (or longer if needed) Adherence was assessed by direct questioning during telephone calls and recorded electronically on assessment forms. A clinic protocol and training package was developed to operationally support the oral SACT clinic. The protocol outlined scope, responsibilities and clinic pathway, for all tumour types. The pilot was conducted September 2020 - May 2021, followed by a post-pilot patient surveys and focus groups. Results: During the pilot, 63 patients were seen in the oral SACT clinic, equating to a total of 209 appointments (61 PTCs and 148 follow up reviews). 100 patients completed the baseline survey and 15 completed the postpilot survey. The clinic and post-survey numbers were lower than planned due to the Covid-19 pandemic. Figure 1 summarises the results. Discussion and conclusion: Implementation of the oral SACT clinic has demonstrated positive benefits to patients. It has provided a tailored, consistent model of patient care providing additional support where needed. Overall, patients' confidence in recognition and management of side effects and taking medication as prescribed has improved. Furthermore, patients felt more supported than at baseline. For adherence, survey results didn't demonstrate improvement in comparison to baseline. However, data from clinic interviews showed improvement. The survey respondents were limited due to covid-19 and consequent late circulation. Next steps: More work is planned with more respondents and focus groups to fully evaluate service impact. Alongside the training package developed and economic evaluation, this will inform reconfiguration of existing oral SACT clinic services at GSTT.
ABSTRACT
Introduction: In March 2020 the UK reported its first coronavirus related death. The weeks following saw rapid and frequent changes to the delivery of healthcare;face-to-face appointments were limited, elective procedures cancelled, and concerns about the availability of PPE began to surface. The potential impact of changing personal and professional circumstances on junior doctor well-being has been alluded to in statements from all UK Royal Colleges. We present results from the first part of a planned longitudinal prospective cohort study tracking trainee experiences during the pandemic. Methods: In May 2020, two months after than start of the pandemic, all UK paediatric cardiology trainees were invited to participate in an electronic survey. Questions addressed the work environment, training experiences and personal circumstances. Individual interviews were also conducted with 4 trainees. Results: 30/45 (67%) paediatric cardiology trainees from 7/10 U.K training regions (Liverpool, Cardiff and Belfast were not represented) completed the survey. Respondents were mostly aged 30-40 (77%), 48% female and 6 (20%) from ethnic minority backgrounds. The majority were working full time 27 (90%) and in higher/sub-speciality training 23 (77%). Most felt safe at work (89%) with access to appropriate PPE. Perceptions of workload intensity varied by region. 79% received formal teaching at 50%-100% of pre-pandemic levels. However, 93% reported reduced opportunities for sub-speciality training;61% characterised this as very significant. Well-being was almost unanimously negatively affected. Conclusions: Even during the first wave of the pandemic, the majority of U.K paediatric cardiology trainees felt safe at work. Workload intensity varied, reflecting changes in the configuration of cardiac services;in 1 London Centre and the East-Midlands, surgical/ interventional activity was paused. Higher/sub-speciality training was most impacted;where elective activity provides most experience. Well-being was virtually unanimously negatively impacted. COVID-19 has been the defining global healthcare crisis of the modern era. There has been a measurable impact on paediatric cardiology trainees;fewer cardiac catheterisations', restricted fetal screening, and a more emergency-driven case mix. Consideration of adjustment to training duration may be required pre-certification and our follow-up survey will aim to evaluate the longer-term implications of the pandemic on training.