Problem: Increasing number of patients living with or recovering from cancer; lack of rehabilitative services for people affected by cancer.
Solution highlights: Reade – an organization specializing in rehabilitative care – introduced a package of services specifically tailored to the needs of cancer patients and cancer survivors; support from Reade’s management in developing protocols and negotiating with national-level actors was essential for the implementation of the initiative; providers within Reade were brought together to apply their skills to treating the complex needs of cancer patients and survivors. Providers work in multidisciplinary teams to enable the delivery of more comprehensive care; initiative leaders built strong working relationships with external providers. This helped bring other providers on board with Reade’s new care concept and generate referrals; a national occupational therapy network supported knowledge sharing and enabled the wider dissemination of lessons learned by the initiative.
Description of practice
Between 2000 and 2010, cancer incidence in the Netherlands rose by more than 40%, reaching 684 per 100 000 population. Positively, cancer survival rates also increased during this time; the standardized death rate for all cancers fell from 198 per 100 000 population in 2000 to 180 per 100 000 population in 2010. Combined, these trends indicated an increase in the number of patients requiring post-cancer care, specifically rehabilitative services after undergoing invasive procedures. This growing need for services targeted to patients affected by cancer was recognized by occupational therapists working for Reade – an organization of specialist rehabilitation centres within Amsterdam which employs a variety of health providers – including physicians, nurses, social workers, psychologists and occupational therapists – to provide inpatient and outpatient rehabilitation services in home, community and hospital settings.
Reade decided to extend their comprehensive package of rehabilitation services, including occupational therapy, to patients in treatment for and recovery from cancer. As providing occupational therapy to cancer patients was a relatively new idea, leaders designed the initiative based on their experience treating patients with other conditions which had similar clinical presentations to those seen with specific cancers, for example, using their experience of treating patients with brain injuries to design care pathways for patients with brain tumours. Leaders also examined the current care guidelines for cancer to identify opportunities within the care pathway where occupational therapy could be added to help improve patient outcomes. New contracts were negotiated with health insurance companies to ensure that Reade’s new services for cancer patients were fully reimbursable, but no additional resources were necessary as the initiative aligned within the existing infrastructure and systems already in place at Reade. Now, multidisciplinary provider teams at Reade deliver personalized care plans to patients affected by cancer to help them to maintain or regain their functioning and independence. Patients are referred by local general practitioners or oncologists; leaders of the initiative sensitized these external providers with education about how occupational therapy benefits patients, helping to encourage referrals and increase providers’ understanding of the role occupational therapy plays in supporting cancer patients and survivors. At present, the initiative continues to be actively implemented and improved based on ongoing clinical experiences. Recently, one of the initiative’s leaders was chosen by the Dutch Association of Occupational Therapists to chair a newly-established Union Branch for Occupational Therapy and Oncology. The Union Branch is currently working to build knowledge of and develop evidence-based guidelines and recommendations on providing occupational therapy to patients affected by cancer and the experience of the Reade initiative is being shared nationally through this network.
Implementation of practice
What stage is the practice currently in?
Who was/is responsible for the implementation of the practice?
At Reade, an occupational therapist – who had recently completed a master’s degree in clinical epidemiology – recognized the growing occupational therapy needs of people affected by cancer and turned to Reade’s management for support in addressing these observed challenges. With managerial support, a multidisciplinary group of providers working within Reade led the design of the initiative.
Official outcomes have not yet been determined. Once the initiative is more established, leaders hope to conduct formal research and build their knowledge base in this emerging area.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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- Jantina Kroese