In 2004, the Australian Health Ministers endorsed the National standard defining the scope of clinical practice which was developed by the Australian Council for Safety & Quality in Health Care – and as a nation which strives to be world-class and no longer a mere ‘Third World’ country, our South African breast health policy we are lobbying for must include the following requirements within the scope of practice in breast cancer treatment:
• Cancer is COMPLEX — and this complexity must be fully incorporated as a medical and social reality within the scope of practice by each and every member of the multidisciplinary team.
• The range of clinicians with different professional expertise (medicine, nursing, psycho-social support, allied health etc.) involved in cancer care is also complex — and proactive, together-teamwork is critical to the success of their collective care.
• The serious complications and side-effects of some treatment, as well as their impact on their hearts and lives of the people receiving the treatment.
• The advances in technology and research that are changing best practice care at a rapid pace and must vigilantly be on the care team’s radar.
• For patients to have access to safe and high quality services, it is important that professionals ensure:
- They have the necessary skills to carry out those aspects of cancer care they undertake and there is institutional capacity and resources to support such care (for example, equipment, staffing and skill mix.)
- They have clear links and open lines of communication with a range of specialties or multidisciplinary care team required for cancer care, for the purpose of clinical advice, referral and continuing education & awareness.
- They follow evidence-based practice or treatment recommendations of a multidisciplinary care team.
- They undertake regular review of their performance and contribute to regular audit of their cancer care.
- They are actively involved in continuing professional development.
- Their patients can make an informed choice about their care, including the options of referral to other professionals or other care centres.
And yet again we see a clear and urgent need for cancer care to be patient-centred! Do you feel the list above includes the aspects necessary for a holistic and effective scope of practice? Let us know in the Comments block below or on our Facebook community page!
Why should the patient be at the centre?
It seems logical to organise healthcare around the needs of the patient, After all, it is the patient who needs the care, and it is the patient who is – or who should be – at the centre of any decisions that are taken about treatment.
For many years, however, this has not been the case. Doctors have often been seen as intellectually superior to their patients and as a result very little explanation about treatment has been seen to be necessary. Patients often believe that the health care workers know best, so they are reluctant to ask questions about different treatment options or to get a second opinion.
This perception has gradually been changing, and since the turn of the century, the concept of a patient centred approach has begun to gain momentum. What was once a radical concept has been pushed into the mainstream, and patient-centeredness is now being seen as an essential foundation for quality care and patient safety in many countries around the world.
That is the theory, at least. In South Africa there are many barriers to a true patient centred approach. The shortage of specialist staff means that healthcare workers and doctors may not have time to find out their patients’ needs. There may not even be time to find out whether the patient understands their diagnosis and the recommended course of treatment. Cultural issues and language can also be barriers to true patient centeredness.
We talked about this in our blog of September 1 where we said:
C = Current Care: Right now, we can only say the standard of current care is, well… careless. And, to quote wise old Dr Seuss: “Unless someone like you cares a whole awful lot, Nothing is going to get better. It’s not.” Let’s get caring: actively!
So, what would we like to see as an ideal patient-centered model in South Africa for people with breast cancer?
- We want providers to partner with patients and their families to find out what the patient needs. It is their body and their life so empathy and humanity must be at the fore. Each person with breast cancer’s preferences for care are important.
- We want health care staff to be supported so that they can focus on their patients. Providers need to feel that they are cared for so that they have the strength to give excellent care to others.
- We know that the patients are not always able to accurately assess the quality of their care, but we want an environment where their questions are heard, and the reasons for a particular treatment protocol are clearly communicated. Patient centred care does not replace excellent medicine, it complements it.
- Patients who are not at the centre of their care often feel dehumanised and fearful. We want clear communication between the healthcare professionals and the patients. Provision must be made in specialist breast clinics for different language needs.