Improving Vulval Surgery Patient Information in the Gynaecology Department at UHW. Catherine Morgan (3rd Year Medical Student) Dr.

Transcription

1 Improving Vulval Surgery Patient Information in the Gynaecology Department at UHW Catherine Morgan (3rd Year Medical Student) Dr. Amanda Tristram

2 I felt bewildered and overwhelmed. VIN Patient, Llandough Hospital, June 2012

3 Vulval Intraepithelial Neoplasia

4 the search for information is generally perceived as a negative experience [that leads to a] sense of isolation. H. Jeffries and C. Clifford (2009)

5 Improving Vulval Surgery Patient Information in the Gynaecology Department at UHW Catherine Morgan and Dr. Amanda Tristram Part 1: To evaluate the current level of information and find out what kind of information patients require. Part 2: Using the evaluation, redesign a Patient Information Leaflet specifically for these women and implement this leaflet and re-evaluate it.

6 Methodology Semi-structured questionnaires Post-operative patients Multi-disciplinary healthcare staff VIN Clinic and Delyth Ward at Llandough Hospital Working alongside Fine Art Senior Lecturer at Cardiff Metropolitan University

7 PRE-Leaflet Current Information What did you want to know? Level of detail? Further information? Personal accounts and drawings useful? Common questions?

8 Part 1a) What was already available? Level of information for wide local excision for VIN is inadequate. A good level of verbal information. A leaflet would aide the current verbal information.

9 Yes too much information can be scary. However, it does need to be told. Using a leaflet from our perspective is good because we say verbally as much as we can and then if the women want to know then at least we know we have given them correct additional information rather than relying on the internet that can make matters worse. Auxillary Nurse, Llandough Hospital, June 2012

10 Part 1b) What did they want? A Leaflet to include: Personal experiences and expressive drawings. Clarify that it is not a cancer, surgery is not a cure and re-occurrence is common. Although it is an uncommon condition, they are not isolated cases. Provide guidance and awareness of the psycho-sexual support available. What the patient needs to bring into hospital the logistics. Summarize the logistics of the day and housekeeping guidelines on the ward. Clear information of wound care. Who to approach if there is a problem. Women are likely to look on the internet for further information therefore direct them to appropriate web-pages. Information for family members.

11 1) Personal Experiences The nurses take such great care of you, after all they see women like me very day. Although you prepare for the worst and expect the best, it was a lot better than I anticipated and I am surprisingly comfortable. At first, I felt isolated and embarrassed but its good to know that you re not alone.

12 2) Expressive Drawings Artwork By Jac Saorsa, Lecturer at Cardiff Metropolitan University

13 VIN Leaflet 2012, Artwork by Jac Saorsa

14

15 3) Psycho-sexual Issues Things have not been the same since my first operation. My relationship with my partner has suffered; something that hadn t crossed my mind I guess making women aware of the emotional sides of a disease is equally important. VIN patient, Llandough Hospital, 2012

16 VIN Leaflet, 2012 Catherine Morgan

17 VIN Leaflet 2012, Catherine Morgan

18 4) Logistics

19 POST-Leaflet Clear and understandable? Improvements? Drawings? Level of detail? Recommend?

20 Part 2: On evaluation Fluent and clear layout. The question/answer layout is effective. Allows women to prepare beforehand and provides an idea of what to expect. A good guide to allow family members what will happen. Answered basic questions regarding psycho-sexual issues. Most importantly, provided awareness of the support available.

21 Conclusion There was a need for a leaflet specific to wide local excision surgery for VIN. Patients put emphasis on wanting expressive drawings as a way to relate, psycho-sexual support and summary of the logistics of the day. Developed an appropriate and effective leaflet for VIN wide local excision surgical patients. Leaflet included a new style of artwork courtesy of Jac Saorsa which on the whole, proved effective.

22

23 References 1. The NHS Cancer Plan and the New NHS: Providing a Patient-Centred Service. London: NHS Executive; Hilary Jeffries and Colette Clifford. Searching: The Lived Experience of Women With Cancer of the Vulva. Cancer Nursing; 32: The American College of Obstetricians and Gynaecologists; Committee Opinion. Management of Vulvar Intraepithelial Neoplasia. 118; Practise Research Report: Evaluating the patient journey approach to ensure health care is centred on patients. Nursing Times. 2009: 105; R.W. Todd, D.M. Luesley, Medical management of vulvar intraepithelial neoplasia, J Low Genit Tract Dis, 9 (4) (2005), pp R.W. Jones, D.M. Rowan, Vulvar intraepithelial neoplasia III: a clinical study of the outcome in 113 cases with relation to the later development of invasive vulvar carcinoma, Obstet Gynecol, 84 (5) (1994), pp B.L. Andersen, D. Turnquist, J. LaPolla, D. TurnerSexual functioning after treatment of in situ vulvar cancer: preliminary reportobstet Gynecol, 71 (1) (1988), pp B.L. Andersen, N.F. HackerPsychosexual adjustment after vulvar surgeryobstet Gynecol, 62 (4) (1983), pp B. Thuesen, B. Andreasson, J.E. BockSexual function and somatopsychic reactions after local excision of vulvar intra-epithelial neoplasiaacta Obstet Gynecol Scand, 71 (2) (1992), pp

24 Thank you Any questions? Acknowledgements: Dr Amanda Tristram Jac Saorsa All the patients and Healthcare staff at Llandough Hospital