Table 3.
New and amended recommendations
| Workshop 1: new recommendations | ||
|---|---|---|
| Poll number and title | New recommendation | Comments |
| Poll 4: information and support | 4.8 Pain management, methods, and potential side effects should be discussed with patients before, during, and after treatment, with level of detail and choices offered as appropriate | Suggested by a service user who had not had pain management and opiate side effects explained to her and reported suffering from paranoid thoughts likely to have been caused by high levels of opioid use via PCA |
| Poll 6: communication, logistics and staffing | 6.6 Ward bookings for long duration brachytherapy should include the option to stay the night after treatment finishes, to allow sufficient recovery time if needed | Suggested by a service user who had been encouraged to leave hospital when she did not feel ready. She suggested that patients should be given a choice, to stay on ward for an extra night after brachytherapy completion |
| Poll 6: communication, logistics and staffing | 6.7 Pregnancy checks before theatre procedures and radiation delivery should be handled with sensitivity where previous treatment has prevented this possibility | Suggested by a service user who had found the frequent questions about the possibility of pregnancy was upsetting and insensitive when treatment had caused infertility |
| Poll 7: facilities on wards | 7.8 Consideration should be given to the location of brachytherapy ward facilities and where possible avoid entry and exit routes near sensitive areas such as maternity units | Suggested by a service user who had to walk through a maternity unit to reach the ward for brachytherapy. She found this upsetting, insensitive and hoped it might be considered when designing future services |
| Workshop 1: recommendation amendments | ||
| Poll number, title, recommendation number | Original recommendation | Amended recommendation |
| Poll 1: pain management. Recommendation 5 | Each centre should provide individualised advice on pain control before discharge from hospital | Each centre should provide individualised advice on short term pain management before discharge from hospital |
| Poll 2: medication for anxiety and distress. Recommendation 1 | The protocol should include consideration of medication to reduce anxiety while staying on the ward the night before brachytherapy | The protocol should include consideration of medication or other interventions to reduce anxiety while staying on the ward or at home the night before brachytherapy |
| Poll 2: medication for anxiety and distress. Recommendation 5 | The protocol should state the frequency that pain, anxiety and distress will be reviewed by senior brachytherapy clinicians | The protocol should state the minimum frequency that pain, anxiety and distress will be reviewed by senior brachytherapy clinicians |
| Poll 2: management of anxiety and distress. Recommendation 6 | The protocol should include frequency of ward rounds with oncologist and nursing staff for regular review and management of pain, anxiety and distress | … and management of pain, anxiety and distress, in addition to personalised reviews at times needed by the patient |
| Poll 2: Title: medication for anxiety and distress | Poll title: medication for anxiety and distress | Poll title: Management of anxiety and distress |
| Poll 2: medication for anxiety and distress. Recommendations 1, 2 3, 4, 7 and 8 | …need for drugs… |
Six recommendations had “or other interventions” added, to read: need for drugs or other interventions |
| Poll 3: general medical management. Recommendation 1 | Each centre should have a protocol for prevention and treatment of nausea and vomiting, including additional options and adaptations when medication does not work | …when medication does not work, and consideration of non-medical options. Explanatory notes: non-medical options may include herbal remedies such as ginger, relaxation techniques, music therapy or massage |
| Poll number, title, recommendation number | Original recommendation | Amended recommendation |
| Poll 4: information and support. Recommendation 7 | Each centre should provide assessment of the need for psychological support after brachytherapy | Each centre should provide assessment of the need for psychological support after brachytherapy and be able to provide this or refer patients as needed |
| Poll 5: patient care/ward nursing care. Recommendation 9 | Ward staff should receive additional training in the care and compassion needed to support patients during brachytherapy | Explanatory notes: This may include training such as advanced communication skills, a need for clinical supervision sessions or staff debriefing |
| Poll 6: communication, logistics and staffing. Recommendation 3 | Each centre should carry out regular service evaluation to check that staffing levels are appropriate throughout the brachytherapy pathway | Each centre should carry out regular service evaluation to check that staffing levels are appropriate throughout the brachytherapy pathway, including contingency planning for absence of key staff |
| Poll 7: facilities on wards. Recommendation 1 | Centres should offer patients a choice of single room or wardroom, considering individual preferences for privacy or company/distractions | Centres should where possible offer patients a choice of a single room or shared wardroom, considering individual preferences for privacy or company/distractions |
| Workshop 2: Recommendation amendments | ||
| Poll 5: patient care/ward nursing care. Recommendation 10 | Centres should provide intensified care standards for brachytherapy patients on ward, i.e. fewer patients that one nurse should be allocated to look after, therefore a greater allocation of nursing time to brachytherapy patients | Centres should provide specialised care standards for brachytherapy patients on ward, i.e. fewer patients that one nurse should be allocated to look after, therefore a greater allocation of nursing time to brachytherapy patients |
| Workshop 3: Recommendation amendments | ||
| Poll 1: pain management. Recommendation 4 | Each centre should have a protocol for pain management for applicator removal to meet the needs of individual patients | Each centre should have a protocol for pain management for applicator removal to meet the needs of individual patients (fully informed of procedure) |
| Poll 2: management of anxiety and distress. Recommendation 5 | The protocol should state the minimum frequency that pain, anxiety and distress will be reviewed by senior brachytherapy clinicians | The protocol should state the minimum frequency or threshold for pain, anxiety and distress to be reviewed by senior brachytherapy clinicians or senior ward clinicians |
| Poll 5: patient care/ward nursing care. Recommendation 9 |
Ward staff should receive additional training in the care and compassion needed to support patients during brachytherapy This may include training such as advanced communication skills and a need for clinical supervision sessions or debriefing for staff |
Ward staff should receive additional training in the nursing care and compassion needed to support patients during brachytherapy This may include training such as advanced communication skills and a need for clinical supervision sessions or debriefing for staff, and management of complex pain |