On the 4 of February, the University of Manchester commemorated World Cancer Day by hosting a webinar with oncology academics, practitioners and cancer patients to discuss efforts to improve patient care. In the UK, one in two people are likely to develop cancer in their lifetimes, and oncology has often been critiqued for being too paternalistic in its choice of vigorous treatment plans. Dr Suz Johnson, Director of the Transformative Oncology course, argues that “adopting a holistic view to develop personalised strategies for cancer treatment is vital.”
In the webinar, she further explained there should be “equity in care because every person is entitled to education about their treatment options.” Listening to patient feedback gives practitioners a privileged insight into lived experiences, which Dr Johnson suggests challenges healthcare professionals to be more empathetic.
Mike Thorpe was diagnosed with prostate cancer in 2014 and received a combination of treatments at The Christie Hospital in Manchester. Mike is now a volunteer for Cancer Research UK working as an interviewer for the Cancer Patient Experience Survey. During the webinar, Thorpe stated, “the treatment experience can be bewildering, getting a diagnosis is going into a new and scary world you never thought you would be in.” Mike recalled a quote from a fellow patient that doctors should focus on “the fleshy bit around the tumour, also called the patient.”
He feels every clinician should be asking their patients what is most important to them. For example, some patients want quality rather than quantity of life. Professor Cliona Kirwan, a breast cancer surgeon and lecturer, supported this action and thinks “our job as clinicians is to give back control to the patient.”
Imogen Westwood, a bone cancer survivor who works at the Bone Cancer Research Trust, added “some doctors only focus on the efficacy of the treatments, and have a disconnect to the patients’ lifestyles and the reality of their future”. Imogen is also a master’s student in Healthcare Ethics and Law at the University of Manchester.
Starting with the medics
So, how does the University of Manchester train its student medics to listen to and understand patients as people? Olivia Timperley is an intercalating medical student from the University of East Anglia, who is currently completing her MRes in Medical Science at the University of Manchester. Olivia spoke to me about her practical experience in holistic medical treatments in cancer care.
“Navigating cancer care has always been difficult for patients. From initial investigations, where the burden of a diagnosis has not yet been unearthed, to the endless appointments with the many different specialists who all play a part in the lengthy and often scary road ahead. Arguably the biggest gap to overcome is the one between the professional, who delivers the burden of truth, and the patient who carries it day-to-day. There is never just one treatment answer. Patients, and indeed the treatments available in oncology, are complex and this disparity needs to be met with intricate plans that are both unique and successful in their aims.”
Timperley continues, saying, “For example, the patients I have come across in my four years at medical school all have different prognoses and aims. If that is to survive long enough with a terminal diagnosis to see their children married or to simply do nothing – you can never predict or assume what response you will get. Possibly the most important thing I have learnt during my placements is how to deal with uncertainty. Medicine is not an exact science as we all would like to believe. Although we can use evidence, national statistics and experience to predict certain outcomes, this is never fool-proof. Uncertainty should be shared with patients to remove barriers to genuine communication and ensure expectations are managed appropriately.
I have been taught that patient feedback is a continual process that should be explored at every encounter. That could be the disclosure that a patient is experiencing side effects with chemotherapy, that can be symptomatically treated with another medication, or that they simply no longer desire to cure the disease. If communication is sincere, medical professionals can alter care accordingly to ensure that patient journeys are as steady as possible.”
Manchester cancer patient initiatives
In her role at the Bone Cancer Research Trust, Imogen Westwood consulted on the co-development of medical communication resources written by cancer patients. Imogen proofread information booklets for patients and symptom cards for dentists. She explained dentists may observe early onset symptoms of child bone cancers, which are often misdiagnosed as growing pains.
Dr Suz Johnson also mentioned cancer screening initiatives taking place in Manchester communities that are less likely to engage with health care. These are held at community centres and churches to increase accessibility. Mike Thorpe added that the 2016 lung health check service run by Macmillan and the University Hospital provided cancer screening vans in supermarket car parks in Manchesters’ most deprived areas. Previously 80% of lung cancers were diagnosed at Stages 3 and 4, which is very difficult to treat, but the pilot engagement scheme detected 80% of lung cancers at Stages 1 and 2. This immense difference in patient diagnoses justified the rollout of this scheme across Manchester, which now includes the Manchester City Etihad Stadium.
After treatment, reflective information gathered from patients and their families can also inform medical practices. Zara Linn is an intercalating medic studying for an MSc in Cardiovascular Health and Disease at the University of Manchester who spoke to me about patient feedback processes.
“In Warrington Hospital, volunteers take the time to speak to patients and families to receive feedback on their experiences within the hospital. This can be given prior to inpatient discharge as well as by-day cases in outpatient clinics. This “Friends and Family Survey” can be completed in alternative forms such as written surveys, text messages or interactive voice calls. The questions are either multiple choice or short answers and assess whether patients would recommend this trust to others; how they felt about the care provided during their time of stay; and what they think could be improved. It is important to gather not only the patient’s perspective but also the relative’s opinions. How relatives had been treated by the team can additionally offer important insight and alternative perspectives.
The volunteers closely work with the corporate nursing lead at Warrington hospital as part of the quality improvement process. The responses are gathered and processed and then fed back to specific departments. The updated figures (both good and bad) are communicated weekly to the hospital via team briefings. Staff in each department will take the time to discuss how the care given can be changed accordingly to satisfy patients’ needs holistically.
However, this gathering of feedback needs to be actively reinforced in all NHS trusts. During my placement last year at a different location, I had not witnessed many surveys being handed out or completed by patients. The corporate teams will have to further emphasise the importance of survey completion to all team members to ensure continual improvement of patient care.”
The University of Manchester’s Transformative Oncology programme is delivered fully online. It is taught in collaboration with the Manchester Cancer Research Center, with links to The Christie Hospital in south Manchester. The progressive curriculum focuses on patient outreach, new screening initiatives, biobanks and improving cancer care through empathic innovation.
The University of Manchester Webinars
James Wood works in the recruitment and marketing team for Transnational Education at the university as a course advisor and organised the “World Cancer Day: Closing the care gap” webinar. James regularly runs webinars to provide prospective applicants with learning opportunities related to the university’s online and blended programmes. Recordings of these and other webinars can be found on the YouTube channel.
“These webinars usually involve members of the academic staff, current/former students, and other guest speakers from the industry. In addition to this World Cancer Day webinar, I also hosted a webinar on the Synergies between Medicine and Science in the Oncology Field, as well as a Challenges to Sustainable Power Systems webinar.
As for upcoming events, I am hosting a webinar on the Latest Trends and Leadership Practices in the Development Sector, on February 23 for the Master of Leadership for Development which is a joint partnership course with The University of Melbourne.
My colleague is also running a webinar (Don’t Look Up: Ignoring the Looming Crisis in Public Education) on February 23 for Educational Leadership in Practice course.” The registration link for Don’t Look Up can be found here.
Wood is also potentially running a webinar on Crypto Exchanges and Regulations in March. Stay up to date with that here.