A needs assessment of Lymphoedema services in Fife: an exploration of Physiotherapy and District Nursing Management.

Abstract

Introduction: The physical and psychosocial effects of lymphoedema have profound effects on function and quality of life. While the disease is incurable, specific management is used to minimise and control symptoms. Strategies include compression garments and bandaging, specialised massage, skin care, and exercise1. A needs assessment of lymphoedema services in Fife was commissioned by the Core Cancer Review Group in Fife and supervised by Queen Margaret Hospital. An early finding indicated that many General Practitioners refer individuals with lymphoedema to local Physiotherapy and District Nursing (DN) services. However, the capability of these services in providing the required management was unknown. Therefore, a postal survey was conducted to explore the levels of experience, confidence and knowledge of Physiotherapy and DN staff in relation to the treatment of lymphoedema. Method: A postal questionnaire was sent to all Physiotherapy and DN services (n=36 and 53) in Fife. This strategy was used to obtain a broad overview of specific issues. The local ethics committee did not require a submission for ethical approval. Descriptive analysis of responses to both open and closed questions was carried out in relation to the number of clinicians represented by each response. Results: Response rates from local Physiotherapy and DN units were 58% and 53%, respectively. Findings are summarised below: Clinicians represented: Physiotherapists (n=60) District Nurses (n=91) % of clinicians with experience of lymphoedema management 26.67 56.04 Mean number of patients treated by each clinician 2.94 1.27 % of clinicans with experience who expressed confidence in lymphoedema management 25.00 27.45 Most frequently mentioned management options (frequency count) Limb elevation (4); massage (3); exercise (3) Compression garments / bandaging (5); skin care advice (3) Fewer Physiotherapists than DNs had experience of lymphoedema management, but those few had treated more patients. However, clinicians with experience frequently lacked confidence in treating lymphoedema and the suggested management strategies reflected incomplete knowledge regarding recommended practice. Conclusions: These findings represent a localised pilot investigation. The issue requires further study to a greater depth and in different geographical regions. Non-specialist Physiotherapists and DNs appear to lack experience, confidence and knowledge of lymphoedema management. Therefore, specialist lymphoedema services are recommended and increased awareness of management services and strategies should be promoted. References: 1. Badger, C. and Jeffs, E. (1997) Macmillan Lymphoedema Project.- London, Macmillan Cancer Relief.