Embedding rehabilitation into cancer care continuum: an implementation study

Fary Khan; Bhasker Amatya; Alaeldin Elmalik; Krystal Song; Demi Diaz; Michael Dickinson

doi:10.2340/jrm.v56.40855

Authors

Fary Khan Department of Rehabilitation, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, Victoria, Australia; Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
Bhasker Amatya Department of Rehabilitation, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, Victoria, Australia; Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia; Department of Clinical Haematology, Peter MacCallum Cancer Centre, and Royal Melbourne Hospital, Parkville, Victoria, Australia https://orcid.org/0000-0003-4793-1104
Alaeldin Elmalik Department of Rehabilitation, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
Krystal Song Department of Rehabilitation, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, Victoria, Australia; Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
Demi Diaz Patient Access & Flow, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
Michael Dickinson Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia; Department of Clinical Haematology, Peter MacCallum Cancer Centre, and Royal Melbourne Hospital, Parkville, Victoria, Australia

DOI:

https://doi.org/10.2340/jrm.v56.40855

Keywords:

cancer, rehabilitation, implementation, barriers, facilitators

Abstract

Objectives: To implement and evaluate a rehabilitation-inclusive service delivery model at a tertiary cancer hospital.

Methods: The “Rehab-Toolkit”, a structured assessment tool comprising validated functional measures, was introduced in an inpatient cancer service. Consecutive inpatients were enrolled, and a Reach, Effectiveness, Adoption, Implementation, and Maintenance framework guided the analysis of barriers and facilitators for subacute care at clinic and system levels.

Results: The implementation of the Rehab-Toolkit was incorporated into routine inpatient care. Major pre-implementation barriers included: absence of routine standardized functional assessment tools, limited coordination amongst acute and subacute care providers, low awareness of rehabilitation medicine amongst patients and professionals, and insufficient engagement of subacute care with interdisciplinary stakeholders in clinical decision-making. Following the intervention, there was a notable increase in awareness and the contributory role of subacute rehabilitation services, rehabilitation “needs” assessment, and referral pathways. Recommendations for process change included: development of clinical pathways, establishment of subacute referral systems and discharge coordinator roles, inclusion of subacute rehabilitation services in acute interdisciplinary team meetings, enhanced staff education and knowledge.

Conclusion: Integration of rehabilitation services into cancer care can proactively manage functional morbidity. While the implementation process proved feasible and effective, robust process evalu-ation and longer term follow-up are necessary for sustained success.

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