Authors (including presenting author) :
Chan SM(1), Ling WM(1), Chan SY(1), Chan KK(2), Yu KS(1), Chan SH(1), Fung CHL(1), Yeung SKD(1), Tong WH(3), Chiang WH (3), Leung SN (4), Choi H(5), Wu PY(1)
Affiliation :
(1) Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, (2) Department of Respiratory Medicine-Palliative Care Center, Ruttonjee & Tang Shiu Kin Hospitals, (3) Department of Physiotherapy, Pamela Youde Nethersole Eastern Hospital, (4) Department of Occupational Therapy, Pamela Youde Nethersole Eastern Hospital, (5) School of Public Health, The University of Hong Kong
Introduction :
Metastatic spinal cord compression (MSCC) is an oncological emergency which may cause irreversible neurological damage, resulting in serious medical complications and adverse impact on psychosocial well-being and quality of life. A local audit on MSCC inpatient care from September 2018 to August 2019 revealed delayed access to multidisciplinary supportive care for structured rehabilitation, lack of routine psychosocial assessment and guidance on symptom management.
To address these issues, an integrated care pathway (ICP) was developed by a dedicated multidisciplinary team of doctors, nurses, physiotherapists, occupational therapists, and social workers at Department of Clinical Oncology, PYNEH and implemented in September 2019. It aims to provide structured, evidence-based holistic care, including timely definitive treatment for MSCC, tailored rehabilitation and psychosocial interventions.
Objectives :
To evaluate the effectiveness of the ICP to enhance the quality of multidisciplinary supportive care for MSCC, and review on staff compliance.
Methodology :
Patients receiving inpatient oncology care for MSCC before (September 2018 to August 2019) and after (September 2019 to August 2020) the implementation of the ICP were retrospectively reviewed.
Quality of care domains including timeliness of access to definitive treatment for MSCC, referral to multidisciplinary team for structured rehabilitation, symptom management, supportive strategies to prevent medical complications, psychosocial assessment, and discharge planning, were evaluated and compared between the two patient cohorts.
Staff compliance to the ICP was also reviewed.
Result & Outcome :
Twenty-one patients and forty patients were identified in the pre-and post-ICP cohorts. All patients were managed under the ICP after its implementation, with 85% initiated within 1 day of MSCC diagnosis.
The ICP brought statistically significant improvement in clinical documentation of spinal stability (14% vs 100%; p<0.001), access to care by allied health professionals (physiotherapist 81% vs 100%, occupational therapist 76.2% vs 95%, social worker 42.9% vs 75%; p<0.05 for all), and attention to thromboprophylaxis (referral for anti-embolism stockings 19% vs 75%; p<0.001). There was also a trend towards improvement in relevant symptom management (pain, constipation), and discharge planning. The median length of hospitalisation was shortened from 13 to 10 days.
Conclusions:
Patients with MSCC are vulnerable to develop devastating physical and psychosocial complications. Implementation of a well-coordinated ICP enhances the quality of holistic care provision by a multidisciplinary team.
