QUALITY OF LIFE: WHAT THE BRAIN CANCER COMMUNITY NEEDS
was in end of life phase but was accused by the district nurse of being selfish, which led him to take extreme action at a time when he needed to be building a rehabilitation team around him: ‘I have decided to take control. I am going to change doctors, as I should stop getting frustrated by the situation. I am going to change to a practice that is closer to home and apparently has a robust procedure for fast tracking those critically ill to either a doctor’s visit or at the least a phone call. I am also in the belief that I will request that another district nurse is appointed. I am very low at the moment and do not need to be advised by the district nurse (who has only just appeared on the scene) that I am being selfish and very unkind to Jane by not allowing her to use a commode. I only read this in Jane’s notes. So I am angry. A lack of tact I fear!’ Carer
Summary Unsurprisingly, there are gaps in neuro-rehabilitation and neuro-psychosocial support as our interactions with carers and patients diagnosed with a brain tumour reveal. The causes for this are complex but it isn’t just a resource issue but is also an attitude of mind – of all involved. Carers and patients don’t understand the purpose of neuro-rehabilitation, or how the emphasis is placed on restoring or maximising independence with activities of daily living, mobility, cognition, and communication. Rehabilitation interventions can be applied in all stages of the disease, although rehabilitation goals change as the stage of illness advances. Preventive re-habilitation can maintain independence in patients who undergo treatment and who have potential loss of function. When tumour progression causes a decline in functional skills, or the disease causes neurological deficit, rehabilitation assumes a supportive role, with goals adjusted. If patients and carers were more informed about the progression of the disease they could be better prepared and intervene earlier. During terminal stages of illness, palliative rehabilitation can improve and maintain comfort and quality of life until the end of life. Carers and patients need to be more specific and more proactive in their asks of the support services, outlining specifically what the problem is so that additional help can be targeted effectively. It is difficult to ask for support if you don’t know what is available. This could so easily be addressed. A key question which we ask regularly is ‘what are you struggling with the most?’ Once this is articulated it is easy to define what it is needed. There is a mindset with some clinicians that once the patient is through a particular phase of their care pathway, they become someone else’s problem. At a cancer network meeting, when reviewing the progress against the IOG, a neurosurgeon stated that once the patient has had neurosurgery ‘they become someone else’s problem’. Never mind that the surgery may leave the patient with complex rehabilitation needs. And again, once discharged home the secondary care team assumes the primary care team will pick up the support and rehabilitation. This is not always the case, particularly if the carer and patient don’t know what to ask for, whom to ask or where to go.
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