A consideration of the needs of the adult patient with dementia attending for radiotherapy and its impact on the practical consent process

Towards an improved dementia care experience in clinical radiography practice: A state-of-the-art review

INTRODUCTION

The increasing global incidence rate of dementia and associated co/multimorbidity has consequently led to a rise in the number of people with dementia (PwD) requiring clinical radiography care services. This review aims to explore and integrate findings from diverse settings with a focus on the experiences of PwD and stakeholders, towards the development of a holistic approach for dementia care and management within the context of radiography services.

METHOD

An electronic search was performed across the following databases: PUBMED, CINAHL, Medline, SCOPUS, and ScienceDirect for articles published from January 2009 and June 2023. Articles were included if they fulfilled a predefined criteria mainly focused on experiences of PwD and/or other stakeholders when using the radiography services. Data obtained from the included studies were analysed using a result-based convergent synthesis.

RESULT

Eleven studies from diverse settings met the inclusion criteria. A mix of both positive and negative experiences of PwD and stakeholders were reported following visits to radiology and radiotherapy departments were highlighted across settings. The findings were themed around the need for: person-centred care, effective communication, attitudinal changes of staff, specialised and improved clinical environment and inclusion of caregivers for the care of PwD.

DISCUSSION

This study emphasise the critical importance of adopting holistic approaches to caring for PwD. This involves adopting a person-centred approach, actively involving caregivers, effective communication, and adequate training for radiographers to provide quality services, all in dementia-friendly environments.

CONCLUSION

The experiences of various stakeholders highlight the need for a more holistic approach and strategy for the care and management of PwD within the context of the radiography services. This calls for an urgent need for a comprehensive strategy that includes awareness creation of staff to enhance the quality of care and the overall experience for PwD using the radiography services.

The impact of liquefaction disaster on farming systems at agriculture land based on technical and psychosocial perspectives

This research aims to determine the attitudes of the farmers whose lands are affected by liquefaction in Jono Oge, Central Sulawesi Province, The Republic of Indonesia. The methods used here were integrated survey and experimental design. The survey approach was intended to figure out the attitudes of the farmers viewpoints: (1) to return to their activities on the agricultural lands affected by liquefaction; (2) to consume their own agricultural products; and (3) of their willingness to be relocated. The experimental design approach was used to figure out the effectiveness of organic material input combined with the SP-36 fertilizer. The obtained results were analyzed using the Likert Scale, diversity test, correlational test, and regression test. The results showed that the farmers persevered farming on the lands affected by liquefaction (Index = 88.82%) yet refused to consume their own agricultural products with the reason that corpses remained buried beneath their lands (Index = 27.82%); and they also refused to be relocated (Index = 28.80%). The continued production suitability of the affected land was also investigated. Terrain profile identification results in Jono Oge showed the disaster impact was dominantly landslide as it still showed a clear characteristic horizon between the topsoil and the sub soil. This contrasts to terrain at Petobo, Central Sulawesi Province, where the high mix of the topsoil with the sub soil of agricultural land affected by liquefaction, prevented demarcation of the horizon. The land treatment of organic material and SP-36 fertilizer showed that the combined dose (M) of 40-kg ha-1 with P 300-kg ha-1 had the highest effect by changing the field pH from 5.7 to 6.41, increased the availability of P and increased the corncob indicator plant weight. Based on these indications, the lands affected by the liquefaction in Jono Oge can still be used as agricultural lands through restoration, from both social and technical aspects.

Cancer and dementia: an exploratory study of the experience of cancer treatment in people with dementia

OBJECTIVE

Patients with comorbid cancer and dementia have poorer outcomes than those without dementia. We observe oncology teams managing patients with dementia and memory loss and explore these patients' needs and experiences of outpatient cancer services.

METHODS

A single site investigation of case study design to examine practices in four clinics using multi-methods of data collection: retrospective note review, observation, interviews, and recorded consultations. A framework analytic approach identifies themes within and across cases.

RESULTS

Thirty-three clinical encounters with patients with memory loss were observed. Ten consultations were audio-recorded and 16 individuals interviewed (n = 6 patients-carer dyads, n = 1 lone patient, and n = 5 staff). Medical records were reviewed for 338 cases. Cancer referrals did not document memory health, so clinicians rely on patient/carer disclosure to identify patients with memory problems. In practice, the problem often remains hidden. Treating teams who do become aware of memory difficulties are unsure how to support patients, but marked memory loss can limit treatment options and preclude radical intent. Carers are key facilitators of successful cancer consultations and management. Their support needs are largely unrecognized.

CONCLUSIONS

Training that educates cancer teams on how to identify and support individuals with memory problems before and during treatment and recognize the carer role may facilitate complex cancer care and help reduce inequalities of outcomes.

Reducing patient distress: a model for dementia care

More than 750000 people in the UK have some form of dementia; with a rise expected over the next 25 years. With early diagnosis of cancer, more patients with dementia will attend for cancer treatment. Immobilisation masks, used to ensure accurate head and neck radiotherapy, may trigger panic in patients, even without prior mental health problems. This single case study reports on the care provided to a patient with dementia and his carer, his wife Betty, during cancer treatment. Bert was diagnosed with dementia 10 years prior to his cancer diagnosis. The use of sedation appeared to trigger confusion rather than facilitate procedures. Bert's case illustrates how an individualised contract of care could be developed to help maximise interactions, ensure ongoing consent and maintain dignity during difficult and challenging medical procedures.

Calming panic states in the Mould Room and beyond: A pilot complementary therapy head and neck cancer service

Purpose: The service was piloted in response to requests for assistance with patients experiencing severe anxiety undergoing head and neck radiotherapy. This paper describes the aims of the service, interventions provided and the recorded responses of patients to the support given.

Data: Information about who referred, patient demographics, the interventions provided and patient feedback (n = 112) was extracted from treatment records over a 15-month period.

Findings: All referred patients successfully completed procedures and treatment. About 43 patients voluntarily disclosed past trauma, for example, sexual abuse, assault, childhood trauma, which they judged to have been linked to their claustrophobic responses. Advice and support was given to 40 patients also referred for smoking cessation; an additional three patients requested support when cravings returned.

Conclusion: There is a paucity of information about the extent of the distress triggered by radiotherapy procedures and what interventions could be offered in practice. Further work is required to include an economic assessment and longer term effects on patient compliance with treatment and smoking cessation. Training needs for complementary therapists and radiotherapy staff at this centre were also identified; these are being addressed.