An evaluation of the provision of oncology rehabilitation services via telemedicine using a participatory design approach.

BACKGROUND: The COVID-19 pandemic has fundamentally impacted the delivery of healthcare services globally. In line with UK government guidelines on social distancing, the use of telemedicine was implemented to facilitate the ongoing provision of cancer rehabilitation. PURPOSE: We sought to evaluate and co-design telemedicine services to meet the complex needs of our patients and carers at a tertiary cancer centre. METHODS: Experience-based co-design methodology was adapted to include virtual methods. Staff members (n = 12) and patients (n = 11) who had delivered or received therapies services at our UK cancer centre since March 2020 were recruited to take part in one-to-one virtual interviews. Patient interviews were video recorded, analysed and edited to a 30-min "trigger film". Patient and staff virtual events were undertaken thereafter. A joint virtual patient and staff event occurred. Staff and patients watched the trigger film and as partners, agreed areas for change and developed groups for service co-design. RESULTS: Positive aspects regarding telemedicine provision were highlighted including reduced financial and time burden on patients, and increased flexibility for both staff and patients. The key concerns included digital exclusion, safety, communication and patient choice. Four co-design groups have been established to enact changes in these priority areas. CONCLUSION: Using a participatory design approach, we have worked in partnership with patients and staff to ensure the safe, acceptable and effective delivery of rehabilitation services with integrated telemedicine.

Prophylactic swallowing exercises for patients receiving radiotherapy for head and neck cancer.

PURPOSE OF REVIEW: Oncological treatment outcomes in head and neck cancer suggest both acute and longer-term oropharyngeal dysphagia. Studies have been published exploring the potential to improve swallowing outcomes using more targeted treatment modalities such as intensity-modulated radiotherapy (IMRT) and through the introduction of swallowing exercises prior to treatment. In this article, we will explore the literature relating to prophylactic swallowing exercises for patients undergoing (chemo-)radiotherapy. RECENT FINDINGS: Recent studies have attempted to evaluate the benefit of prophylactic, pretreatment swallowing exercises for patients undergoing (chemo-)radiotherapy. We identified three peer-reviewed published studies which present data on the potential benefit of exercise. Only one randomized control trial which includes multidimensional swallowing evaluation with instrumental measures has been published. Authors of all the reviewed studies agree that randomized control trials including baseline measures are required with longitudinal follow-up. SUMMARY: More research is required to complement oncological clinical trials evaluating the impact of prophylactic exercise on swallowing outcome. Multidimensional swallowing evaluation including instrumental and patient-reported measures should be conducted pretreatment and longitudinally to develop the evidence base for intervention in patients undergoing organ-preserving treatment protocols.