SMASAC Short Life Working Group on Lymphoedema - Lymphoedema Care in Scotland, Achieving Equity and Quality

Section 4: Education, Training and Research of Health and Social Care Professionals

Research has highlighted a lack of awareness and knowledge of lymphoedema in health care professionals generally and a dearth of trained practitioners, with some Health Boards having little or no provision (Sneddon et al, 2008). To improve both quality of care and equity of access to care for the growing population of people with lymphoedema, as discussed in Section 1, and to adopt an anticipatory care approach with an aim of reducing incidence and severity, education at all levels is essential. The level of knowledge required by professionals who predominantly deal with those at risk of lymphoedema or whose needs are less complex will differ from those seeing people with complex or severe lymphoedema.

Needs are also context specific (Davies et al, 2012), so there are areas of care provision in which it may be appropriate to identify some individuals for whom it would be useful to develop knowledge or skills in particular aspects of lymphoedema treatment, but who do not require preparation as a specialist practitioner, e.g. in cancer centres where there is a concentration of people 'at risk' or with early lymphoedema.

The tables in Appendix 7 are broadly adapted from a model proposed by Sneddon (2007) to identify the levels of knowledge and skill required to meet patient needs in different contexts, with related competencies and suggested ways of learning. They also reflect what anyone with, or at risk of, lymphoedema should reasonably expect from the various health and social care professionals. Each part of the table indicates which outcomes might be expected from the various professionals in different contexts. The overarching outcomes to be expected from improved education and training are as follows:

• Prompt recognition of symptoms and signs suggesting lymphoedema
• Initiation of appropriate investigations to exclude or confirm diagnosis
• Prompt recognition and appropriate management of complications, including cellulitis and lymphorrhoea
• Management according to an agreed treatment pathway
• Referral onwards to specialist practitioner or surgical service where appropriate
• Support of self management for both prevention and long term maintenance to improve quality of life
• Seamless care in which patients are seen by the most appropriate health professional for the severity of their condition (see Tiers of Care page 20)
• Equity of provision of lymphoedema services across Scotland

These outcomes are synergistic with many of the top ten priorities of people with lymphoedema identified by the Macmillan Lymphoedema Project Scotland (2013) (Page 15 of this report).

They are consistent with the approach to maximise the potential for self management with professional support as close to the patient as possible. Nonetheless, all Health Boards should have provision for referral of people with complex lymphoedema, or during exacerbations of their lymphoedema, to a specialist service for advice or for more intensive or specialist treatment.

Recommendations