RESUMEN
OBJECTIVE: To describe: (1) the type and frequency of interventions undertaken by regional cancer specialist Allied Health Professionals (AHPs); and (2) regional generalist AHPs' exposure and confidence in undertaking these interventions. DESIGN: Multiphase, observational study including a prospective study and a cross-sectional survey. SETTING: Two regional Queensland Hospitals. PARTICIPANTS: Cancer specialist AHPs (n = 13 in a prospective study; n = 7 in a cross-sectional survey) and generalist AHPs (n = 36 in a cross-sectional survey), across six disciplines from two regional hospitals and cancer services. MAIN OUTCOME MEASURES: Phase 1: Frequency of cancer care AHP occasions of service and interventions. Phase 2: Current practice in cancer care AHP interventions; confidence; access to training, professional development and mentorship; barriers to working in cancer care, among cancer care and generalist AHPs. RESULTS: Over 10-months, cancer care AHPs collectively delivered 12 393 interventions across 8850 occasions of service. Only four cancer care interventions were exclusively or predominantly carried out by cancer care AHPs-laryngectomy pre-operative counselling, laryngectomy rehabilitation and tracheostomy management (speech pathology) and lymphoedema management (physiotherapy). Generalist AHPs reported slightly lower confidence across all tasks if asked to carry out known interventions in a cancer setting compared with familiar settings. The primary perceived barrier to working in cancer care was lack of skills/experience/training reported by most CC AHPs, generalist Physiotherapists and Speech Pathologists, but not other generalist AHPs. CONCLUSION: There was a significant overlap in interventions undertaken in the cancer care and generalist setting for AHPs. Appropriate on-boarding to contextualise interventions to cancer care is recommended to overcome reported lower confidence.
Asunto(s)
Neoplasias , Patología del Habla y Lenguaje , Humanos , Estudios Transversales , Estudios Prospectivos , Queensland , Recursos Humanos , Técnicos Medios en SaludRESUMEN
Objective Delegation and skill sharing are emerging service strategies for allied health (AH) professionals working in Queensland regional cancer care services. The aim of the present study was to describe the consistency between two services for the types and frequency of tasks provided and the agreement between teams in the decision to delegate or skill share clinical tasks, thereby determining the potential applicability to other services. Methods Datasets provided by two similar services were collated. Descriptive statistical analyses were used to assess the extent of agreement. Results In all, 214 tasks were identified as being undertaken by the services (92% agreement). Across the services, 70 tasks were identified as high frequency (equal to or more frequently than weekly) and 29 as not high frequency (46% agreement). Of the 68 tasks that were risk assessed, agreement was 66% for delegation and 60% for skill sharing, with high-frequency and intervention tasks more likely to be delegated. Conclusions Strong consistency was apparent for the clinical tasks undertaken by the two cancer care AH teams, with moderate agreement for the frequency of tasks performed. The proportion of tasks considered appropriate for skill sharing and/or delegation was similar, although variation at the task level was apparent. Further research is warranted to examine the range of factors that affect the decision to skill share or delegate. What is known about the topic? There is limited research evidence regarding the use of skill sharing and delegation service models for AH in cancer care services. In particular, the extent to which decisions about task safety and appropriateness for delegation or skill sharing can be generalised across services has not been investigated. What does this paper add? This study investigated the level of clinical task consistency between two similar AH cancer care teams in regional centres. It also examined the level of agreement with regard to delegation and skill sharing to provide an indication of the level of local service influence on workforce and service model decisions. What are the implications for practitioners? Local factors have a modest influence on delegation and skill sharing decisions of AH teams. Practitioners need to be actively engaged in decision making at the local level to ensure the clinical service model meets local needs. However, teams should also capitalise on commonalities between settings to limit duplication of training and resource development through collaborative networks.