28 Jun 2023Part of our HSR UK Conference 2023 series
In the ever-changing landscape of healthcare, the concept of Ambulatory Care is gaining momentum as a transformative model for delivering cancer treatment. It represents a shift towards more person-centred and self-managed care, empowering individuals to take an active role in their own health. In this blog, Alison Finch presents the concept of ambulatory cancer care, its benefits and the potential it holds, particularly for young people’s care.
Understanding Ambulatory Care (AC)
AC is a model of healthcare that enables patients to receive medical treatment without staying in the hospital overnight. In the cancer setting, it refers to a service model where patients receive chemotherapy treatments and intravenous fluids through portable devices such as infusion pumps, which enable patients to undergo therapies close to the hospital but not needing to stay overnight on an inpatient ward.
There are known benefits of AC, including:
Increased Patient Autonomy: Ambulatory Care empowers patients by giving them greater control over their healthcare. Patients can actively participate in their treatment process, monitor their own progress, and make informed decisions in consultation with healthcare professionals.
Efficiencies in care: In contrast to traditional hospital-based care, Ambulatory Care reduces the need for inpatient beds, helping avoid treatment delays. Creating inpatient beds for those most in need, AC can additionally offer cost benefits to the hospital.
After a successful pilot for adults in the UK in 2003 at University College London Hospitals NHS Foundation Trust (UCLH), the NHS introduced Ambulatory Care for Teenage and Young Adult (TYA) cancer patients in 2011 at UCLH. Research funded by the NIHR and Health Education England, has recently found that AC is transformative for young people undergoing cancer treatment. These ongoing research efforts have helped to form a baseline of evidence with and for the TYA cancer community, which – importantly - incorporates personal experiences of receiving AC. Thanks to this work, we now know that:
Ambulatory Care enhances quality of life: AC keeps young people anchored in aspects of their usual life, maintain their daily routine, see social contacts and engage in activities that, to them, are important. By avoiding overnight hospital stays, young people experience less disruption to their lives, which supports their mental health and overall wellbeing. A characteristic of Ambulatory Care, and contributing to this, is that it embeds mobility, momentum, and a feeling of making progress.
Ambulatory Care is an assets-based approach to healthcare: by focusing on the strengths, capacities, and resources of young people, AC allows them to exercise agency. A central feature of Ambulatory Care is that, in contrast to a hospital ward, young people are actively engaged in their own care. In an environment where they are not so closely monitored, young people come to trust themselves and their innate capacities to self-monitor and undertake care requirements that would traditionally sit with a ward team.
Ambulatory Care is built on partnerships: AC requires a partnership approach to care in which, alongside health professionals, a young person’s accompanying companion is pivotal to their positive experience of the care pathway. Based on their individual contexts and symptoms, it is not always feasible for teenage and young adult patients to undertake Ambulatory Care alone. Their companion becomes, in effect, a member of their multidisciplinary healthcare team. Together with tailoring education and support for young people, the research calls for greater investment in those who accompany them in AC.
This blog is based on a presentation by an NIHR ARC North Thames researcher at the forthcoming HSR UK Conference 2023. “Fostering young people’s agency: the transition of inpatient cancer treatment to an ambulatory model. Participatory research informing the national development of young people’s Ambulatory Care services” will be presented by Alison Finch, University College London Hospitals NHS Foundation and ARC North THames, and Robert Rietz, University Hospitals Sussex NHS Foundation Trust.
Click here to find out more about Alison Finch’s work with ARC North Thames.
Robert Rietz is an academic foundation trainee doctor. Having personal experience of cancer care during his time as a medical student, he joined the research team as a young associate co-researcher in 2020 and has volunteered in this capacity since. You can learn more about his co-researcher experience in a forthcoming blog post.
Click here to learn more about the development of ambulatory cancer care in the UK.