Page 102 - HHR-HNR 2.0

these limitations calls for a multidisciplinary approach, in which one aims at integrated care that is tailored to each patient\u2019s needs and preferences (Wiederholt, Connor et al. 2007, Eades, Chasen et al. 2009, Ouwens, Hulscher et al. 2009, De Leeuw, Van den Berg et al. 2013, Eades, Murphy et al. 2013). The employment of a case manager (preferably a head and neck oncology nurse) can ensure the optimal flow of information within the often fragmented oncological multidisciplinary treatment process (IGZ 2009).\u000DThe responsibilities of the head and neck oncology nurse / case manager within the rehabilitation programme include the providing of information on rehabilitation options, screening for and determining rehabilitation needs and, where necessary, referring to single-issue allied health or multidisciplinary rehabilitative care. They work together with, and under the supervision of, the rehabilitation specialist. Throughout the rehabilitation process, the case manager coordinates both the information to the patient and the communication between the various disciplines, thereby playing a connecting role in the multidisciplinary process. The rehabilitation specialist is responsible for monitoring the quality and effectiveness of the rehabilitation process. The case manager facilitates this process through the use of valid measuring instruments.\u000D5.2.2. Screening and referral upon rehabilitation needs\u000DPatients with a rehabilitation need may be referred by the head and neck surgeon, medical oncologist, radiotherapist, oncology nurse, or by allied health disciplines. Patients treated in any of the other NWHHT centres can also be referred to the head and neck rehabilitation programme, which is currently unique in the Netherlands. Screening for and determining multiple care needs or rehabilitation needs is performed in line with the national guideline Oncological rehabilitation (IKNL 2011).\u000DThe case manager uses several measuring instruments, including the Distress thermometer, the Hospital Anxiety and Depression scale (HADS), and the Visual Analogue scale (VAS) for cancer-related fatigue, as well as a conversation with the patient, to identify single-issue or multiple/complex problems (see flowchart above). Based on the arguments discussed below, the selection of screening tools deviates in part from the Oncological guideline.\u000DThe Distress thermometer consists of a VAS 0-10 score, displayed as a thermometer measuring the severity of complaints, and a problem list (PL) with 47 dichotomous items, scoring for complaints in several domains (practical, family/social, emotional, religious/spiritual, physical). The Distress thermometer has not been validated yet, but is currently the most frequently used tool in the oncological setting, and its use is recommended in the national guidelines \u2018Screening for psychosocial distress\u2019 and \u2018Oncological rehabilitation\u2019 (IKNL-c 2010, IKNL 2011). With a cut-off point for the thermometer of \u22655 and the indication of multiple problems on the problem list it is recommended that the patient be given additional screening or is referred to multidisciplinary rehabilitation.\u000DRather than the CES-D, as recommended in the Oncological guideline, the Antoni van Leeuwenhoek uses the HADS as additional screening instrument for measuring distress, since this tool screens for both depression and anxiety. The HADS is a validated screening tool for the detection of depression, distress and anxiety in the oncological setting (Vodermaier and Millman 2011). The Antoni van Leeuwenhoek, following the recommendations of the PSOE (Psychology Oncology Epidemiology department), applies a cut-off point of \u226511 on the HADS for referral to medical social work and/or psychology and/or psychiatry to further diagnose depression or anxiety. If any further problems in\u000D101\u000D