Page 94 - HHR-HNR 2.0

3.2 Schematic overview head and neck rehabilitation (HNR) care path\u000DIdentification of the rehabilitative care need\u000DHead and neck surgeon, radiotherapist, allied health professionals and/or oncology nurse\u000DCase manager\u000DDetermining suitability for rehabilitation. Multiple or complex rehabilitation need. Tools: distress\u000Dthermometer, VAS - fatigue, HADS, SNAQ\u000D- no rehabilitative care need - addiction problem\u000D- referral to monodisciplinary care\u000DStart of HNR\u000DNo HNR\u000DNo HNR\u000DIntake rehabilitation specialist\u000DInclusion/ Exclusion HNR\u000DIndication for one or more HNR modules\u00E0referral to team/allied health professionals\u000DIntake and start of paramedic treatment\u000DIntake, clinimetrics and treatment of selected modules takes place. The allied health professional draws up individualised SMART goals with the patient.\u000DStart/follow-up (MDT) meeting\u000DOn the basis of clinimetrics the allied health professionals involved devise SMART rehabilitation goals. These are discussed in a multidisciplinary meeting, where the core problem is determined.\u000DConsultation rehabilitation specialist\u000DDiscussion of the tailored rehabilitation programme and its progress.\u000DMDT meeting\u000DThe SMART goals and primary goal are reviewed e.g. every six weeks.\u000DEnd evaluation (MDT meeting)\u000DThe rehabilitation programme is assessed with clinimetric measurements by the allied health professionals. If necessary, follow-up primary care is organised.\u000DAbbreviations: VAS fatigue = visual analogue fatigue scale/ HADS = Hospital Anxiety and Depression Scale/ SNAQ = Short Nutritional Assessment Questionnaire/ SMART = specific, measurable, acceptable, realistic, time-based\u000D93\u000D