Parallel Session 5 - Bringing Innovation to Allied Health Practice

Cancer is regarded as a life threatening disease not only involved in physical distress but generates adverse and stressful experiences to patients. The prevalence rate of psychological distress in lung cancer patients is as high as 43.4%. Enhanced Psychosocial Care (EPC) services was launched throughout 7 clusters of Hospital Authority in 2020 to enhance the psychosocial support to cancer patients. Resilience, thought to be modifiable, is important for promoting successful illness adaptation. In the context of cancer, resilience refers to a patient's global orientation of confidence in coping stress (GOCCS), social support, personal protective attributes etc. The aims of this study in Kowloon West Cluster (KWC) are to (1) assess the change of GOCCS from our strength oriented psychosocial intervention; (2) explore patient satisfaction to service and (3) inform future strategies in developing a good psychosocial intervention for lung cancer patients. Methodology This is a one arm pre-post study (n=61). Participants were invited to fill in Orientation to Life Questionnaire-13 (OLQ-13) before and after intervention, and a customized questionnaire concerning their satisfaction towards the EPC program. Result Statistically significant improvement from baseline to after intervention in GOCCS (mean difference= -4.7; p < .000). Participants revealed high satisfaction (23.3/25) to the EPC program in KWC provided by MSW. Study also indicates that nearly half (46%) of participants suffered from moderate to high levels of psychological distress (≥6/10) followed by multiple psychosocial concerns/distress before receiving EPC. Worry (72.1%), sadness (54.1%), feeling depressed (37.7%), finance (55.1%), working (27.9%), treatment decision (23%) are the top psychosocial concerns. Data also showed that psychological distress is associated with the level of GOCCS of advanced lung cancer patients while the existence of some sociodemographic characteristics of patients like separation with spouse, employment and financial concerns, and negative mood correlate with patients who may have lower GOCCS level and more psychological distress. Conclusion This is the first study to examine the effectiveness of psychosocial intervention by MSWs to enhance resilience of advanced lung cancer patients in the Hong Kong Chinese context. The pilot demonstrates this systemic intervention to advanced cancer patients leading them with more resilience in adjusting the illness and persuade further randomized controlled trials expanding to more cancer groups.

Child & adolescent (C&A) mental health service demonstrates a growing demand in Hong Kong in recent 10 years as reflected by the increasing trend of SOPD new case waiting time though various new service models have been incorporated. As a result, there was a great demand for allied health training services to address the mental health needs of this population.
Occupational Therapist is one of the core member of the C&A multidisciplinary team providing program-based training for patients of various developmental disorders, including Autistic Spectrum Disorder, Attention Deficit & Hyperactivity Disorder and other Mood Disorders. 
With the sudden pandemic attack of COVID-19 in early 2020 in Hong Kong, most consultation and training services were disrupted. Opportunities for new service model created. Inspired by the commercial world of work-from-home with daily online business meeting and the arrangement of online class for school students in the educational field, Occupational therapist in the C&A team of the NTWC grasp the opportunity and transform our training service to deliver online. The first telehealth program piloted in July 2020. Outcome evaluation was conducted for all participants and their feedback were collected through survey. We go through different hurdles including hardware & software preparation, liaison with stake holders and arranging related logistics. With the positive feedback from our patients and their carers, we keep expending our telehealth service for different age groups and different conditions. A total telehealth attendance counts of 8318 was attained during 2020 & 2022.
Upon the resumption of Day Hospital service and OPD group service in January 2023, supported with the positive feedback from carers and stake holders, we transformed our traditional face-to-face service model to hybrid service model which includes both face-to-face class and telehealth class in program protocols. Free telehealth classes were gradually shifted to charged service after validating the protocol-driven programs at COC levels. In December 2023, with the support of Virtual Office established by CSC(AH) office in NTWC, we smoothly shifted all telehealth class conducted online via ZOOM to HA Go.
To conclude, C&A mental health service in NTWC transited smoothly from traditional to pandemic and then a new normal with hybrid service mode embedded into our mainstream service.

To facilitate radiotherapy, patient 3D imaging called simulation is essential prior to sophisticated computer treatment planning. Over decades, we have been using Computed Tomography (CT) as the primary simulator CT-Sim, with Magnetic Resonance Imaging (MRI) being overlaid to the CT image set for the target and organs localization. CT images are important for RT plan radiation dose calculation while the MRI ones are excellent for the body tissues discrimination. Simulation images are also used as a 3D reference frame to set up the patient precisely for the subsequent actual RT treatment. With the advancement of technology, MR images at certain body sites can be converted to pseudo-CT good enough for RT planning. Hence the dedicated MRI can become the MR-Sim, sharing the workload of the CT-Sim, improving the image quality, and achieving better treatment simulation. It is highly desirable if the Oncology Department could install an MR-Sim on site in parallel with the existing CT-Sim, so that all the simulation processes could be completed in one go in the same department.
In New Territories West Cluster Tuen Mun Hospital an Oncology-based MR-Sim was installed in 2022. This is the first such equipment in HA costing about HK$23Million. With the implementation of this MR-Sim, the equipment is taking up most of the RT simulation works requiring MR imaging, alleviating the burden of the Radiology-based MRI units, and greatly improving the workflow of our oncology patients during the simulation processes. Upon initial utilization, the new MR-Sim is now operating with a throughput of about eight oncology patients per day-session of simulation. The Oncology Department finds it very valuable, useful and convenient in serving our patients, leading to even higher quality treatments.
In this presentation, the improvement of patient services and developments in the relevant aspects in TMH will be shared. These include Image-Guided Brachytherapy, escalation of simulation quality, MR-Only treatment planning, and functional MRI research. These contribute to the differences that the new MR-Simulator has brought to the Oncology Department of the Tuen Mun Hospital since 2022.

Kwan KCP (1), Lau SM (1), Yung CMJ (1), Lo HK (2), Chan HL (1), Hui CWC (1), Yip E (2), Ip MW (1), Tam D (2), Yeung J (2), Wan S (2)
(1) Department of Ear, Nose and Throat (ENT), Pamela Youde Nethersole Eastern Hospital
(2) Physiotherapy Department, Pamela Youde Nethersole Eastern Hospital


Introduction
Vestibular disorder accounts for near 10% of all Ear, Nose and Throat (ENT) Specialist Out-patient Clinic (SOPC) new case referral, with long routine waiting time. In 2022, a new integrated service model involving nursing and different allied health professionals was first introduced in Hong Kong East Cluster to provide early assessment and management to patients with dizziness, vertigo and balance problem.


Objectives
To develop a new multidisciplinary integrated service model to tackle the problem of long SOPC waiting time by providing priority vestibular assessment, timely vestibular physiotherapy and early nursing care to patients.
 
Methodology
Over a period of 19 months from 7 July 2022 to 7 February 2024, 564 patients were recruited and attended IVC. They first attended a combined clinic and were jointly assessed by ENT nurses and Physiotherapists within 8 weeks. Patients with red flag features were identified and with doctor appointment advanced. 291 patients (51.6%) were arranged vestibular physiotherapy and had their first session within 8 weeks. All patients went on with early videonystagmography (VNG) assessment by audiologists whilst suitable patients would be given early vestibular physiotherapy including canalith repositioning maneuver, gaze stabilization, habituation exercises and balance training. Patients were reassessed by ENT nurse in bundle clinic after VNG and completion of rehabilitation. SOPC appointment of cases with suspected red flag features would be advanced along service pathway.


Results
Among those completed full course of physiotherapy, all patients demonstrated statistically significant decrease in Dizziness Handicap Inventory (DHI) score and Numeric Rating Scale (NRS) of subjective dizziness, while balance (Sharpened Romberg Scale and single leg stand test) was reported statistically significantly improved. Upon outcome evaluation, more than two-third of patients reported symptoms relieved by 70-100%. 


Conclusions and Public Health Implications
The encouraging results demonstrated how a multidisciplinary service pathway remodeling could drastically shorten the waiting time and enhance the quality and safety of patient care in public healthcare sector.