An Intergration of Medicine and Art

Improving Vulval Surgery Patient Information in the Gynaecology

Department at UHW

Catherine Morgan (4th Year Medical Student)Dr Amanda Tristram (Senior Clinical Lecturer Gynaecological

Oncology)Dr Jac Saorsa (Lecturer in Drawing: Fine Art)

‘I felt bewildered and overwhelmed.’

VIN Patient, Llandough Hospital, June 2012

Vulval Intraepithelial Neoplasia

‘…the search for information is generally perceived as a negative experience [that leads

to a] sense of isolation.’ H. Jeffries and C. Clifford (2009)

Improving Vulval Surgery Patient Information in the Gynaecology

Department at UHW

Catherine Morgan, Dr Amanda Tristram and Jac Saorsa

• Part 1: To evaluate the current level of information and find out what kind of information patients require.

• Part 2: Using the evaluation, redesign a Patient Information Leaflet specifically for these women and implement this leaflet and re-evaluate it.

Methodology• Semi-structured questionnaires• 12 Post-operative patients • 8 Multi-disciplinary healthcare staff• VIN Clinic and Delyth Ward at

Llandough Hospital• Working alongside Fine Art

Lecturer at Cardiff Metropolitan University

Part 1a) What was already available? Level of information for wide local

excision for VIN is inadequate. A good level of verbal information. A leaflet would aide the current verbal

information.

Part 1b) What did they want?

A Leaflet to include:

Personal experiences and expressive drawings.

Clarify that it is not a cancer, surgery is not a cure and re-occurrence is common.

Although it is an uncommon condition, they are not isolated cases. Provide guidance and awareness of the psycho-sexual support

available. What the patient needs to bring into hospital – the logistics. Summarize the logistics of the day and housekeeping guidelines on

the ward. Clear information of wound care. Who to approach if there is a problem. Women are likely to look on the internet for further information

therefore direct them to appropriate web-pages. Information for family members.

Factual Information = What’s going on?

Personal Accounts = What are other women thinking?

Expressive drawings = What are other women feeling?

In relation to the expressive drawings…

• 75% of patients gave positive comments.• Of the 25% = graphic nature.

• 37.5% of HCS gave positive comments.• Of the 62.5% = the more expressive drawings.

Part 2: On evaluation Fluent and clear layout. The question/answer layout is effective. Allows women to prepare beforehand and

provides an idea of what to expect. A good guide to allow family members what will

happen.Drawings effective to visualize

what will happen and to could relate to diagnosis in particular.

Answered basic questions regarding psycho-sexual issues.

Most importantly, provided awareness of the support available.

There was a need for a leaflet specific to wide local excision surgery for VIN.

Patients put emphasis on wanting expressive drawings as a way to relate and visualize, awareness of the psycho-sexual support available and a summary of the logistics of the day.

Developed an appropriate and effective leaflet for VIN wide local excision surgical patients.

Leaflet included a new style of artwork courtesy of Jac Saorsa which on the whole, proved effective.

Conclusion

Thank you for listening.

Acknowledgements:

Dr Amanda TristramDr Jac Saorsa

All the patients and Healthcare staff at Llandough Hospital

www.drawingcancer.wordpress.com

1. The NHS Cancer Plan and the New NHS: Providing a Patient-Centred Service. London: NHS Executive; 2004.

2. Hilary Jeffries and Colette Clifford. Searching: The Lived Experience of Women With Cancer of the Vulva. Cancer Nursing; 32:6. 2009.

3. The American College of Obstetricians and Gynaecologists; Committee Opinion. Management of Vulvar Intraepithelial Neoplasia. 118;5 2011.

4. Practise Research Report: Evaluating the patient journey approach to ensure health care is centred on patients. Nursing Times. 2009: 105;22.

5. R.W. Todd, D.M. Luesley, Medical management of vulvar intraepithelial neoplasia, J Low Genit Tract Dis, 9 (4) (2005), pp. 206–212

6. R.W. Jones, D.M. Rowan, Vulvar intraepithelial neoplasia III: a clinical study of the outcome in 113 cases with relation to the later development of invasive vulvar carcinoma, Obstet Gynecol, 84 (5) (1994), pp. 741–745

7. B.L. Andersen, D. Turnquist, J. LaPolla, D. TurnerSexual functioning after treatment of in situ vulvar cancer: preliminary reportObstet Gynecol, 71 (1) (1988), pp. 15–19

8.  B.L. Andersen, N.F. HackerPsychosexual adjustment after vulvar surgeryObstet Gynecol, 62 (4) (1983), pp. 457–462

9.   B. Thuesen, B. Andreasson, J.E. BockSexual function and somatopsychic reactions after local excision of vulvar intra-epithelial neoplasiaActa Obstet Gynecol Scand, 71 (2) (1992), pp. 126–128

References