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3. Elements of Patient Advocacy for Radiographers

The following five elements of patient advocacy put forward by SCoR are presented here to provide a guide to radiographers on the anticipated range of roles which might be undertaken as part of empowering patients in any healthcare environment; bearing in mind that the type and nature of the advocacy role is dependent on context and appropriateness. Radiographers must ensure that they are objective in their dealings with patients and that they do not knowingly or unknowingly manipulate patients into any decisions that the healthcare teams prefer.

  1. Guarding patients’ rights and conserving the patients’ best interests
  2. Protecting/maintaining patients’ autonomy
  3. Protecting patients against any type of malpractice: suspected or blatant
  4. Championing ethical and social justice in the provision of healthcare
  5. Referring patients to the most appropriate service

A selection of real life case studies is also presented below to illustrate particular advocacy roles

3.1 Guarding patients’ rights and conserving the patients’ best interests.

This may be undertaken by acting on behalf of those patients who may be intimidated by the situation they find themselves in or have limited competence or ability to express themselves, examples are:

  1. Representing patients’ values and rights to others
  2. Promoting patients’ health through ensuring appropriateness of examination or treatment
  3. Ensuring any radiation dose is appropriate and if so is kept as low as reasonably achievable
  4. Recognising when patients are too shy to complain or to ask questions or who may be feeling powerless or intimidated by professionals or the environment
  5. Helping patients to communicate with doctors
  6. Recognising in patients the possibility of their illiteracy or poor command of the English language and ensuring their wants are attended to and, in some cases, stating their preferences
  7. Recognising those patients who may be unaware of their right to refuse treatment and supporting those who may choose not to have treatment

Case Study: Radiographer A

An imaging request was received by the radiographer to carry out an abdominal computed tomography (CT) examination on a young woman of 16 years who was an in-patient. The radiographer was concerned about the request as, on reading the clinical details, she saw that an ultrasound examination had already been undertaken. She contacted the ultrasound department to ask about the results of the ultrasound examination and found that a positive diagnosis had been made from the examination.

In light of this knowledge, on querying the CT request with the ward, she was told that a junior doctor had requested the CT scan without referring to the Consultant. The patient did not need the CT scan at all.

Case Study: Radiographer B

A patient undergoing radiotherapy treatment indicated to the radiographer that she knew that she was dying and did not wish to undergo further treatment. She was too shy to tell her Consultant as she thought this decision might upset him and appear to be a reflection on his professional care. The radiographer spoke to the Consultant on the patient’s behalf and her decision was respected by all and treatment subsequently halted.

3.2 Protecting/maintaining patients’ autonomy

Examples are:

  1. Providing appropriate information in order to gain legal and valid informed consent. The radiographer may be the best placed person to provide information to enable the service user to appreciate all options available to them prior to giving consent to an imaging procedure or a course of radiotherapy
  2. Providing sufficient information for patients to take decisions whilst at the same time realising that a requirement to make a decision may be stressful for a patient
  3. Recognising that most individuals are competent to make decisions
  4. Respecting a patient’s decision even if you do not agree with it
  5. Recognising those who may be unable to comprehend instructions so clarifying information and/or instructions

Case Study: Radiographer C

The radiographer was about to undertake a Barium Enema on an elderly lady and in line with normal practice sought to find out what the patient knew about the procedure, provide details and thus be in a position to gain her consent to proceed. The lady indicated that she had thought hard and long about undergoing the examination, had talked it over with her family and decided that she would like to talk to the people who would be doing the enema and explain that now she was here in the department, her choice was not to have the examination.

The radiographer explained that she would have to inform the consultant of this decision. The radiographer also indicated that she would not try to persuade her to continue with the enema at this time.

3.3 Protecting patients against any type of malpractice; suspected or blatant

Examples are:

  1. Identifying illegal, unethical or incompetent behaviour shown to patients by other members of the healthcare team
  2. Reporting any incidents to the most appropriate agency on behalf of a patient or other service user

Malpractice includes negligence, incompetence, unprofessional behaviour, danger to health and safety or the environment and the cover up of any of these.

Please note: Radiographers and others are covered by the Public Interest Disclosure Act (PIDA) 199812 and employing authorities will have a written policy outlining the Act and provide processes and stages for the reporting of suspected malpractice.

Case Study: Radiographer D

During a surgical procedure in theatre at which the radiographer was present to provide radiological services, she heard and witnessed a member of the theatre staff passing inappropriate comments of a sexual nature about the patient about to be placed on the operating couch.

The radiographer thought that such comments were insulting and unprofessional.

The radiographer later reported the incident, using the Employing Authority’s written policy procedure.

3.4 Championing ethical and social justice in the provision of healthcare

Examples are:

  1. Striving for changes in healthcare provision on behalf of individuals, communities and society through a variety of channels eg access to Magnetic Resonance Imaging (MRI) scanning or screening facilities
  2. Ensuring inequalities in the provision of healthcare activities or inconsistencies in care are brought to the attention of the employing authority, are followed up and subsequently corrected
  3. Participating in healthcare policy making activities at local and national level

Case Study: Radiographer E and others

An ultrasound department with long waiting times for non obstetric ultrasound scans was unable to meet the target wait of thirteen weeks despite skill mix and role extension measures being in place. A number of sonographers working with the radiologists and clinical manager implemented a series of measures including: effective DNA (did not attend) and annual leave policies, effective use of clerical staff to free up sonographer time, extending the scanning day to include lunchtime, weekend and evening sessions, effectively managing RIS (radiology information system) data to provide accurate waiting times and the active management of long term waiters.

The results was the reduction in ultrasound waiting times, over the period of a year, for routine non obstetric ultrasound from 28 weeks to 8 weeks and a reduced 'did not attend' rate from 11% to 4%.

McCready D (2007) Reducing Ultrasound Waits Synergy News : SCoR13

3.5 Referring patients to the most appropriate service

Examples are:

  1. In cases of complaint
  2. When it is realised that the patient may benefit from specialised assistance
  3. In the provision of specialist advice through the use of such services as the Patient Advice and Liaison Services.

The Patient Advice and Liaison Services (PALS) was established in response to the Bristol Royal Infirmary inquiry report14 which recommended representation of patient interests on the inside of the NHS at every level.

One of the core functions of PALS is to ‘act as a gateway to appropriate independent advice and advocacy support to local and national sources….’15

The idea is that PALS should support staff at all levels to develop a responsive culture and to see that all members of staff have a role to act as a PAL and not be an alternative to individual staff taking on an advocacy role.

Case Study: Radiographer F

A patient had been attending a radiotherapy department for a six week course of treatment. On the third visit he became very upset and tearful and was reluctant to continue. The radiographer spent a lot of time with the patient who told her that his younger brother had died in a road accident two weeks ago. The patient felt it was unfair that he was still alive despite his condition but that his young brother was dead and that he was having trouble coming to terms with his loss. Both parents were dead so he felt he had no one to turn to. The radiographer contacted the Trust’s PALS and they arranged for bereavement counselling for the patient.

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