Kathryn Lubasch, Consultant Genetic Counsellor, OUH NHS Foundation Trust
Kathryn Lubasch was working as a genetic counsellor in the Inherited Cardiac Conditions (ICC) team when she first saw an opportunity to improve patient care through research, and successfully applied for OAHP career development funding to take the idea forward.
“Mental health issues are more common amongst people with ICC than those without,” Kathryn explains, “We rely on referral from the consultants and nurses, but I was concerned that we might not be identifying those most at risk during their visits to the ICC clinic. Sometimes patients will ask for support, but others only open up only in response to certain questions, so they might easily be missed if they don’t get the right prompt.”
Kathryn was aware that cardiologist consultants and nurses have a lot to go through with patients in these clinics already. Her idea was to look for key factors that might help identify patients most likely to benefit from genetic counselling and find an easy and practical method to screen patients in the clinic.
The OAHP funding bought out some of Kathryn’s time to carry out the research, which involved looking back at previous studies with ICC patients and at other research which might be transferable to those conditions.
Kathryn identified the main factors which could help to identify those patients most likely to benefit from extra support.
One is bereavement – as referral to the ICC clinic can be due to the sudden death of someone with an ICC that the family were unaware of. In this situation, not only are family members grieving, but they are feeling anxiety about other family members, especially children, and guilt that they failed the relative they have lost.
Another is changes to lifestyle, as for a keen athlete who is forced to give up the sport that may be central to their lives. Those with implanted cardiac defibrillators are also more likely to suffer from fear and anxiety, due to uncertainty around when the device might activate.
Kathryn also looked at questionnaires that could be used to identify patients who are struggling with their mental health.
“A lot of them were quite involved and would be really useful for a research study to track changes in mental health, but they really weren’t practical to implement in a busy clinic,” she says. “Answering some of the questions could also bring up lots of emotions. I wouldn’t want patients to be in that situation and then not get the support they need there and then, as that could actually be detrimental to their mental health.”
Kathryn’s research identified a verbal assessment tool called BATHE, which she felt would be more appropriate. It takes no more than a few minutes to carry out, though longer if time permits and the patient requires it. The acronym helps the clinician remember the five main questions to cover. B is for background, which a cardiologist or nurse will know already. A is for how the condition is affecting the patient’s life. T is for what troubles them most. H is for how they are handling that, to see what strategies they are using already. And E is for empathy – to show the patient that their concerns and difficulties are being listened to and to offer further support. The aim is that this would help clinicians identify which patients might require treatment for their anxiety and/or referral to genetic counselling.
Although Kathryn is no longer working in ICC, she is in discussions with the current Principal Genetic Counsellor in the team to look at how to introduce BATHE into the clinic, with some clinicians already expressing interest. She has also implemented the tool into her own practice. Kathryn is also hoping to present her findings at the National Conference of the Association of Genetic Nurses and Counsellors next year.
The project has opened up new areas that Kathryn is now keen to look into.
“I naively thought that I’d do a two-year project and come up with an answer,” she says. “But what you come up with is more questions. One that interests me is how to support patients to manage anxiety they may have around exercise, that prevents them from doing prescribed exercise deemed safe for their heart condition. Supporting patients in this way could enable them to increase their activity levels in a safe way that helps both their physical and mental health.
“I felt very supported by my managers, but it was still challenging to carve out the research time each week around my clinical workload. For anyone considering research, I’d recommend setting a fixed day to dedicate to research, almost as if your clinical role was part time. That will enable you to fully immerse yourself in the work and gain the greatest benefit.”