AMPATH Multiple Myeloma Program Adopts Telephone Counselling for Patient Care

Since its inception a decade ago, the AMPATH Multiple Myeloma (MM) Program has significantly improved diagnosis and access to care for patients in western Kenya. The program is now adopting a telephone counselling platform to provide psychosocial support, peer mentoring and patient monitoring.

The AMPATH MM Program was established in 2012 to find, link and retain clients diagnosed with multiple myeloma. The program is achieving its goals through four pillars:

·       Clinical care including diagnosing, treating and following-up with MM clients.

·       Training and sensitization that targets both healthcare clinicians and the community

·       Patient support that assists needy clients in enrolling with the National Health Insurance Fund (NHIF), arranging transportation to the health facility for their clinic appointments, and organizing support group meetings for clients and caregivers.

·       Research and information dissemination which involves publications of manuscripts and engagement in policy development and advocacy.

COVID-19 impeded movement and this presented a challenge to the training sessions for health care providers, survivors and champions. To respond to this challenge, the AMPATH MM program conducted a training facilitated by the Bristol Myers Squibb Foundation (BMSF) Country Lead Dr. Lillian Kimani in June 2022. This training was aimed at ensuring that the program staff and selected patients and caregivers effectively adopt the use of telephone counselling to manage myeloma clients presenting with unique needs.

The telephone counselling platform will facilitate the following services:

Provision of psychosocial counselling to myeloma clients

AMPATH MM team

Chronic illnesses such as multiple myeloma present significant psychosocial burdens to both the client and caregiver, and they need intervention and support for better care outcomes. The program will use telephone counselling techniques to remotely provide psychosocial support to myeloma clients. This will help cut costs related to traveling to health facilities and bring services closer to patients.

Provision of myeloma peer-to-peer mentoring

The AMPATH Multiple Myeloma Program intends to adopt a Myeloma Mentors Program to provide patients and caregivers with the opportunity to connect with trained mentors. These mentors will provide personal experiences as well as counselling to help inform, activate, empower and support other patients and caregivers in the multiple myeloma community. This will be done via telephone. The program also plans to use those trained during this session as trainers of trainees (TOT) in tele-counselling and community sensitization of myeloma.

Utilizing telemedicine platforms to remotely review myeloma clients in remission

Myeloma treatment can take one of three paths: induction therapy to reduce the number of myeloma cells followed by a stem cell transplant and maintenance; induction therapy and maintenance; and palliative (pain and non-curative) care.

Health care workers follow up with patients throughout their journey, personalizing treatment plans for them. In most cases, patients who have achieved remission are given longer return to clinic dates. However, since these patients do not have the disease symptoms while in remission, their adherence to the clinic schedules is poor and they easily get lost to follow-up. Patients often show up at later dates with advanced disease leading to poor survival rates. The program will use the telemedicine platform to remotely review these clients and appropriately link them back to care as soon as it is deemed necessary.

This training also provided a platform to understand the unique issues affecting myeloma caregivers and patients and identified possible interventions for the challenges including:

·       Distance to the health facility

·       Support groups for advocacy

·       Psychosocial oncology counselling

·       Financial constraint

·       Multiple Myeloma sensitization at the community level

·       Remote patient access and consultations during emergencies

The AMPATH MM Program developed the following strategies to address these challenges:

1.     Community remote engagement

High transportation costs, fears of contracting COVID-19 and the overstretched health care facilities can prevent MM patients from accessing the regular follow-up care they need from a hematologist. Tele-counselling is a response strategy to these challenges as it allows task shifting, remote patient and caregiver engagement and follow-up care.

2.     Support group formation

Information is needed at the community level which creates the need to strengthen and build the capacity for MM care in the community. Support groups that are legally identifiable will be created within the stipulated guidelines and home visits will be considered for clients who are lost to follow-up.

3.     Education and training

The program will build capacity for clinical teams to offer service remotely as well as continuous training and sensitization of caregivers and patients.

Other strategic interventions include integrating palliative care services into remote patient community services and developing tools for caregivers to remotely monitor the patients’ progress. The team will also establish a toll-free number for MM patients and develop various tools for patient tracing and follow-up. Further, the program encourages research on remote myeloma patient follow-up and identification to trained myeloma ambassadors.

Read more about multiple myeloma

AMPATH staff and myeloma ambassadors participated in the training.