This document describes a project to improve vulval surgery patient information at a hospital in the UK. The project involved evaluating the current information available, interviewing past patients and medical staff, and designing a new patient information leaflet. The new leaflet included personal patient experiences, expressive drawings to help patients visualize the procedure, information on post-operative support, and details about the surgery process. The leaflet was well-received in evaluations, providing patients with a better understanding of their procedure and helping to alleviate feelings of isolation.

1. 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)

2. ‘I felt bewildered and
overwhelmed.’
VIN Patient, Llandough Hospital, June 2012

3. Vulval Intraepithelial Neoplasia

4. ‘…the search for information is
generally perceived as a negative
experience [that leads to a]
sense of isolation.’
H. Jeffries and C. Clifford (2009)

5. 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.

6. 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

7. 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.

8. 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.

14. Factual Information = What’s going on?
Personal Accounts = What are other women
thinking?
Expressive drawings = What are other women
feeling?

15. 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.

17. 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.

18.  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

20. Thank you for listening.
Acknowledgements:
Dr Amanda Tristram
Dr Jac Saorsa
All the patients and Healthcare staff at Llandough Hospital
www.drawingcancer.wordpress.c
om

21. 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