How available is photobiomodulation for children?
What is the problem?
Photobiomodulation is a red light or low-level laser therapy that can be used to prevent mucositis from occurring during cancer treatment. Photobiomodulation is recommended for children and young people at high risk of developing mucositis during their cancer treatment in international guidance.
Despite being recommended in professional guidance, we knew it was not being used everywhere in the U.K. We completed a survey research study to find out where it was being used. We also asked healthcare professionals what they felt the barriers to using photobiomodulation were.
What we did
We sent a survey around the Children’s Cancer and Leukaemia Group professional network asking about people’s use of photobiomodulation as part of standard care. Professionals who responded were anonymous but told us where they worked. They were asked whether children in their hospital received photobiomodulation, and whether there were any plans to start a photobiomodulation service. They were asked what they felt the challenges were to setting up a photobiomodulation service. We looked at these challenges using a behaviour science approach called the Theoretical Domains Framework. We used this framework to place these challenges into groups, informed by behaviour science theory. We then analysed these challenges before bringing them together into summaries.
What we found
We had a response from all of the 20 Principal Treatment Centres within the Children’s Cancer and Leukaemia Group. We found at that time in 2021, only 2 hospitals in Scotland were delivering photobiomodulation for their patients. Another 3 hospitals were planning on setting up a service.
The main challenges that healthcare professionals faced were:
Healthcare professionals lacked knowledge around photobiomodulation and how to bring it into their services. It was felt that guidance in this area would be helpful for professionals. Where photobiomodulation had been set up successfully, this was with support from staff with previous experience of it.
A need for guidance to address a lack of knowledge about photobiomodulation
There is no consensus on what photobiomodulation training should look like. There are also a wide range of ways to deliver it. This uncertainty and lack of standardisation was a barrier. Healthcare professionals with previous experience of delivering photobiomodulation were helpful in setting up new services.
Staff need access to training for skills acquisition
Setting up photobiomodulation services requires a range of people. This includes equipment manufacturers, families, dental professionals, nurses and doctors. There is a lack of clarity over whose job role photobiomodulation, which is seen as a challenge.
Multiple, well identified groups need to work together towards implementation
Laser photobiomodulation systems require laser safe spaces and specific training which was seen as a barrier. Hospitals need sufficient staff, funding and time to deliver photobiomodulation which was also seen as a challenge.
Resources required for implementation are diverse
Healthcare professionals who are enthusiastic about setting up photobiomodulation services were seen as a key facilitator. Good relationships between medical and dental teams were also reported as being helpful to setting up services. Where there was no dental team present this was seen as a challenge to setting up services.
The influence of different groups on each other is important
There was a concern from healthcare professionals that children and young people (particularly adolescents) might not accept photobiomodulation treatment. This was seen as a barrier in setting up services. Where families saw a benefit to the treatment, this was seen as helpful to setting up services.
Families and professionals need to feel there is a benefit
What did we do with our findings?
We presented this research at national and international conferences to share our findings with healthcare professionals. This included sharing our findings at the British Society of Paediatric Dentistry Conference in 2022, where this work won the Research Prize.
We wrote our findings into a journal article which has been published in the Supportive Care in Cancer Journal for academics to read.
This research shows that photobiomodulation is not widely available for children and young people in the U.K. This limits their ability to benefit from this treatment during their cancer care. It demonstrated that healthcare professionals feel that they need support in setting up these services in terms of knowledge and skills. It showed some of the challenges faced by healthcare professionals in setting up these services. It also highlighted an area of concern around the acceptability of the treatment and inspired us to research this question.