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V. Beattie



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    MO27 - Patient Centred Care (ID 141)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      MO27.09 - Guideline for Telephone Follow Up for Patients Undergoing<br /> Thoracic Surgery (ID 1592)

      11:20 - 11:25  |  Author(s): V. Beattie

      • Abstract
      • Presentation
      • Slides

      Background
      Lung cancer affects nearly 41, 500 people per year in the United Kingdom (UK) of which 5000 (12%) will undergo major lung resection for primary lung cancer with approximately 15% of all patients having complications post operatively. Once the patient develops a post surgical pulmonary complication mortality increases from 0.5% to 12%, ITU admission rate increases from 1.5% to 26% and the length of stay increases from 5 to 14 days. The UK National Lung Cancer Forum for Nurses have produced a Guideline for Telephone Follow Up for Patients Undergoing Thoracic Surgery . The aim of the Guideline is to help to provide a telephone follow up service to patients to reduce rates of re-admission and to improve patients satisfaction of their care. The guideline was produced following an audit of patients who had undergone thoracic surgery and a consensus of expert opinion within the thoracic surgical speciality.

      Methods
      In 2012 a retrospective audit of patients who had lung surgery was undertaken by UK National Lung Cancer Forum for Nurses Thoracic Surgical Group (TSG) in 2012 to assess the timing of intervention after discharge and what assessments would be important to patients. Following a literature review, opinions gathered from Thoracic Surgeons (who worked with the TSG members) and other Lung Cancer Nurse Specialists an assessment was made on how best to support patients after lung surgery. The guideline was developed through regular meetings of the TSG and was developed following the audit, literature review and consideration of the expert views provided.

      Results
      The audit data was collected from 147 patients from across four Thoracic Surgical Centres in the UK and received 439 comments and focused specifically on post-operative care. The data showed that the consensus opinion from patients was that a preferred interval for post-operative assessment by telephone was between two and seven days after discharge and provided information on the aspects of care that were important to them. The aspects of care that were important to patients included wound management, pain, breathlessness, activity, anxiety, constipation, fatigue and sleep. Following the literature review and expert opinion gathered from Thoracic Surgeons and Clinical Nurse Specialists the decision was made to produce the Guideline for Telephone Follow Up for Patients Undergoing Thoracic Surgery for which can be used by any health professional. The guideline includes assessment tools and interventions utilising best available evidence to assist in the identification of concerns or problems that a patient may face after thoracic surgery. The full guideline can be found at www.nlcfn.org.uk

      Conclusion
      This guideline aims to help support health professionals in the provision of a follow up service to patients after thoracic surgery. The audit of patients who had undergone lung surgery helped to focus on the problems that patients had identified as being important to them and, together, with best available evidence and expert consensus opinion allowed the development of this guideline. The guideline is being utilised in thoracic centres in the UK and could be adapted for use in other countries.

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    O07 - Supportive and Surgical Care (ID 136)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      O07.05 - Guidelines to Prepare and Support Patients Undergoing a Lung Resection (ID 101)

      11:15 - 11:25  |  Author(s): V. Beattie

      • Abstract
      • Presentation
      • Slides

      Background
      Lung cancer affects nearly 40,000 patients per year in the UK of which 5000 (12%) will undergo major lung resection for primary lung cancer. Approximately 15% of patients will have complications post operatively. Once the patient develops a post surgical pulmonary complication mortality increases from 0.5% to 12%, ITU admission rate increases from 1.5% to 26% and the length of stay increases from 5 to 14 days. A Lack of preparedness prevents patients immediately engaging in post operative activities successfully and can result in an increase in patient’s anxiety, post operative complications and length of stay in hospital. The United Kingdom National Lung Cancer Forum for Nurses Thoracic Surgical Group (TSG) has produced this Guideline to aid health care professionals in the preparation and support of patients undergoing a lung resection with an aim to promote patient self management.

      Methods
      Following a literature review and discussion amongst this specialist group the Guideline was developed focusing on key topic areas and interventions which included: poor nutrition, before and during the healing process is associated with poor wound healing risks of hospital death and pulmonary complications after lung cancer resection are increased by smoking patients who receive a multi-disciplinary rehabilitation and early mobilisation achieve earlier discharge from hospital and significantly reduce in hospital morbidities and complication rates patient’s satisfaction regarding pain management significantly correlates to the preoperative information they have received good quality patient information is vital in reducing patient’s anxiety and improving the overall patient experience

      Results
      The Guideline was developed to support any health professional involved in the provision of care for patients who are undergoing thoracic surgery. The Guideline includes information for health professionals providing examples of current best practice and information for patients. The aim of the Guideline is to support self management, support patients through the surgical pathway, and improve patient outcomes and patient experience. The full guideline can be found at http://www.nlcfn.org.uk/editorimages/Guidelines%20to%20Prepare%20etc.pdf

      Conclusion
      The Guideline is relevant to all patients who are undergoing a lung resection. The Guideline includes a series of broad statements and where necessary local procedures should be developed to complement the guidelines in each clinical area. The Guideline compliments the Surgical Follow Up Guideline also produced by the NLCFN Thoracic Surgical Group.

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    O19 - Support and Palliation I (ID 138)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      O19.05 - Guidance for the Assessment of Patients following Palliative Radiotherapy for Lung Cancer (ID 112)

      11:15 - 11:25  |  Author(s): V. Beattie

      • Abstract
      • Presentation
      • Slides

      Background
      Palliative radiotherapy to the thorax is very effective at managing symptoms and improving quality of life but can also have significant toxicity. Dosing decisions are a balance between potential benefit and toxicity in patients whose prognosis and performance status is poor and who are likely to have multiple co-morbidities and complex causation of symptoms. Observations made by the members of the Uinted Kingdom National Lung Cancer Forum for Nurses (NLCFN) raised concerns that this group of patients may not be receiving optimal intervention and support following palliative radiotherapy. The NLCFN has therefore produced Guidance for the Assessment of Patients following Palliative Radiotherapy for Lung Cancer to aid Lung Cancer Nurse Specialists (LCNS) in the assessment and intervention of patients undergoing low dose palliative radiotherapy for symptoms related to lung cancer and side effects from treatment.

      Methods
      A NLCFN working group was created to analyse the observation of sub-optimal care following palliative radiotherapy. A literature review was undertaken to identify current best evidence and practice. A survey was undertaken to question LCNS, Clinical Oncologists, as well as Radiographers who could provide whether there was a need for such a guideline. 53 responses were received. Following analysis of the survey and discussion within the working group the Guidance for the Assessment of Patients following Palliative Radiotherapy for Lung Cancer was produced. The guidance aims to aid LCNS in the assessment and intervention of patients undergoing low dose palliative radiotherapy for symptoms related to lung cancer and side effects from treatment. Table 1 Figure 1Figure 2Figure 3

      Results
      Following the literature review, although there was significant evidence of toxicity profiles and effects of treatment, there were no examples of how to address the support needs of patients following palliative radiotherapy to the thorax. Of the 53 responses, 75% said that there was a need for the service, 54% were not aware of current practice in radiotherapy follow up support, with 55 % stating that a review should take place between 1 and 2 weeks after treatment. The working group produced the guideline following discussion in relation to these outcomes.

      Conclusion
      The Guidance for the Assessment of Patients following Palliative Radiotherapy for Lung Cancer aims to guide LCNS and the treating teams in the assessment and intervention of patients undergoing low dose palliative radiotherapy for symptoms related to lung cancer. The guideline contains flow charts with recommended interventions together with documentation proforma and Common Toxicity Criteria. In the UK patients are treated in Cancer Centres and often repatriated to secondary care for review and follow-up. The formal assessments provided in the Guidance can be implemented either in the clinic, telephone or home visit. The guideline could be adapted for use in other health care systems other than the UK and can be found at http://www.nlcfn.org.uk/NLCFN-guidelines.htm

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

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