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  O26 - Support and Palliation II (ID 140)

  • Event: WCLC 2013
  • Type: Oral Abstract Session
  • Track: Nurses
  • Presentations: 1
  • Moderators:J. White, Y. Lai
  • Coordinates: 10/29/2013, 16:15 - 17:45, Bayside 104, Level 1

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    O26.01 - The impact of the lung cancer clinical nurse specialist on access to anti-cancer treatment (ID 1018)

    16:15 - 16:25  |  Author(s): A. McDonnell
    • Abstract
    • Presentation
    • Slides

    Background
    The National Lung Cancer Audit (NLCA) (NHS Information Centre, 2011) reports annually on services provided to 38,000 lung cancer patients in the nited Kingdom (UK). The 2010 NLCA reported that only 58% of lung cancer patients in England and Wales received active treatment (chemotherapy, surgery and radiotherapy), with only 14% of patients receiving surgery. Lung Cancer Nurse Specialists (LCNS) make an important contribution to patient care and patient experience and their input is captured in the audit. The 2010 NLCA revealed a possible association between access to a LCNS and access to treatment: 64% of patients seen by a LCNS received anti-cancer treatment compared to 30% of those who did not (Ford, 2011, The Lancet 2011). The reason for this observation cannot be ascertained from the NCLA data. Thus investigation outside of the audit is required. This study begins that process using case study methodology. The study is funded by a grant from the General Nursing Council Trust. The aims of this study are to explore the role of the LCNS within the lung cancer multi-disciplinary team (MDT), identify ways the LCNS can increase treatment access for people with lung cancer and generaterecommendations for MDTs and for future research.

    Methods
    A collective case study, comprising four individual LCNS in four different lung cancer MDTs (McDonnell, 2012, Stake 1995). LCNS cases were selected on the basis of variation in access to treatment rates and access to a LCNS according to the NLCA data. The four LCNSs also had different models of working within the MDT and patient pathway. Methods included in-depth individual interviews with the LCNS and clinical lead plus four other MDT members, giving a total interview sample of 24. Observation of practice and documentary analysis were also used. Findings will be tested further in group interviews over the summer.

    Results
    These findings provide insight into how the LCNS works across the patient pathway to influence access to treatment, while maintaining patient preference as central to practice. The findings are presented here in four themes: practice approaches, people, places and facilitators, with illustrations of how factors combined to increase or decrease access to treatment. Approaches to LCNS practice identified in the study included negotiating, brokering and co-ordinating in order to maximise treatment access and maintain patient focus. The range of people and places the LCNS works with across different disciplines, services and health sectors means they become the lynchpin to clinical treatment decisions. The study indicates how workload, relationships, job security and organisational structures operate as key facilitators to effective treatment decision making

    Conclusion
    This in-depth qualitative study provides valuable insights into the complex landscape that MDTs operate within and helps to explain why the observed association between seeing a LCNS and access to treatment may occur. The study illustrates the value of qualitative research in understanding quantitative data such as that generated by national registries and audits. Recommendations for MDTs and data capture in the NLCA audit are considered.

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