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L. Magee
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ORAL 15 - Outcome Management in Lung Cancer Patients (ID 113)
- Event: WCLC 2015
- Type: Oral Session
- Track: Nursing and Allied Professionals
- Presentations: 2
- Moderators:K. White, M.T. Freeman
- Coordinates: 9/07/2015, 16:45 - 18:15, 102+104+106
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ORAL15.05 - Using Your Voice (UYV) - How to Use Your Nursing Voice at the Multi-Disciplinary Team (MDT) Meeting (ID 1604)
17:28 - 17:39 | Author(s): L. Magee
- Abstract
- Presentation
Background:
The role of the lung cancer nurse specialist (LCNS) varies across the UK, some working within teams and others as lone workers. Each LCNS brings strengths to the role and are individual in their approach. Over several years the National Lung Cancer Audit has highlighted the association between access to a LCNS and receipt of anti-cancer treatment. In 2013, 65.6% of patients who saw a LCNS received anti-cancer treatment, compared to 27.1% of those who did not see a LCNS[1]. A more detailed analysis has been carried out at Sheffield Hallam University Opening doors to treatment[2]. In the time-pressured setting of a MDT meeting it can be difficult to get your point across. This is where a real impact can be achieved in acting as patient advocate. A joint working initiative between Lilly Oncology and the National Lung Cancer Forum For nurses (NLCFN) has developed with the aim to help improve the contribution of the LCNS in the MDT meeting.
Methods:
LCNSs, particularly those new in post, were invited to apply for a place in the first UYV workshops on 6[th] and 7[th] October 2014 in London. Experienced professionals delivered the UYV programme including: - insights training - building confidence in order to effectively represent your patient in the MDT meeting - developing skills to manage challenging conversations - invaluable communication skills and strategies - greater understanding of Performance Status assessment A 12 week reflection period requiring submission of 3 reflective pieces of work followed the workshops. A mentor scheme was facilitated by 4 NLCFN committee members with teleconference calls organised by Lilly Oncology between the participants, their mentor and expert speakers. A final How you were heard closing workshop 19/01/2015, completed the training.
Results:
20 applications were received and all were offered and accepted a place. Formal evaluation of the workshops will be led by the Faculty of Health and Wellbeing, Sheffield Hallam University using mixed methods of data collection and analysis against: - the extent to which the LCNS feels more confident and competent to effectively influence patient outcomes at the MDT as a result of attending the workshop - the potential impact of using this model of training in comparison to other courses Initial feedback evaluation indicates that 100% of the delegates agreed that the programme was of value to their clinical practise and influenced how likely they are to contribute to the MDT. Emergent themes include perceived power relationships, confidence, self-efficacy and self-belief. Increased insight into own and others communication styles has been enlightening, with improved knowledge and confidence in assessing Performance Status. Post course online survey results are awaited which we are keen to share.
Conclusion:
This collaboration has proved very successful and repeat UYV Workshops for 2015 have been planned. Confidence / self-efficacy development for specialist practitioner roles and inter-professional working will be considered for future development. 1. http://www.hqip.org.uk/assets/NCAPOP-Library/NCAPOP-2014-15/HSCICNLCA-2014finalinteractivereport.pdf 2.http://www.shu.ac.uk/research/hsc/sites/shu.ac.uk/files/REVISED%20FINAL%20DRAFT%20GNC%20T%20LCNS%207%203%2014%20(2).pdf
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ORAL15.06 - A Prospective Audit on Smoking Cessation and Lung Cancer Nurse Specialist Intervention within a Thoracic Oncology Service (ID 1605)
17:39 - 17:50 | Author(s): L. Magee
- Abstract
- Presentation
Background:
Lung cancer is the most common smoking-related malignancy in the UK. Smoking cessation can improve survival, treatment efficacy and overall quality of life. The Lung Cancer Nurse Specialist (LCNS) is in a unique position to assess smoking history and the motivation/willingness of the patient to quit. The aim of this audit is to assess the effectiveness of the LCNS at assessing, actioning and documenting the smoking history and smoking cessation input of patients attending the Papworth Thoracic Oncology Service (PATHOS).
Methods:
A formic form was designed to include the audit criterion and aid data collection. Patients attending PATHOS from 01/09/2012 to 07/12/2012, with suspected or confirmed lung cancer, underwent a smoking assessment by one of 6 LCNSs.
Results:
Of 199 patients attending PATHOS 148 were suspected of having primary lung cancer. 118 (80%) had smoking audit forms completed by the LCNS. Of the 30 patients where no audit form was completed, 29 had smoking history recorded in nursing documentation and actioned as appropriate, 1 patient had no smoking history recorded. Expected audit standards of 100% were: All LCNSs (keyworkers) will have level 1 smoking cessation training - 83% (5/6) All patients assessed will have smoking assessment documented in holistic care plan - 80% (118/148) LCNS will discuss with all smokers the benefits of cessation and document - 100% (32/32) All smokers will be offered the NHS leaflet “It’s so much easier since I quit” or individualised Information Prescription and document in holistic assessment care plan - 97% (31/32) All smokers willing to consider quitting will be signposted to a smoking cessation service / GP clinic / National Helpline - 67% (18/27) Via audit forms received 16 (14%) patients never smoked, 70 (59%) ex-smokers, 32 (27%) current smokers. Of the current smokers the mean age to start smoking was 16.5 years. 21 (66%) smoked within 30 minutes of waking, 3 (9%) 31-60 minutes of waking and 8 (25%) after 60 minutes. 27 (84%) of smokers were willing to quit.
Conclusion:
Smoking cessation is an integral part of the LCNS role to help improve clinical outcomes and effectiveness. Meeting patients at various stages of the diagnosis and treatment pathway they are in a privileged position to affect change. Continued skill developments and improved understanding of smoking cessation strategies will increase their effectiveness. Recommendations: All LCNS to complete smoking cessation training level 1 and level 2 training within 1 year with annual update. Use: Ask / Assess / Advise / Assist / Arrange protocol to assist smoking cessation intervention. Nursing notes to include assessment of patient's progress in smoking cessation in order to monitor impact of intervention. Include smoking cessation advice as part of hospital Comissioning for Quality and Innovation (CQUIN).
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P2.09 - Poster Session/ Nursing and Allied Professionals (ID 227)
- Event: WCLC 2015
- Type: Poster
- Track: Nursing and Allied Professionals
- Presentations: 2
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.09-004 - Prospective Audit of Lung Cancer Nurse Specialists Telephone Link Line Call to Surgical Patients 30 Days Post Hospital Discharge (ID 1606)
09:30 - 09:30 | Author(s): L. Magee
- Abstract
Background:
The Lung Cancer Nurse Specialists (LCNS) at Papworth Hospital provide support and information throughout the surgical patient’s pathway. The Thoracic Enhanced Recovery Program has shortened post-operative length-of-stay from 9 days (2010) to 5 days (2013). The aim of this audit was to evaluate the role of a follow up telephone link line call 30 days post-surgery. There is evidence in the literature that telephone contact is beneficial for patients. Patients receive a telephone call from a LCNS within the first week of their discharge and this is considered to be a good means of providing health education and advice, managing symptoms, recognizing complications early and giving reassurance to patients after discharge. However, in order to gain a more detailed account of a patient’s recovery / rehabilitation (particularly visits to A&E, readmissions and complications) it was proposed that a second phone call be made by the LCNS at 30 days post discharge.
Methods:
A data collection spreadsheet was designed. From 01/01/2013 to 31/08/2013 patients following a lung cancer resection received a telephone call from a LCNS, 30 days post-surgical discharge. A holistic assessment of the patient’s needs, and their progress was explored and actioned. Information regarding advice sought, recovery perception and readmission rates were gained.
Results:
101 patients underwent surgery, 93 received a 30 day call (61M/32F). 91 (98%) were aware of whom to contact following discharge and were able to name their LCNS. 73 felt ready for discharge, 11 unsure, 9 not ready (8 unanswered). 37 recovered better than expected, 35 as expected, 15 slower and 6 worse than expected. Post-operative pain was more persistent / severe in thoracotomy patients 48/57 (84%) compared to a video assisted thoracoscopy approach 24/36 (66%). 26 patients required advice for constipation, 7 diarrhoea. 60 breathlessness on exertion, 1 discharged home on oxygen. 10 felt low in mood since discharge. 7 were readmitted within 30days.
Conclusion:
The 30 day post discharge link line call has revealed some areas of self-care needs which appear not to have been fully understood or addressed. Patients were perhaps not able to retain the information. The introduction of a structured pre-operative education program may assist with addressing these issues. Also, active telephone follow ups, initiated by the LCNS, appeared relevant to the problems patients face after discharge. With telephone follow-up information can be reinforced, thereby increasing compliance, and ensuring the physical and emotional comfort of the patient. Limitations to this audit include the use of no nationally recognised quality of life tools / scales. A review of the timing and number of calls to a patient with focus given to pain, constipation and psychological support will help deliver a more comprehensive service.
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P2.09-005 - Living With Lung Cancer - Preferred Sources of Patient Support and Information: The Papworth Experience (ID 1607)
09:30 - 09:30 | Author(s): L. Magee
- Abstract
Background:
Support groups can help to improve patients' coping and mental adjustment to a cancer diagnosis and treatment. They have also been shown to have a positive impact on psychological wellbeing and reduce anxiety and depression. However, at Papworth Hospital (a regional cardio-thoracic centre), it became increasingly difficult to recruit patients to the lung cancer support group. Consequently, before starting any new initiative, the decision was made to disband the group in December 2013 and to identify alternative and beneficial ways of supporting patients.
Methods:
With patient user involvement, a questionnaire was designed Living with lung cancer - how can we help you? From 12/05/2014 to 30/05/2014, 100 questionnaires were distributed to all patients with a confirmed diagnosis of lung cancer who attended a thoracic oncology outpatient clinic. Responses were anonymous and returned to a secure box for review in the audit department.
Results:
81% of the questionnaires were returned. Patients were referred to Papworth from 8 different hospitals in the region. 79% were over 60 years old at diagnosis. 84% recorded a diagnosis within the last 4 years, the remaining recording diagnosis back to 2001. Since diagnosis, the most useful sources of information are listed below as recorded by the patients (please note more than one answer could be selected):
Of those diagnosed within the last 12 months the Lung Cancer Nurse Specialist (LCNS) was the most useful source of information. The questionnaire proposed a number of topics that might be included in some form of additional support of which 34% were interested. The most common request was for information on symptom control (breathlessness and fatigue), relaxation techniques and treatment options. The questionnaire suggested a number of different formats for providing additional support. Of the 27 respondents, 15 (55%) preferred telephone support from a LCNS.Family/ friends 38 Hospital doctor 62 LCNS / key worker 60 GP 32 District nurses 9 Macmillan nurses 9 Hospice 3 Cancer Centre 3
Conclusion:
The LCNS plays a pivotal role in providing relevant information and support. The challenge is to find new and innovative ways that will help to optimize patients’ psychosocial as well as physical wellbeing. Consideration will be given to increasing telephone support to signpost patients to appropriate information on treatment options and symptom control. We plan to audit the effectiveness of LCNS telephone consultations to ascertain the impact on patient wellbeing. Different types of relaxaion techniques such as yoga classes will be explored. Co-ordination of information management within a large geographical area, incorporating many hospitals and local community facilities, is essential.
