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M. King
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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: 1
- Moderators:K. White, M.T. Freeman
- Coordinates: 9/07/2015, 16:45 - 18:15, 102+104+106
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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): M. King
- 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: 1
- 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): M. King
- 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.
