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M. Nematollahi
Moderator of
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OA14 - Nurses in Care for Lung Cancer and in Research (ID 398)
- Event: WCLC 2016
- Type: Oral Session
- Track: Nurses
- Presentations: 8
- Moderators:M. Culligan, M. Nematollahi
- Coordinates: 12/06/2016, 16:00 - 17:30, Schubert 5
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- Abstract
- Presentation
Background:
The advanced practice nurse in lung cancer (APNLC) has shown to play a key role in meeting the complex supportive care needs of patients with lung cancer. Nurses working in novel advanced practice nursing (APN) roles encounter a range of barriers to effective practice particularly in countries without an existing regulation of these novel roles. Being accepted by patients and healthcare professionals (HCPs) is fundamental for successful role implementation. The University Hospital of Lausanne (CHUV) was the first comprehensive cancer center in Switzerland to integrate an APNLC into the specialized multidisciplinary team (MDT) of the thoracic cancer center. To overcome barriers to implementing the APNLC role and promote its long-term viability, we aimed to explore the acceptability of this novel APNLC role from the perspective of the MDT and the patients cared for by the APNLC.
Methods:
This qualitative study was part of a larger implementation study (ClinicalTrials.gov, Number: NCT02362204). During summer 2015, we conducted focus groups and semi-structured interviews in the thoracic cancer center of CHUV. Participants were purposefully sampled and included patients with lung cancer (n=4) and HCPs from the MDT [physicians (n=6), nurses (n=5)], a social worker and the APNLC. Semi-structured individual interviews were conducted to examine the perspectives of patients and the APNLC alike. Focus groups were employed to gather perspectives from the MDT. Data were analyzed using thematic content analysis.
Results:
Three main themes emerged describing the acceptability of the APNLC: “role identification”, “role-specific contribution” and “flexible service provision”. Physicians and patients identified the specific APNLC role within the MDT. In particular, they valued specific contributions to continuity of care, psychosocial support and self-management of symptoms. Nurses perceived the APNLC role as overlapping with the traditional oncology nurse role. They were concerned about losing part of their traditional role. Flexibility in service provision was seen as strength of the APNLC role yet also posed organizational challenges related to the work-load.
Conclusion:
The new APNLC role appears to be well-accepted by patients and physicians. Barriers identified during the implementation of the APNLC role were primarily related to intra-professional and organizational challenges. The intra-professional role tension could challenge effective role implementation. To maximize the acceptability of a new APNLC role - particularly in countries that are in an early stage of APN role development - we recommend formalizing nursing role expectations, providing appropriate support/resources and promoting a national plan for APN accreditation and certification.
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OA14.02 - Nursing and Allied Healthcare Practitioner Driven Initiative to Develop an Integrated Educational and Assessment Program for Immunotherapy (ID 5716)
16:10 - 16:20 | Author(s): M. Davies, L. Barbarotta, R. Abramovitz, L. Cardone, F. Corolla, M. Randall-Doran, M. Fradkin, S. Kulakowski, K. Guttmann, S. Okon, L. Tuttle, E. Duffield
- Abstract
- Presentation
Background:
Immunotherapy is rapidly becoming recognized as the fourth pillar of treatment for lung cancer. As an academic center of excellence, our staff have developed expertise with immune-oncology (I-O) agents though clinical trials. Currently two agents (Nivolumab and Pembrolizumab) have been FDA-approved for the treatment of lung cancer. Variability existed in patient assessment, patient education and staff education regarding how to identify and manage immune-related adverse events (IrAEs).
Methods:
Initial evaluation consisted of an online staff survey and interviews to assess the educational materials available for instruction of both patients and staff. A review of existing educational materials was conducted to determine the breadth of information available as well as knowledge gaps. The evaluation revealed a lack of standardization, with inconsistency in the educational messages being delivered. A focused working group including CNS, APRNs, Pharmacists and RNs from the academic hub and broader community care center network was convened with the goal of developing educational platforms for nursing staff as well as patients. Bringing stakeholders together was felt to be important to increase buy-in across the spectrum of care locations, as well as to ensure that the program was effective and appropriate for all sites. Program components included the following: -Education for staff to better identify and manage IrAEs -Development of an electronic nursing flow-sheet to standardize patient assessment and document IrAEs in the lung cancer population. -Automatic notification through the EMR to alert staff in non-oncology settings regarding I-O patients. -Development of a forum for patient education to better understand I-O therapy and how to identify and manage IrAEs. - Development of lung cancer specific telephone triage guidelines
Results:
The outcomes of implementing the I-O program include increased patient participation in educational forums and improved patient satisfaction metrics. Incorporation of the I-O assessment flow-sheet and telephone triage guidelines will improve staff competency, as well as standardize documentation and monitoring of IrAEs. These metrics will allow for more accurate tracking of IrAes throughout the course of treatment.
Conclusion:
The I-O Integrated Education and Assessment Program standardizes practice across all oncology care delivery sites within our network. This program allows patients to receive the highest level of care at convenient regional locations closer to home, with the goal of maintaining patient safety while maximizing the benefit they may receive from I-O therapies. An integrated
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OA14.03 - Integrating Therapies into a Specialist Lung Cancer Nursing Team: An Evaluation (ID 5057)
16:20 - 16:30 | Author(s): C. Brimacombe, H. Ball
- Abstract
- Presentation
Background:
A diagnosis of advanced lung cancer inevitably results in deterioration in both health and functional status. This threatens a person’s independence and dignity and can be a burden to their family and carers. The lung cancer nursing team at Oxford identified a lack of timely therapy provision for their patient group and sought to improve this, concluding that having an occupational therapist (OT) in the team would significantly expand/diversify the service that could be offered to patients. Lung cancer therapy goals were identified as a) working with patients and carers to anticipate functional need rather than waiting for a crisis to occur b) providing a rapid, flexible and responsive service to those with existing needs and c) working in a keyworker role outside of traditional therapy expertise supporting patients at diagnosis, making treatment decisions and providing information .
Methods:
Funding was obtained from Macmillan Cancer Support for a three year project looking at delivering a new model of care. An Advanced Therapist Practitioner (ATP) with an OT background was recruited and embedded into the nursing team full time. Referrals were received from all members of the lung cancer MDT, the inpatient team, primary and palliative care. Interventions included home assessment, outpatient clinic review, breathlessness and anxiety management, provision of aids, support, education and advice.
Results:
Data was gathered from a one year period when there were 305 new lung cancer diagnoses. 165 (54%) patients had identified therapy needs. A further 40 (13%) patients were seen by the ATP as part of her generic keyworker role. 205 referrals resulted in a total of 1005 interventions averaging 5 per person. Interventions were allocated to three levels ranging from simple telephone calls and liaison to complex case management. Average time from referral to first contact with the patient was half a day. The value of the role was measured in three ways: User Feedback Event, Satisfaction Questionnaire and a Stakeholder Questionnaire. Outcomes were overwhelmingly positive.
Conclusion:
Lung cancer patients have high functional needs. An ATP can become an integral part of traditional specialist nursing teams, is able to work in a keyworker capacity and is well accepted and used by the lung cancer MDT. The ATP role provides a strong bridge between primary and secondary care environments and preserves independence and dignity for longer. Evidence from users and stakeholders demonstrated high levels of satisfaction and quality of care.
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OA14.04 - Discussant for OA14.01, OA14.02, OA14.03 (ID 7093)
16:30 - 16:45 | Author(s): B. Eaby-Sandy
- Abstract
- Presentation
Abstract not provided
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OA14.05 - A Framework to Support the Lung Cancer Nurse Specialist in the Development and Evaluation of Nurse-Led Clinics (ID 6030)
16:45 - 16:55 | Author(s): S. Morgan, S. Savory, J. Draffan, V. Beattie, J. Roberts, D. Borthwick, J. Morley, S. Bolton, J. Fenemore, S. Field, C. Thomas, P. Rees, K. Davies, S. Vizor
- Abstract
- Presentation
Background:
The United Kingdom National Lung Cancer Forum for Nurses Workshop 2015 produced guidance to support Lung Cancer nurse Specialists in developing and evaluating nurse-led clinics. Nurse-led clinics have been in existence for years with little guidance on structure and evaluation. They are safe and effective. Nurses provide individual care that makes a difference to patient outcomes. There is vast evidence available for nurse-led services but significantly less on lung cancer specific services despite a growing body of evidence to support this.
Methods:
A literature search was performed. This included developing a lung cancer nurse-led clinic, evaluation, audit tool and measurement. The initial search found limited number of relevant documents. Therefore the search was widened to include developing general nurse-led services. The NLCFN members were surveyed to evaluate current nurse-led clinics. The questionnaire comprised of eighteen questions incorporating all aspects of nurse-led follow up.
Results:
60% responded, suggesting a high interest in the area. Over half of the respondents ran nurse-led clinics. These included telephone, results, post-surgery, Health & Well being, TKI and breathlessness clinic. However 67% had not evaluated or audited these, 74% didn’t have patient information leaflets and 96% had access to medical cover. The seven most important steps in developing a lung cancer nurse-led clinic are: Aims and Objectives, Planning and Consultation, Multidisciplinary Support, Infrastructure, promoting the nurse-led service, Professional Development and Audit and Evaluation. These formed the basis of this framework.
Conclusion:
NICE (2011), suggests that patients should be offered a “follow-up led by a LCNS” . However, nurse-led clinics are challenging and there are many practical and emotional hurdles to be overcome. This framework supports LCNS’s in developing and evaluating nurse-led clinics . It gives clear guidance to be considered when developing and new service as well as advising on audit/evaluation tools and developing patient information leaflets.
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OA14.06 - The Role of a Multi-Disciplinary Team Approach to Early Rehabilitation and Symptom Management in Thoracic Oncology (ID 5013)
16:55 - 17:05 | Author(s): P. Labuc, T. Fynmore
- Abstract
- Presentation
Background:
In the United Kingdom thoracic cancer is mainly diagnosed in an older population, who generally have significant co-morbidities, and advanced stage disease. Due to this, they experiences high levels of disease burden, both physical and psychological, impacting on individuals’ functional independence and quality of life (QoL). The national governing bodies, such as NICE and LCA, recommend that all patients should have access to an Holistic Needs Assessment (HNA) and rehabilitation services. At Guy's And St Thomas' NHS Foundation Trust (GSTFT) we have developed a multi-disciplinary team (MDT), consisting of Dietetics, Occupational Therapy (OT) and Physiotherapy (PT), who are present within the outpatient thoracic oncology clinics and aim to address the rehabilitation and supportive care needs of all patients.
Methods:
All new thoracic oncology patients attending outpatient consultant lead clinics at GSTFT were offered an HNA, in order to identify their individual concerns/needs. The assessments are completed by the MDT and individual intervention plans created. Over a three-month period, January to March 2015, data was collected on patient's diagnosis, treatment offered, treatment intent, symptom concerns, QoL indicators, onward MDT referrals and mortality.
Results:
82 patients completed the assessments, of these 85% reported unmet needs/concerns. The main tumour types seen were Adenocarcinoma, Squamous cell carcinoma, mesothelioma and small cell lung cancer. Of those reporting symptoms the most common were; breathlessness (55%), fatigue (52%), reduced appetite (43%), weight loss (41%), pain (37%), emotions/mood (33%). sleep concerns (33%), and reduced mobility (32%). 69 patients had onward referrals to supportive care services. The most common referrals were; OT (65%), PT (60%), Dietitian (43%), and patient information (38%). 66% of patients were provided with on the spot MDT intervention.
Conclusion:
Providing thoracic oncology patients access to an MDT service on their initial oncology visit, has enabled early identification of the key symptoms this patient group experience, as well as the need for allied health services. This has supported the role of early rehabilitation as being integral to improving patient's level of symptom burden and QoL. Moving forward it would be beneficial to do a comparative study of the symptoms and intervention needs of this patient group over a longitudinal analysis, with the aim of showing the impact of early rehabilitation on patient's QoL, survivorship, and life expectancy.
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OA14.07 - The Relationship between Lung Cancer Stigma and Patient Reported Outcomes (ID 6379)
17:05 - 17:15 | Author(s): R. Maguire, L. Lewis, J. McPhelim, J.K. Cataldo, R. Milroy, K. Woods, M. Perham
- Abstract
- Presentation
Background:
Patients with lung cancer (LC) report lower quality of life (QoL) and higher levels of psychological distress compared to other cancer populations (Hewitt et al, 2013). Lung cancer stigma (LCS) may in part explain these findings. Evidence from studies in the Unites States has shown associations between LCS and lower QoL, higher symptom burden and higher levels of anxiety and depression (Cataldo et al, 2013). Whether these associations exist in people diagnosed with LC in the United Kingdom is unknown. Therefore this study explored the prevalence of LCS and its relationship with patient outcomes as well as QoL in a Scottish population.
Methods:
This study was a cross-sectional study. Patients (n=201) diagnosed with LC were recruited by health care professionals at follow-up clinics at four hospitals in Scotland. Participants completed questionnaires to collect demographic data and assess perceived LCS, QoL, symptom severity and level of depression. Clinical data was collected by casenote review. Bivariate correlations were performed to investigate the relationships between stigma, demographics, and patient outcomes. Multiple regression further explored the individual contributions of LCS on symptom burden and quality of life.
Results:
Participants had a mean age of 69 years (range 41-89 years), 46.8% were males, 92.0% were ever smokers, 17.9% current smokers. The mean LCS score was 53.1 (SD=14.1, range 31-124,). There were significant correlations between higher LCS and age (r= -0.28, p<0.001), being a current smoker (r= 0.17, p<0.05), deprivation index (r=0.15, p<0.05) depression (r=0.40, p<0.001), symptom burden (r=2.60, p<0.001), and QoL (r= - 0.52, p<0.001). Multiple regression revealed an overall model that explained 30.6% of the total variance of stigma (F=14.82, p<0.001). Perceived stigma also accounted for significant unique variance in QoL (4.3%, p<0.001) and depression (3.6%, p<0.001) above and beyond that accounted for by relevant variables. No contribution of stigma on symptom burden was found.
Conclusion:
Stigma was correlated with depression, and QoL. Therefore, it is expected that depression and stigma share some of the explanation of variance of QoL. Nevertheless, stigma was found to have a unique contribution on QoL, and on depression. With this in mind, management of patients with LC could determine the patients’ experience of stigma to tailor treatment plans to improve QoL and psychosocial outcomes. Being younger was correlated with higher LCS. This might reflect changed attitudes toward smoking due to changed marketing strategies in the 1960s.
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OA14.08 - Discussant for OA14.05, OA14.06, OA14.07 (ID 7094)
17:15 - 17:30 | Author(s): M. Duffy
- Abstract
- Presentation
Abstract not provided
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