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D. Borthwick
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NU02 - Preparing Patients for Treatment (ID 270)
- Event: WCLC 2016
- Type: Nurses Session
- Track: Nurses
- Presentations: 4
- Moderators:D. Borthwick, A. Fraser
- Coordinates: 12/05/2016, 16:00 - 17:30, Schubert 5
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NU02.01 - Preparing Patients for Treatment. Providing Psychosocial Support for Lung Cancer Patients Preparing to Enter Treatment (ID 6453)
16:00 - 16:20 | Author(s): A.C. Škufca Smrdel
- Abstract
- Presentation
Abstract:
Background: Lung cancer and its treatment have a major physical impact, as well as emotional, social, psychological, spiritual, functional and practical challenges and consequences, both for the patient and his relatives. While coping with the disease they become aware of vulnerability and mortality, they are balancing hope and the realisation of mortal danger(1). Preconceptions which patients are harbouring could be an important factor at coping with the lung cancer. Both smokers (or former smokers) and non-smokers are being stigmatised, and lung cancer is connected with stereotype representation of incurable disease(2). Life is never the same as before the diagnosis. In the comprehensive approach to lung cancer, team work is of paramount importance. Beside the standard oncological treatment, for the patient there is a benefit of an early palliative care. This benefit beside better quality of life (due to better quality of life, less depression and less aggressive treatment) confers also an increase of survival(3). Here, the nurse is an important member of comprehensive care team, and is the one spending the greatest amount of time at bedside. Methods: We reviewed the literature and the current clinical practice. Results: In operationalising psychosocial care in oncology many authors are advocating so called tiered approach(4,5). Providing psycho-social support to lung cancer patients is the task of all medical workers included in the multidisciplinary care. And all cancer patients have the basic psycho-social needs, such as informational needs, basic emotional support, adequate communication, screening of needs on on-going basis and the symptom management. Patients experiencing more profound distress or have more unmet needs, should be directed into the specialist care provided by the mental health professionals or other professionals needed. At the psycho-social care of the lung cancer patients entering the treatment, there should be an emphasis on the adequate patient information concerning the disease, planned treatment, side effects and their management, the possibilities of patient’s contribution to the treatment, and also patients’ fears and existential issues should be addressed. It is important for the patient to get as many information as he deems necessary, being careful about the pace the information is given. Despite the amount of information offered in media in the recent time – many of them unfortunately also untested – many patients in their search for information prefer getting information in one-to-one communication with health provider, in relation with whom they are experiencing confidence, safety, care and professionalism(1). It is important to present the information, at the same time accurate and still preserving the hope even in the face of the odious situation, thus giving the patient and his relatives emotional support and strengthening their functional coping strategies. Therefore, medical professionals should develop good communication skills; these are proven to be associated with less unmet needs(6)by the patient and also with the increase of informed decisions regarding treatment(7). In patients with poorer communication skills, assertiveness support can help with the communication with the medical professionals but also with the relatives. The cognitive behavioural therapy strategies can take a pivotal place. Cognitive interventions are focused on the way of thinking about a situation and through it influences the behavioural and emotional response, like cognitive restructuration, helping the patient in development of positive alternative to negative thought, or distraction, changing the patient focus. Behavioural interventions, such as relaxation techniques, can help controlling physiological responses in stressful situations. An important place in the support of patient’s psycho-social needs is taking into consideration emotional and social support. In addition to patient’s relatives, friends and peers, medical workers represent an integral part of it. In the patient’s preparation for treatment, it is important to recognize those experiencing more profound distress or having more unmet needs, thus needing more help. Research has shown that cancer patients are experiencing more physical problems - the most common are pain, dyspnoea, fatigue, cough(8) - and also have more unmet needs than other patients. In excess of 80 % of lung cancer patients are experiencing some degree of psychological distress. This is more than other cancer type patients are experiencing. Depression estimates are ranging between 11 and 44 % and the fear of recurrence is ranging from 5 % up to the 89 %(8). The severity of distress is varying through the process of treatment and rehabilitation; the time of diagnosis is a period during which more patients are entering psycho-social treatment than later during treatment(1,5). With the aim of early recognition of patients with more profound distress, screening procedures are being implemented. Beside different questionnaires, International Psycho-Oncology Society is striving to implement the distress thermometer with 10 grades(9). The psycho-social interventions, performed by mental health professionals are proven to increase wellbeing, improve adjustment and coping, and reduce distress in people with cancer. In the field of psycho-oncology, the most commonly used methods are cognitive behavioural therapy, learning of relaxation skills, psycho education, and also partnership and family therapy(4). Providing psycho-social treatment for patients with more profound distress is connected with multiple challenges. Beside patient recognition and implementation of screening programmes, the next challenge is patient’s compliance, as psychological treatment can for a patient still be stigmata. Despite limited evidence of its efficacy patients prefer emotional and social help from the nurse than from allied professionals, because their medical expertise is seen as an advantage(5). In many healthcare systems the availability of psycho-social treatment, to the patient who needs it in the proper time, and the development of required resources, still in many cases underutilised, is the next challenge. This, despite proven ethical, emotional as well as economic benefits of psycho-social treatment. Conclusion:The nurse is playing one of the crucial roles in comprehensive treatment of lung cancer patients. She is indispensable in providing psycho-social support to the lung cancer patients, preparing to enter treatment. She is providing the basic psycho-social support, such as patient’s need for relevant information, basic emotional support, communication, screening for needs on an ongoing basis, symptom management. She is also pivotal in recognizing patients, experiencing more profound distress or has more unmet needs and can run a screening programme. REFERENCES: 1. Missel M, Pedersen JH, Hendriksen C, Tewes M, Adamsen L. Diagnosis as the First Critical Point in the Treatment Trajectory: An Exploration of Operable Lung Cancer Patients’ Lived Experiences. Cancer Nurs. 2015;38(6):E12-21. 2. Pujol J-L, Mérel J-P, Roth C. How preconceptions about lung cancer treatment interact with medical discourse for patients who accept chemotherapy? Psychooncology. 2016 Jul 23 [cited 2016 Aug 21]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/27449209 Accessed August 20, 2016 3. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–42. 4. Hutchison SD, Steginga SK, Dunn J. The tiered model of psychosocial intervention in cancer: a community based approach. Psychooncology. 2006;15(6):541–6. 5. Brebach R, Sharpe L, Costa DSJ, Rhodes P, Butow P. Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence. Psychooncology. 2016;25(8):882–90. 6. Walling AM, Keating NL, Kahn KL, Dy S, Mack JW, Malin J, et al. Lower Patient Ratings of Physician Communication Are Associated With Unmet Need for Symptom Management in Patients With Lung and Colorectal Cancer. J Oncol Pract. 2016;12(6):e654-69. 7. Janssens A, Kohl S, Michielsen T, Van Langendonck S, Hiddinga BI, van Meerbeeck JP. Illness understanding in patients with advanced lung cancer: curse or blessing? Ann Palliat Med. 2016;5(2):135–8. 8. Pozo CLP, Morgan MAA, Gray JE. Survivorship issues for patients with lung cancer. Cancer Control. 2014;21(1):40–50. 9. Bultz BD. Guide to implementing screening for distress, the 6th vital sign: Background, recommendations, and implementation. Cancer Journey Action Gr. 2009;(May):4–43.
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NU02.02 - Preoperative Thoracic Surgery Patient Education Program Development (ID 6454)
16:20 - 16:40 | Author(s): K.O. Kuhns
- Abstract
- Presentation
Abstract:
Purpose: To develop a cost-effective preoperative patient teaching program that includes a patient teaching video along with written material that improves patient satisfaction, decreases patient anxiety, decreases readmission rates associated with post-operative complications, and optimizes overall outcomes of thoracic surgery patients. Overview: Patients undergoing surgery usually have little knowledge of what to expect during the preoperative, postoperative, and recovery period following thoracic surgery. Multiple studies have shown that good quality preoperative teaching increases patient satisfaction, improves patient outcomes, and decreases patient readmission rates following surgery. Although the benefit of preoperative education is widely recognized in the literature, finding the resources available to provide efficient and effective teaching is a challenge. Patients who are diagnosed with a suspicious lung nodule or lung cancer are usually overwhelmed when attempting to navigate through the health care system. During the initial surgical visit a battery of studies and often additional diagnostic procedures are ordered for staging and surgical clearance. The details of the surgery are discussed and the surgical consent is obtained. The patient and family are inundated with so much information that pre-operative teaching is not effective at this time. Further, in outpatient health care settings there is a finite amount of time within a visit for a provider to promote all of the pre-operative patient education. It has been the experience of this thoracic surgery practice that providing the patients and families an opportunity to undergo pre-operative teaching in another setting, such as in their own homes, typically results in increased retention of the information, and patients do better not only in the pre-operative period but in the post-operative and recovery stages as well. Developing a well-designed preoperative teaching program requires a multidisciplinary approach and utilization of resources already available to build upon and promote better programs that optimize patient and caregiver learning and retention. Pre-operative education and teaching is not just to provide information, but also to help patients acquire the knowledge needed to change behaviors and to promote better health. Individuals within the care team with particular interest in patient education should be utilized in helping to develop an effective preoperative teaching program. Collaborating with nurses and advanced practice providers across the care continuum is ideal: these members of the team have both the knowledge base and the access to patients and their families needed to provide effective patient education. Method: “A Patient’s Guide to Thoracic Surgery” is a thoracic teaching manual that was customized to fit our thoracic patient population. It was developed by a group of nurses and advanced practice providers who were interested in developing thoracic patient education at our institution. The booklet includes basic information concerning how to prepare for thoracic surgery, as well as what to expect before and after the surgery. Our thoracic team saw the need for additional education and developed a patient education video, “A Patient’s Guide to Thoracic Surgery Video” that includes pre-operative teaching, what to expect after surgery, and after discharge. The video was funded by a grant that our hospital provides annually, funding various projects that support research, education, and clinical care. The team wrote a script and worked with the hospital IT department to create the video. Patients receive both the pre-operative teaching booklet and video during the initial office visit and the major points of the teaching material are reviewed at this time. The patient is instructed to read through the information and watch the video at their convenience. They are also encouraged to call the office to discuss what they learned and answer any questions they may have. The outpatient nurse practitioner calls and sometimes meets with the patients at least once again prior to surgery to review the patients’ pre-operative studies, update their pre-operative paperwork, and to answer any questions or concerns about their upcoming surgery. The patients are asked if they have read through the material and watched the video. During this encounter, updates on smoking cessation and exercise are documented and discussed. Following surgery, additional teaching is done by the nursing staff and the teaching video and discharge instructions are again reviewed. Furthermore, the patient is phoned for a “day after discharge” call by a thoracic team member to check on the patient’s progress and answer any questions the patient or family may have. The patients and their families are seen in the office for a post-operative visit usually 2-3 weeks after discharge. A 10 question “Thoracic Video Patient Satisfaction Survey” is completed during this initial post-op visit. This survey asks the patients to rate the educational video on content and how helpful they felt the video was in preparing them for surgery and for what to expect after surgery. Results: A “Thoracic Video Satisfaction Survey” has been given to all patients undergoing thoracic surgery at Penn Presbyterian Medical Center; Philadelphia, Pennsylvania over the past several months. Preliminary results have shown that since the implementation of the thoracic teaching video in conjunction with the written material there has been an increase in patient’s satisfaction and a decrease in anxiety associated with thoracic surgery Conclusion: Providing patients with multi-format education materials and the ability to review them on their own time has proven successful at achieving the stated goals. Moving forward we intend to build upon this resource to improve the patient education program at our institution. Additionally, we hope to conduct a formal research project in conjunction with other institutions such as the University of Maryland to continue to develop thoracic patient education and to help identify which programs work best in promoting patient education and changing behaviors in the thoracic surgery population.
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NU02.03 - Ethical Decision Making (ID 6455)
16:40 - 17:00 | Author(s): S. Ruppert
- Abstract
- Presentation
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Ethical decision making is very important in the context of treatment of cancer patients. These decisions can lead to withdrawal or withholding of life-sustaining therapy, or change the goal of the therapy from curative to palliative. “Do-not-reanimate” or “allow-natural-death” orders are also part of ethical decision making. Sometimes pain treatment is adapted or palliative sedation is started. It is necessary to make these decisions to ensure dignity at the end-of-life, which is a human right. Ethical decision making is usually done state-of-the-art in the context of Palliative Care, which means dialogue with the patient, the next of kin and other health-care-professionals involved in the treatment. The decision making process is structured, documented and can be replicated for everyone. Most of the time, these decisions are made by physicians only, without a dialogue, especially in Austria in hospitals or nursing homes. Sometimes patients are involved, but more often only their relatives. Physicians rarely ask other health-care-professionals for their opinion. End-of-life-decision-making seldom occurs as a structured well documented process. But the fact, that by law physicians have to take the final decision, does not prevent them from listening to and involving the perspective of the different persons concerned. If the discussion stops with the question “Who is allowed to decide?” then decisions would only be made because of having legal authority and not because of ethical reasons. (Vanlaere & Gastmans, 2008, Arndt, 2007) From an ethical perspective these decisions are often decisions between the autonomy of patients and the care of health care professionals. It is crucial to preserve the dignity of the suffering human being. It is a challenge to make reasonable ethical decisions in a context characterized by strong pressure for efficient and flexible organisational structures on the one side and complex values on the other side. (Gastmans & Vanlaere, 2005). It is not always clear what is right and what is wrong, or what is good and what is bad. Sometimes health care professionals, especially physicians, try to avoid these decisions by not to deciding anything, but avoidance is also a decision. Ethical decision making is much more difficult, if the suffering person cannot express his wishes anymore. Then, physicians and other health care professionals, who are included in the decision-making-process, have to find out the person`s wishes. It is very important that ethical decision making is based on indication for treatment, futility and the wish of patient. (Bundeskanzleramt, 2015) Ethical decision making should include all persons involved – physician, patient, relatives, nurses and also, if appropriate pastor or other religious leader, social workers and other health care professionals. The involvement of patients and – if they wish – their next of kin is necessary. Austrian medical guidelines (Valentin et al. 2004) recommended that nurses and other members of the multidisciplinary team had to be involved in such decisions. The decision making process should be structured, documented and - depending on the context – regularly evaluated. Several models exist for ethical decision making and help to guide and structure the dialogues. Individual ethical case conferences could be part of clinical ethical counseling, which also includes ethical education and providing guidelines. (Zentrale Ethikkommission, 2006). Examples of such decision-making-models are the model of Gastmans and Vanlaere (Vanlaere & Gastmans, 2008) based on the personalism and care-ethic, the Nijmwegener-model of Steinkamp and Gordijn (Steinkamp, 2012) and the model of Arndt (2007). Decision-making-models are not simply checklists. Health care professionals have to use them with empathy in the context of their own experience and values. (Körtner, 2012). General guidelines could deviate from frequently arising problems, but there always would be individual cases, which represent marginal cases because they burst all limits (Körtner, 2012). By using decision-making-models health care professionals have to be alert, not to use those strictly according to the written instructions. The sensitivity for the individual and his special situation has to be preserved. A discussion or counselling, where all persons concerned make a choice together according to their values and principles, is the best guarantee for a well-grounded ethical decision and gives more sense of security for a good result. Nevertheless, there is no guarantee for a right or good action. (Körtner, 2012). Because of the emotional burden of end-of-life-decisions, these models are also helpful to include all important aspects. The participants of these dialogues have to respect the values of the others and to see the situation from their point of view. Using decision-making-models guarantees to involve all relevant individuals. Furthermore, the decision making process becomes repeatable and visible. Finally, it is important to mention that ethical-decision-making can’t be reduced to using decision-making-models. Ethical thinking is a result of dynamic mutual reactions between emotions, intuition, standardization and rational reasoning. (Van der Arend & Gastmans, 2009) The role of nurses in this decision making process and also in the realization of these decisions is rarely recognized. But nurses play an important role in ethical decision making - as national (Ruppert et al., 2012) studies show. Nurses have the closest relationship to the patient compared to all health care professionals. They communicate daily with patients, know their problems, emotions, understand the social context and values. Furthermore, nurses execute the end-of-life-decisions, by, for example, not calling the rescue team. Therefore, it is very important, that nurses reflect and create actively their role in the ethical decision making process. They have to know which end-of-life-decisions are available and legal in the country where they work. Furthermore, they need knowledge in nursing ethics and ethical frame conditions of their organisations. Nurses have to become part of the ethical-decision-making; especially, if discussing ethical problem with the help of decision-making-models becomes routine because this has a vital impact on the daily nursing practise. Then nurses get used to reflect their acts, the values and principles laying behind and to involve the perspectives, values and norms of other individuals. If decision-making is consciously trained, it has a positive impact on situations, where reflection isn’t possible. (Arndt, 2007) Literature: Arndt, Marianne (2007): Ethik denken. Maßstäbe zum Handeln in der Pflege. Stuttgart: Thieme Verlag, 2. Unveränderte Auflage. Bundeskanzleramt (2015): Sterben in Würde. Empfehlungen zur Begleitung und Betreuung von Menschen am Lebensende und damit verbundene Fragestellungen. Stellungnahme der Bioethikkommission. Gastmans, Chris & Vanlaere, Linus (2005): Cirkels van zorg. Ethisch omgaan met ouderen. Leuven: Ten Have. Körtner, Ulrich (2012): Grundkurs Pflegeethik. Wien: Facultas Verlag, 2. Auflage. Ruppert Sabine; Heindl Patrik & Kozon Vlastimil (2012): Rolle der Pflege bei ethischen Entscheidungen. In: Imago Hominis 19 (2), S. 97-105. Steinkamp, Norbert (2012): Methoden ethischer Entscheidungsfindung im Pflegealltag. In: Monteverde Settimio (Hrsg.): Handbuch Pflegeethik. Ethisch denken und handeln in den Praxisfeldern der Pflege. Stuttgart: W. Kohlhammer Verlag, S. 175-192. Valentin, Andreas; Druml, Wilfred & Steltzer, Heinz (2004): Konsensuspapier der Intensivmedizinischen Gesellschaften Österreichs (2004): Empfehlungen zum Thema Therapiebegrenzung und -beendigung an Intensivstationen. In: Wiener Klinische Wochenschrift, 116/21-22: 763-767. Van der Arend, Arie & Gastmans, Chris (2009): Ethisch zorg verlenen. Handboek voor de verpleegkundige beroepen. Baarn: Hbuitgevers, 4. korrigierte Druck, 5. Auflage. Vanlaere, Linus & Gastmans, Chris (2008): Een goed gesprek voor een zo goed mogelijke zorg. Een zorgethische en personalistische overlegmethode. In: Tijdschrift voor Gezondheitdszorg en ethiek 18(2), S. 45-49. Zentrale Ethikkommission bei der Bundesärztekammer (2006): Ethikberatung in der klinischen Medizin. Deutsches Ärzteblatt 103 (24): A1703-1707.
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NU02.04 - Discussant (ID 6880)
17:00 - 17:20 | Author(s): H. Titzer
- Abstract
- Presentation
Abstract not provided
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Author 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: 1
- Moderators:M. Culligan, M. Nematollahi
- Coordinates: 12/06/2016, 16:00 - 17:30, Schubert 5
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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): D. Borthwick
- 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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