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J. Taylor
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P1.10 - Nursing/Palliative Care/Ethics (ID 696)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Nursing/Palliative Care/Ethics
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.10-002 - Outcome of Pilot RCT in Lung Cancer Surgery Patients Receiving Either Preop Carbohydrate & Postop Nutritional Drinks or Water (ID 8405)
09:30 - 09:30 | Author(s): J. Taylor
- Abstract
Background:
In recent thoracic surgical studies, malnutrition and/or weight loss are important risk factors for complications after surgery. However, it is uncertain whether modifying or optimising perioperative nutritional state with oral supplements results in a reduction in complications or malnutrition. Enhanced Recovery After Surgery (ERAS) programmes in non-lung surgery include pre-surgery optimisation with carbohydrate loading drinks and post-surgery nutritional supplements. These interventions have proven highly effective in reducing post-operative complications. No trials have been performed in thoracic surgery to assess the impact.
Method:
Single centre mixed method open label Randomised Controlled Trial (RCT) was conducted to assess the feasibility of carrying out a large multicentre RCT in patients undergoing lung resection. A nutritional intervention regime of preoperative carbohydrate-loading drinks 4x200mls evening before surgery and 2X200mls the morning of surgery, and early postoperative nutritional protein supplement drinks twice a week for 2 weeks was compared to the control group receiving an equivalent volume of water. Trial feasibility measures were collected as primary outcome. Postoperative pulmonary complications were measured using the Melbourne group scale along with additional surgical complications. Visual analogue scores of symptoms, Quality of Recovery score 40, quality of life (EQ-5D-5L) and satisfaction questionnaires were collected at baseline, in hospital, 3-4 weeks and 3 month post-surgery along with hand grip and peak flow. Qualitative semi structured interviews post-surgery were undertaken to assess patient experience of the trial and interventions.
Result:
Feasibility criteria’s were met and the study completed recruitment 5 months ahead of target. All elective lung cancer surgery patients were screened of which 41% (n=64) were randomised over 6 month period. The 2 groups were well balanced and tools used to measure outcome robust. 97% of patients were compliant with nutritional drinks scheduled pre-surgery, 89% of 3 month questionnaires were returned completed. Importantly, qualitative interviews demonstrated that the trial and the intervention were acceptable to patients. Patients felt the questionnaires used captured their experience of recovery from surgery well.
Conclusion:
Current international guidelines for enhanced recovery following thoracic surgery cannot recommend pre or post-operative nutrition because of lack of evidence. We have shown an intervention and a trial design of pre-op carbohydrate-loading and post-surgery supplementation is highly acceptable to patients’ with good compliance to both intervention and trial measures. A large multi-centre clinical trial is required to test clinical efficacy in improving outcomes after surgery.
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P3.10 - Nursing/Palliative Care/Ethics (ID 726)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Nursing/Palliative Care/Ethics
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.10-005 - National UK Thoracic Surgery PPI Group Identify Key Questions in Routine Clinical Care for Further Research (ID 10483)
09:30 - 09:30 | Author(s): J. Taylor
- Abstract
Background:
Patient and public involvement helps us understand and improve healthcare and treatments. A national UK group incorporating patient and carers who have had experience of thoracic surgery was developed in 2016. Involving this group could enhance thoracic surgery research. The aim of this study was to determine from the patient and carer perspective what could be improved with the thoracic surgery pathway to increase satisfaction and care thus enhancing clinical outcomes.
Method:
15 patients and carers from the national Thoracic surgery PPI group were sent a questionnaire via post. This consisted of 10 open ended questions regarding the service, education and advice they received before and after their lung surgery. They were also asked to comment on their experience as an inpatient, at the point of discharge and provide any suggestions for improvement. The questions were semi structured which allowed flexibility to follow up responses. Each questionnaire was analysed using phenomenological approach in order to gather a deep understanding of the patients and carer’s experiences through an inductive method.
Result:
Three themes were gathered from this audit; ambiguity regarding information; continuous need for reassurance, reflection, interpretation, and finally psychological impact. Overwhelmingly patients felt they needed additional advice and information to cope with the physical and more importantly mental changes which affected their daily lives following thoracic surgery.
Conclusion:
It is evident that patient and public involvement in developing ideas for further research in thoracic surgery is invaluable. Their insight and experience can assist healthcare professionals make appropriate improvements to the service for the benefit of future patients. From this audit it is apparent that receiving sufficient information and advice is vital to patient to managing the surgical journey and enhance recovery, interventions to support patients mental health would be of benefit to the patients. In order to achieve further in depth and detailed understanding of patient experiences post thoracic surgery, qualitative methods such as focus groups or interviews should be conducted with a larger sample size.
