- Email: [email protected]
112 Understanding the value of the lung cancer nurse specialist
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Poster abstracts, 12th Annual British Thoracic Oncology Group Conference, 2014: Nursing & Supportive Care
and verbal feedback from patients has been good. There have been no adverse clinical incidents as a result of nurse-led follow-up. Conclusion: The establishment of nurse-led thoracic surgical followup clinic is safe and feasible. We feel this has resulted in greater patient satisfaction, a reduction in complaints and has enhanced the training of thoracic surgical registrars by their ability to attend new patient clinic consultations. 109 Creating additional clinic capacity in new lung cancer clinics by use of an advanced nurse practitioner C. Diver *, P. Bhatia, J. Smart, M. Abdelaziz. Tameside Hospital, Fountain Street, Ashton-under-Lyne, OL6 9RW, UK Introduction: Pressure to see suspected lung cancer patients quickly can be challenging with lack of capacity in Consultants clinics. This can be especially difficult during periods of leave. The addition of an Advanced Nurse Practitioner (ANP) may increase the number of appointments available and may provide more scope to see patients urgently. Aim: The aim of this paper is to explain the effect of using the new model on the delivery of the lung cancer service and outcomes for patients at Tameside Hospital. Method: An ANP has skills in medical history taking and clinical examination and is therefore able to make an assessment of new patients suspected of having lung cancer. Using a proforma for assessment ensures that standardised relevant information is obtained. Each case is discussed with the Consultant who formulates a medical plan which is then implemented by the ANP. Clinic capacity over a 2 year period was examined to assess the volume of new suspected lung cancer patients seen and to assess the effectiveness of the ANP in maintaining early accessibility to appointments. Results: The addition of the ANP has increased the number of new appointments per year by 184. During the last year the service expanded by 17% with new referrals increasing from 384 to 450. This meant that we were able to see more patients with no increase in waiting times and that Consultants were able to reduce the number of new patients seen by them. There have been no clinical incidents associated with this new initiative and patients seem to be satisfied. Conclusion: Use of an ANP to assess new patients referred with a suspected lung cancer can help support Consultants by providing additional clinic capacity. As long as each case is overseen directly by a Consultant then patient safety is maintained. A patient survey will be carried out to formally assess satisfaction. 110 Delivering better supportive care to people with lung cancer J. McPhelim1 *, R. Maguire2 , M. Simpson1 . 1 NHS Lanarkshire, UK, 2 University of Surrey, UK Supportive care needs (SCNs) of people with lung cancer (LC) are highly prevalent; yet, are often unrecognised and unmet. Patient Reported Outcome Measures (PROMs) are a way of identifying the SCNs of people with lung cancer in clinical practice. Objectives: To explore the use of PROM’s by lung cancer nurse specialists (LCNS) in the delivery of supportive care to people with LC. Methods: A mixed-methods study design was used. Patients (N = 20) were recruited from 3 sites in Scotland and took part in the study over 3 time-points: baseline (T1), one month (T2), two months (T3). At each time point, patients completed the Sheffield Profile for Assessment and Referral to Care (SPARC) and used the PROM to direct consultations with their LCNS (N = 3). End of study interviews explored patients’/clinicians’ experiences of using the SPARC in the delivery of supportive care. Results: SCNs were highly prevalent at baseline. A significant reduction in overall psychological and spiritual needs from T1 T2,
and family/social and treatment concerns from T1 T3 was recorded. The use of the SPARC resulted in patients disclosing needs that they would not have previously raised and promoted them to ask questions about their condition/care. LCNSs perceived that using the SPARC to guide consultations resulted in patients discussing a wider array of SCNs particularly sensitive issues such as death/dying, concerns regarding family/carers, and sexuality. Conclusion: Our findings demonstrate the feasibility and acceptability of the use of PROMs in the delivery of supportive care to people with LC in clinical practice. 111 A service redesign project addressing lung cancer follow up the Lung Cancer CNS team contribution N. Horne *, H. O’Neil. University Hospital Llandough, Cardiff, UK Background: Within our local service it was highlighted that the number of patients requiring a follow up appointment in the Oncology clinic had increased leading to issues around capacity. Patient waiting times reflect this. It was identified that patients were not always accessing the most appropriate lung cancer follow up for their needs and that the skills of the Lung Cancer CNS were not utilised to their full potential. The follow up service was also shown to have an absence of published follow up guidance. Methods: A one year redesign project was developed in collaboration with Pfizer and some of the core members the Lung Cancer Team. This included the Lung Cancer CNS team, medical, administrative and health board management staff. The project team included an external facilitator who provided access to monthly business meetings with all relevant stakeholders present. Specific involvement from the Lung Cancer CNS team included: CNS team members interviewed individually Each CNS leading allocated workstreams/networking to review external resources/services Questionnaire development, distribution and collation of results Insights training and 360 degree feedback (leadership) Team timeout Results: To date there has been protocol development/guidance: Standardised process for referral Introduction of nurse led clinics × 2 & associated training (e.g. Radiology requesting training) Conclusion: It is too early to evaluate the long term benefits and outcomes of the project. Nevertheless the short term gain is demonstrated in the development of process and protocols for nurse led clinics ensuring appropriate follow up plans for radically treated patients. There has been an opportunity to explore the team roles and develop confidence and skills. This has improved awareness of the individual strengths and created opportunities for all involved. 112 Understanding the value of the lung cancer nurse specialist J. White *. Lead Macmillan Lung Cancer Nurse Specialist and Chair, National Lung Cancer Forum for Nurses, UK Background: The UK National Lung Cancer Forum for Nurses together with the Roy Castle Lung Cancer Foundation have produced a report which aims to showcase the difference Lung Cancer Nurse Specialists (LCNS) make to the lives of patients with lung cancer and their families. Eleven recommendations were made after an examination of peoples experiences of care delivered by LCNSs in addition to LCNSs own accounts of how they help to improve patient outcomes. The recommendations, combined with existing evidence of the positive impact of LCNSs on patient experience from the Cancer Patient Experience Survey and outcomes shown in the National Lung Cancer Audit, builds a compelling picture of the positive value of LCNSs. The report is called Understanding the Value of Lung Cancer Nurse Specialists.
Poster abstracts, 12th Annual British Thoracic Oncology Group Conference, 2014: Nursing & Supportive Care Methods: The National Lung Cancer Audit data was used to gather information about whether patients had been seen by a LCNS and at what point in their pathway. A survey was conducted of patients with lung cancer and their carers with the aim of uncovering people’s experiences of the care delivered by LCNS. A survey of LCNS own accounts of how they help to improve patient outcomes was also undertaken. Information was taken from the Cancer Patient Experience Survey in England to assess the influence that Clinical Nurse Specialists had on the patient’s experience of care. Evidence was analysed from a number of different sources to highlight the potential efficiency savings that LCNS could make due to their role. Results: Results from the Cancer Patient Experience Survey showed that one of the most important findings being that those patients with access to a CNS gave more positive scores of experience than those without. When considering efficiency savings, one study found that service improvments along the lung cancer pathway led by LCNS could release about 10% of cancer expenditure in the area. The National Lung Cancer Audit revealed that around two thirds of patients seen by a LCNS went on to receive active treatment compared to less than a third who did not see a LCNS who were given active treatment. Recommendations from the report: 1. LCNS should be involved in the pre-diagnostic phase of care of suspected patients with lung cancer 2. All national clinical guidelines on lung cancer treatment should reflect the important role played by LCNS 3. NHS Commissioners/providers should ensure that there are sufficient numbers of LCNS 4. All patients should have equitable access to a LCNS at the time of diagnosis 5. LCNS posts should be protected to ensure that patients and their families are offered adequate support 6. LCNS should be provided with necessary resources to aid smoking cessation 7. More research should be undertaken to understand the reasons for the correlation between LCNS input and receipt of active treatment 8. LCNS follow up after treatment should be offered to all patients 9. LCNS should be encouraged to offer nurse led clinics 10. LCNS should be recognised as the patient’s advocate at multidisciplinary team meetings to deliver patient centered care 11. Patients with lung cancer should have access to a LCNS at all stages of their pathway including end-of-life care Conclusion: The report examines the information made available and the role of the LCNS with the aim of helping to understand that vital contribution they make to the delivery of high quality care and to improved outcomes for patients with lung cancer. The report can be found at http://www.roycastle.org/Resources/ Roy%20Castle/Documents/PDF/ UnderstandTheValueOfLungCancerNurseSpecialists_V03.pdf 113 Assisting cancer management by reducing and avoiding hospital admissions: the Nurse Practitioner’s role in the management of malignant pleural effusion M. Eaton-Smith *. Respiratory Nurse Practitioner, Nevill Hall Hospital, Abergavenny, UK Background: Pleural effusions are a frequent presenting feature or complication of advanced cancer. Therapeutic pleural aspiration is often performed in unplanned settings, rushed and by trainee doctors requiring supervision. This can significantly negate a patient’s cancer journey.
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Methods: Over the last seven years, the respiratory nurse practitioner has developed a pioneering independent role, coordinating and providing patient-centred pleural disease service, including management of malignant pleural effusions, thereby enhancing cancer management in patients suitable for more definitive anti-cancer therapies. Results: The respiratory Nurse Practitioner is informed of patients with a suspected pleural effusion from medical practitioners (inpatients or outpatients), oncologists and the lung CNS. Diagnostic ultrasound-guided pleural aspiration is performed by the Nurse Practitioner. Respiratory physicians are informed and a review organised where necessary. Patients are managed as outpatients with personalised plans devised and contact details provided for patient-directed contact. Further intermittent therapeutic pleural aspirations (particularly in patients not suitable for more invasive procedures) are performed at times suitable for patients. The frequency is totally dependent on the individual need, and the Nurse Practitioner can be contacted by the GP, lung CNS, oncology nurse patient or their family. Other management options including thoracoscopic pleurodesis, tunnelled indwelling catheter placement and ward-based pleurodesis are discussed and co-ordinated as indicated by the nurse practitioner. Medical records are updated, managing physicians are informed of progress or problems and the patient avoids unnecessary hospital admissions. Over a 32 month period since January 2011, 718 episodes of care were undertaken with 308 of these being as outpatients. Pleural aspiration was performed on 367 separate occasions for both diagnostic and therapeutic indications with a total volume drained of 232,330 ml. Conclusion: This unique nurse practitioner directed pleural service is efficient, robust and personalised, enabling maximum preservation of quality of life to complement other aspects of cancer management. 114 Lung Cancer CNS role in management of pulmonary nodules: An All Wales Lung Cancer Forum consensus document S. Morgan1,2 *, C.A. Davies1,3 *. 1 Macmillan Lung CNS, UK, 2 Hywel Dda Health Board, UK, 3 Nevill Hall Hospital, Aneurin Bevan University Health Board, UK Introduction: An increasingly high number of new pulmonary nodules are being identified. However, only a small proportion of these nodules are diagnosed as a lung cancer. Whilst it is recognised that patients need support and that appropriate tracking and monitoring of pulmonary nodules is essential. There is uncertainty over the role of the lung cancer team in the management of pulmonary nodules. Method: A workshop was arranged. All lung cancer clinical nurse specialists working within Wales were invited. A patient representative with pulmonary nodule also attended and contributed to discussions. Patient representative comments: “I’m told I don’t have cancer yet I’m given contact details for the lung cancer nurse!” “What are they not telling me?” “This just adds to my worries and concerns!” Results: The All Wales Lung Cancer Forum (AWLCF) agree that the role of the Lung Cancer Nurse Specialist Service (LCNSS) is to support patients and their families whilst undergoing investigation for a suspected lung cancer and following the diagnosis of lung cancer. Following the workshop The AWLCF consensus statement agreed that • At the point when initial investigations are completed by the lung MDT physician and the radiological abnormality is diagnosed as
Poster abstracts, 12th Annual British Thoracic Oncology Group Conference, 2014: Nursing & Supportive Care
and verbal feedback from patients has been good. There have been no adverse clinical incidents as a result of nurse-led follow-up. Conclusion: The establishment of nurse-led thoracic surgical followup clinic is safe and feasible. We feel this has resulted in greater patient satisfaction, a reduction in complaints and has enhanced the training of thoracic surgical registrars by their ability to attend new patient clinic consultations. 109 Creating additional clinic capacity in new lung cancer clinics by use of an advanced nurse practitioner C. Diver *, P. Bhatia, J. Smart, M. Abdelaziz. Tameside Hospital, Fountain Street, Ashton-under-Lyne, OL6 9RW, UK Introduction: Pressure to see suspected lung cancer patients quickly can be challenging with lack of capacity in Consultants clinics. This can be especially difficult during periods of leave. The addition of an Advanced Nurse Practitioner (ANP) may increase the number of appointments available and may provide more scope to see patients urgently. Aim: The aim of this paper is to explain the effect of using the new model on the delivery of the lung cancer service and outcomes for patients at Tameside Hospital. Method: An ANP has skills in medical history taking and clinical examination and is therefore able to make an assessment of new patients suspected of having lung cancer. Using a proforma for assessment ensures that standardised relevant information is obtained. Each case is discussed with the Consultant who formulates a medical plan which is then implemented by the ANP. Clinic capacity over a 2 year period was examined to assess the volume of new suspected lung cancer patients seen and to assess the effectiveness of the ANP in maintaining early accessibility to appointments. Results: The addition of the ANP has increased the number of new appointments per year by 184. During the last year the service expanded by 17% with new referrals increasing from 384 to 450. This meant that we were able to see more patients with no increase in waiting times and that Consultants were able to reduce the number of new patients seen by them. There have been no clinical incidents associated with this new initiative and patients seem to be satisfied. Conclusion: Use of an ANP to assess new patients referred with a suspected lung cancer can help support Consultants by providing additional clinic capacity. As long as each case is overseen directly by a Consultant then patient safety is maintained. A patient survey will be carried out to formally assess satisfaction. 110 Delivering better supportive care to people with lung cancer J. McPhelim1 *, R. Maguire2 , M. Simpson1 . 1 NHS Lanarkshire, UK, 2 University of Surrey, UK Supportive care needs (SCNs) of people with lung cancer (LC) are highly prevalent; yet, are often unrecognised and unmet. Patient Reported Outcome Measures (PROMs) are a way of identifying the SCNs of people with lung cancer in clinical practice. Objectives: To explore the use of PROM’s by lung cancer nurse specialists (LCNS) in the delivery of supportive care to people with LC. Methods: A mixed-methods study design was used. Patients (N = 20) were recruited from 3 sites in Scotland and took part in the study over 3 time-points: baseline (T1), one month (T2), two months (T3). At each time point, patients completed the Sheffield Profile for Assessment and Referral to Care (SPARC) and used the PROM to direct consultations with their LCNS (N = 3). End of study interviews explored patients’/clinicians’ experiences of using the SPARC in the delivery of supportive care. Results: SCNs were highly prevalent at baseline. A significant reduction in overall psychological and spiritual needs from T1 T2,
and family/social and treatment concerns from T1 T3 was recorded. The use of the SPARC resulted in patients disclosing needs that they would not have previously raised and promoted them to ask questions about their condition/care. LCNSs perceived that using the SPARC to guide consultations resulted in patients discussing a wider array of SCNs particularly sensitive issues such as death/dying, concerns regarding family/carers, and sexuality. Conclusion: Our findings demonstrate the feasibility and acceptability of the use of PROMs in the delivery of supportive care to people with LC in clinical practice. 111 A service redesign project addressing lung cancer follow up the Lung Cancer CNS team contribution N. Horne *, H. O’Neil. University Hospital Llandough, Cardiff, UK Background: Within our local service it was highlighted that the number of patients requiring a follow up appointment in the Oncology clinic had increased leading to issues around capacity. Patient waiting times reflect this. It was identified that patients were not always accessing the most appropriate lung cancer follow up for their needs and that the skills of the Lung Cancer CNS were not utilised to their full potential. The follow up service was also shown to have an absence of published follow up guidance. Methods: A one year redesign project was developed in collaboration with Pfizer and some of the core members the Lung Cancer Team. This included the Lung Cancer CNS team, medical, administrative and health board management staff. The project team included an external facilitator who provided access to monthly business meetings with all relevant stakeholders present. Specific involvement from the Lung Cancer CNS team included: CNS team members interviewed individually Each CNS leading allocated workstreams/networking to review external resources/services Questionnaire development, distribution and collation of results Insights training and 360 degree feedback (leadership) Team timeout Results: To date there has been protocol development/guidance: Standardised process for referral Introduction of nurse led clinics × 2 & associated training (e.g. Radiology requesting training) Conclusion: It is too early to evaluate the long term benefits and outcomes of the project. Nevertheless the short term gain is demonstrated in the development of process and protocols for nurse led clinics ensuring appropriate follow up plans for radically treated patients. There has been an opportunity to explore the team roles and develop confidence and skills. This has improved awareness of the individual strengths and created opportunities for all involved. 112 Understanding the value of the lung cancer nurse specialist J. White *. Lead Macmillan Lung Cancer Nurse Specialist and Chair, National Lung Cancer Forum for Nurses, UK Background: The UK National Lung Cancer Forum for Nurses together with the Roy Castle Lung Cancer Foundation have produced a report which aims to showcase the difference Lung Cancer Nurse Specialists (LCNS) make to the lives of patients with lung cancer and their families. Eleven recommendations were made after an examination of peoples experiences of care delivered by LCNSs in addition to LCNSs own accounts of how they help to improve patient outcomes. The recommendations, combined with existing evidence of the positive impact of LCNSs on patient experience from the Cancer Patient Experience Survey and outcomes shown in the National Lung Cancer Audit, builds a compelling picture of the positive value of LCNSs. The report is called Understanding the Value of Lung Cancer Nurse Specialists.
Poster abstracts, 12th Annual British Thoracic Oncology Group Conference, 2014: Nursing & Supportive Care Methods: The National Lung Cancer Audit data was used to gather information about whether patients had been seen by a LCNS and at what point in their pathway. A survey was conducted of patients with lung cancer and their carers with the aim of uncovering people’s experiences of the care delivered by LCNS. A survey of LCNS own accounts of how they help to improve patient outcomes was also undertaken. Information was taken from the Cancer Patient Experience Survey in England to assess the influence that Clinical Nurse Specialists had on the patient’s experience of care. Evidence was analysed from a number of different sources to highlight the potential efficiency savings that LCNS could make due to their role. Results: Results from the Cancer Patient Experience Survey showed that one of the most important findings being that those patients with access to a CNS gave more positive scores of experience than those without. When considering efficiency savings, one study found that service improvments along the lung cancer pathway led by LCNS could release about 10% of cancer expenditure in the area. The National Lung Cancer Audit revealed that around two thirds of patients seen by a LCNS went on to receive active treatment compared to less than a third who did not see a LCNS who were given active treatment. Recommendations from the report: 1. LCNS should be involved in the pre-diagnostic phase of care of suspected patients with lung cancer 2. All national clinical guidelines on lung cancer treatment should reflect the important role played by LCNS 3. NHS Commissioners/providers should ensure that there are sufficient numbers of LCNS 4. All patients should have equitable access to a LCNS at the time of diagnosis 5. LCNS posts should be protected to ensure that patients and their families are offered adequate support 6. LCNS should be provided with necessary resources to aid smoking cessation 7. More research should be undertaken to understand the reasons for the correlation between LCNS input and receipt of active treatment 8. LCNS follow up after treatment should be offered to all patients 9. LCNS should be encouraged to offer nurse led clinics 10. LCNS should be recognised as the patient’s advocate at multidisciplinary team meetings to deliver patient centered care 11. Patients with lung cancer should have access to a LCNS at all stages of their pathway including end-of-life care Conclusion: The report examines the information made available and the role of the LCNS with the aim of helping to understand that vital contribution they make to the delivery of high quality care and to improved outcomes for patients with lung cancer. The report can be found at http://www.roycastle.org/Resources/ Roy%20Castle/Documents/PDF/ UnderstandTheValueOfLungCancerNurseSpecialists_V03.pdf 113 Assisting cancer management by reducing and avoiding hospital admissions: the Nurse Practitioner’s role in the management of malignant pleural effusion M. Eaton-Smith *. Respiratory Nurse Practitioner, Nevill Hall Hospital, Abergavenny, UK Background: Pleural effusions are a frequent presenting feature or complication of advanced cancer. Therapeutic pleural aspiration is often performed in unplanned settings, rushed and by trainee doctors requiring supervision. This can significantly negate a patient’s cancer journey.
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Methods: Over the last seven years, the respiratory nurse practitioner has developed a pioneering independent role, coordinating and providing patient-centred pleural disease service, including management of malignant pleural effusions, thereby enhancing cancer management in patients suitable for more definitive anti-cancer therapies. Results: The respiratory Nurse Practitioner is informed of patients with a suspected pleural effusion from medical practitioners (inpatients or outpatients), oncologists and the lung CNS. Diagnostic ultrasound-guided pleural aspiration is performed by the Nurse Practitioner. Respiratory physicians are informed and a review organised where necessary. Patients are managed as outpatients with personalised plans devised and contact details provided for patient-directed contact. Further intermittent therapeutic pleural aspirations (particularly in patients not suitable for more invasive procedures) are performed at times suitable for patients. The frequency is totally dependent on the individual need, and the Nurse Practitioner can be contacted by the GP, lung CNS, oncology nurse patient or their family. Other management options including thoracoscopic pleurodesis, tunnelled indwelling catheter placement and ward-based pleurodesis are discussed and co-ordinated as indicated by the nurse practitioner. Medical records are updated, managing physicians are informed of progress or problems and the patient avoids unnecessary hospital admissions. Over a 32 month period since January 2011, 718 episodes of care were undertaken with 308 of these being as outpatients. Pleural aspiration was performed on 367 separate occasions for both diagnostic and therapeutic indications with a total volume drained of 232,330 ml. Conclusion: This unique nurse practitioner directed pleural service is efficient, robust and personalised, enabling maximum preservation of quality of life to complement other aspects of cancer management. 114 Lung Cancer CNS role in management of pulmonary nodules: An All Wales Lung Cancer Forum consensus document S. Morgan1,2 *, C.A. Davies1,3 *. 1 Macmillan Lung CNS, UK, 2 Hywel Dda Health Board, UK, 3 Nevill Hall Hospital, Aneurin Bevan University Health Board, UK Introduction: An increasingly high number of new pulmonary nodules are being identified. However, only a small proportion of these nodules are diagnosed as a lung cancer. Whilst it is recognised that patients need support and that appropriate tracking and monitoring of pulmonary nodules is essential. There is uncertainty over the role of the lung cancer team in the management of pulmonary nodules. Method: A workshop was arranged. All lung cancer clinical nurse specialists working within Wales were invited. A patient representative with pulmonary nodule also attended and contributed to discussions. Patient representative comments: “I’m told I don’t have cancer yet I’m given contact details for the lung cancer nurse!” “What are they not telling me?” “This just adds to my worries and concerns!” Results: The All Wales Lung Cancer Forum (AWLCF) agree that the role of the Lung Cancer Nurse Specialist Service (LCNSS) is to support patients and their families whilst undergoing investigation for a suspected lung cancer and following the diagnosis of lung cancer. Following the workshop The AWLCF consensus statement agreed that • At the point when initial investigations are completed by the lung MDT physician and the radiological abnormality is diagnosed as