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110 Motivations of palliative lung cancer patients to participate in a non-placebo clinical trial (QualFRAG)
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Posters, 10th Annual British Thoracic Oncology Group Conference, 2012: Nursing and Supportive Care
patients with thoracic malignancies, particularly Mesothelioma. Historically however, access to the procedure has been limited across the country and also lack of knowledge about the procedure within the health profession has meant that perhaps patients have missed an opportunity for an effective means of pain control. In order to try and address this situation, collaboration took place between the lung cancer CNS and Consultant in Anaesthesia and pain medicine. Method: A poster was designed and presented at Network level to illustrate the technique of percutaneous cordotomy including discussion regarding the potential side-effects as well as benefits of the procedure to raise awareness and educate the multi-disciplinary lung cancer team of the merits of the procedure. A Percutaneous cordotomy service was established in 2010 within the Arden Network by Dr Hugh Antrobus to offer provision for patients placed geographically within central England. A retrospective audit then took place to determine the effectiveness of the service. Results: In a sample of 15 cancer patients experiencing severe pain intensity and high levels of interference on activities of daily living because of pain, percutaneous cordotomy was successful in improving these symptoms and function in 6 out of 8 patients treated. A crude cost analysis indicated savings that could be increased significantly with early referral suggesting that relief achieved cost less than £20 per patient survival day. Conclusions: Percutaneous cordotomy is an effective, safe and affordable service for adults with unilateral cancer-related pain. Referrals should be encouraged early in the disease process for a more successful uptake and outcome, but a more robust follow-up is needed. Education and raising awareness amongst health care professionals about the procedure and service available should continue. 109 Lung cancer and mesothelioma: the journeys end? An analysis of end of life data for patients diagnosed with a lung cancer or mesothelioma in 2009 S. Summerfield *, J. Thompson, D. Dewsbury. Southport & Ormskirk NHS Trust, Southport, UK Introduction: The End of Life Strategy (July, 2008) acknowledges the important role of identifying people approaching the end of life and initiating discussions about preferences for end of life care. Recently, the NHS End of Life Care Programme has contributed significantly to the roll out of programmes such as the Gold Standard Framework, the Liverpool Care Pathway (LCP) and the Preferred Priorities for Care in order to improve the care and support these patients receive as they are approaching the end of their life. Method: Due to the palliative nature of lung cancer, the lung cancer team was keen to review end of life data to ensure timely, appropriate referrals to support quality end of life care for patients and their carers. We reviewed data for all patients diagnosed with a lung cancer or a mesothelioma in 2009 using the Somerset Cancer Register and Palliative Care team data. In particular survival data to ascertain how many patients die within the first year of diagnosis, referral data to palliative care services and for those who died what end of life tools were used. Results: • 22% of our lung cancer patients died in hospital compared to National End of Life figures of 56%. • Our figures identified 48% of patients diagnosed in 2009 were able to die at home. • 79% referred to palliative care and 59% were referred by lung nurse specialists. • The number of patients whose care was supported utilising end of life tools was reassuring with more than 55% of patients experiencing a more co-ordinated approach to their end of life care.
Conclusion: Early assessment, prompt referral to palliative care services and close collaboration between the palliative care, primary care and chest teams is likely to have contributed to these positive figures 110 Motivations of palliative lung cancer patients to participate in a non-placebo clinical trial (QualFRAG) M. Edwards1 *, S. Sivell1 , E. Harrop1 , A. Nelson1 , K. Hood2 , G. Griffiths3 , A. Byrne1 , B. Moore4 , S. Ahmed1 , S. Noble1 . 1 Marie Curie Palliative Care Research Centre, Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK, 2 South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK, 3 Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK, 4 Cancer Research UK, NISCHR, Cardiff, UK Introduction: Palliative care lung cancer patients are underrepresented in oncology trials and very little is understood about their experiences of participating in clinical trials. The FRAGMATIC trial is the largest lung cancer study in the UK and is investigating the effects of Fragmin (a self-injected anti-coagulant) in patients with lung cancer. This current study (QualFRAG) is a qualitative substudy of the FRAGMATIC trial. QualFRAG aims to explore patients’ experiences of participating in a non-placebo trial, including their motivations to take part. Method: Semi-structured interviews will be held at three time points, with two groups of six to ten patients (12 to 20 in total) recruited from the intervention and control arms of the FRAGMATIC trial. Interview s will be analysed using Interpretative Phenomenological Analysis to identify emergent themes that reflect participants’ lived experience. Results: Preliminary results: Reasons participants’ gave for taking part in this non-placebo trial were divided into altruistic (control arm) and egocentric (intervention arm) motives. Participants seemed to accept the study arm they were allocated to; their reasoning related to their concerns about injecting, the potential treatment benefits and their acceptance of dying. Injecting daily was sometimes met with acceptance (intervention arm) but the idea of injecting was also met with concerns and relief (control arm). Conclusions: Participants’ motivations to participate, in retrospect of randomisation, may be related to their acceptance of the arm they have been allocated to and concerns about injecting. This raises the question as to whether control arm participants are displaying more altruistic motives and concentrating on the negative aspects of injecting as a way of coping with not being allocated to receive additional treatment. 111 The gold standard framework acute hospital pilot and its impact on lung cancer services J. Thompson *, S. Summerfield, D. Dewsbury. Southport & Ormskirk NHS Trust, Southport, Merseyside, UK Introduction: Most lung cancer patients present with advanced disease. Lung cancer patients and their carers not only have to come to terms with a cancer diagnosis but often a poor prognosis as well. It is essential that their care needs are identified quickly & efficiently to provide adequate treatment and support both for them and their carers. The Gold Standard Framework is a systematic common-sense approach widely used in primary care for formalising best practice, so quality end of life care becomes standard for every patient. In 2010, Southport & Ormskirk NHS Trust was involved in GSF Acute Hospital Pilot. Method: Aims of the Gold Standard framework (GSF) Acute Hospital programme: • To improve the hospital experience • Improve cross boundary communication • To reduce hospitalisation by reducing length of stay, rapid discharge and admission avoidance.
Posters, 10th Annual British Thoracic Oncology Group Conference, 2012: Nursing and Supportive Care
patients with thoracic malignancies, particularly Mesothelioma. Historically however, access to the procedure has been limited across the country and also lack of knowledge about the procedure within the health profession has meant that perhaps patients have missed an opportunity for an effective means of pain control. In order to try and address this situation, collaboration took place between the lung cancer CNS and Consultant in Anaesthesia and pain medicine. Method: A poster was designed and presented at Network level to illustrate the technique of percutaneous cordotomy including discussion regarding the potential side-effects as well as benefits of the procedure to raise awareness and educate the multi-disciplinary lung cancer team of the merits of the procedure. A Percutaneous cordotomy service was established in 2010 within the Arden Network by Dr Hugh Antrobus to offer provision for patients placed geographically within central England. A retrospective audit then took place to determine the effectiveness of the service. Results: In a sample of 15 cancer patients experiencing severe pain intensity and high levels of interference on activities of daily living because of pain, percutaneous cordotomy was successful in improving these symptoms and function in 6 out of 8 patients treated. A crude cost analysis indicated savings that could be increased significantly with early referral suggesting that relief achieved cost less than £20 per patient survival day. Conclusions: Percutaneous cordotomy is an effective, safe and affordable service for adults with unilateral cancer-related pain. Referrals should be encouraged early in the disease process for a more successful uptake and outcome, but a more robust follow-up is needed. Education and raising awareness amongst health care professionals about the procedure and service available should continue. 109 Lung cancer and mesothelioma: the journeys end? An analysis of end of life data for patients diagnosed with a lung cancer or mesothelioma in 2009 S. Summerfield *, J. Thompson, D. Dewsbury. Southport & Ormskirk NHS Trust, Southport, UK Introduction: The End of Life Strategy (July, 2008) acknowledges the important role of identifying people approaching the end of life and initiating discussions about preferences for end of life care. Recently, the NHS End of Life Care Programme has contributed significantly to the roll out of programmes such as the Gold Standard Framework, the Liverpool Care Pathway (LCP) and the Preferred Priorities for Care in order to improve the care and support these patients receive as they are approaching the end of their life. Method: Due to the palliative nature of lung cancer, the lung cancer team was keen to review end of life data to ensure timely, appropriate referrals to support quality end of life care for patients and their carers. We reviewed data for all patients diagnosed with a lung cancer or a mesothelioma in 2009 using the Somerset Cancer Register and Palliative Care team data. In particular survival data to ascertain how many patients die within the first year of diagnosis, referral data to palliative care services and for those who died what end of life tools were used. Results: • 22% of our lung cancer patients died in hospital compared to National End of Life figures of 56%. • Our figures identified 48% of patients diagnosed in 2009 were able to die at home. • 79% referred to palliative care and 59% were referred by lung nurse specialists. • The number of patients whose care was supported utilising end of life tools was reassuring with more than 55% of patients experiencing a more co-ordinated approach to their end of life care.
Conclusion: Early assessment, prompt referral to palliative care services and close collaboration between the palliative care, primary care and chest teams is likely to have contributed to these positive figures 110 Motivations of palliative lung cancer patients to participate in a non-placebo clinical trial (QualFRAG) M. Edwards1 *, S. Sivell1 , E. Harrop1 , A. Nelson1 , K. Hood2 , G. Griffiths3 , A. Byrne1 , B. Moore4 , S. Ahmed1 , S. Noble1 . 1 Marie Curie Palliative Care Research Centre, Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK, 2 South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK, 3 Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK, 4 Cancer Research UK, NISCHR, Cardiff, UK Introduction: Palliative care lung cancer patients are underrepresented in oncology trials and very little is understood about their experiences of participating in clinical trials. The FRAGMATIC trial is the largest lung cancer study in the UK and is investigating the effects of Fragmin (a self-injected anti-coagulant) in patients with lung cancer. This current study (QualFRAG) is a qualitative substudy of the FRAGMATIC trial. QualFRAG aims to explore patients’ experiences of participating in a non-placebo trial, including their motivations to take part. Method: Semi-structured interviews will be held at three time points, with two groups of six to ten patients (12 to 20 in total) recruited from the intervention and control arms of the FRAGMATIC trial. Interview s will be analysed using Interpretative Phenomenological Analysis to identify emergent themes that reflect participants’ lived experience. Results: Preliminary results: Reasons participants’ gave for taking part in this non-placebo trial were divided into altruistic (control arm) and egocentric (intervention arm) motives. Participants seemed to accept the study arm they were allocated to; their reasoning related to their concerns about injecting, the potential treatment benefits and their acceptance of dying. Injecting daily was sometimes met with acceptance (intervention arm) but the idea of injecting was also met with concerns and relief (control arm). Conclusions: Participants’ motivations to participate, in retrospect of randomisation, may be related to their acceptance of the arm they have been allocated to and concerns about injecting. This raises the question as to whether control arm participants are displaying more altruistic motives and concentrating on the negative aspects of injecting as a way of coping with not being allocated to receive additional treatment. 111 The gold standard framework acute hospital pilot and its impact on lung cancer services J. Thompson *, S. Summerfield, D. Dewsbury. Southport & Ormskirk NHS Trust, Southport, Merseyside, UK Introduction: Most lung cancer patients present with advanced disease. Lung cancer patients and their carers not only have to come to terms with a cancer diagnosis but often a poor prognosis as well. It is essential that their care needs are identified quickly & efficiently to provide adequate treatment and support both for them and their carers. The Gold Standard Framework is a systematic common-sense approach widely used in primary care for formalising best practice, so quality end of life care becomes standard for every patient. In 2010, Southport & Ormskirk NHS Trust was involved in GSF Acute Hospital Pilot. Method: Aims of the Gold Standard framework (GSF) Acute Hospital programme: • To improve the hospital experience • Improve cross boundary communication • To reduce hospitalisation by reducing length of stay, rapid discharge and admission avoidance.