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31. Advanced Nurse Practitioners – New roles and outcomes in symptomatic breast clinic
S26 29. Challenging current assumptions about the basis of the surgical relationship with new breast cancer patients Helen Beesley1, Sarah Pegman3, Christopher Holcombe1, Peter Salmon2 1 Royal Liverpool & Broadgreen University Hospitals NHS Trust, Liverpool, UK 2 University of Liverpool, Liverpool, UK 3 Clinical Psychology Service for Children, Blackpool, UK Introduction: Cancer clinicians are exhorted to build clinical relationships with their patients over time by using patient-centred communication skills and, in particular, addressing patients’ emotional needs. An alternative view is that patients’ sense of relationship is a response to clinicians’ expertise and authority and therefore is normally present from the start. Method: Following research ethics approval, women (N ¼ 133) over 18 years old and due to undergo surgery for primary breast cancer were recruited consecutively from pre-operative clinics. We measured the intensity of patients’ sense of relationship with their surgeon after their first brief meeting, using a standardised questionnaire (Working Alliance Inventory) in order to compare it with reports published over the last 15 years which used the same questionnaire with patients in other types and stages of clinical relationship. Results: Patients’ alliance (strength of relationship) with their surgeons was very high (mean 6.13, SD 0.8, on a 1e7 scale), after only a relatively brief meeting. Previous reports using the same measurement scale mainly described relationships characterized by many hours of talk addressing patients’ emotional needs. Mean alliance in the present study was nevertheless very high compared to those reports, being at the 90th percentile of those reports. Conclusion: Patients with breast cancer feel an intense sense of relationship with the surgeon from the first meeting, consistent with the view that their sense of relationship arises primarily from their recognition of the surgeon’s expertise and authority. The challenge for surgeons is therefore not usually to ‘build a relationship’ but to recognize and support the sense of relationship that patients have from the start. http://dx.doi.org/10.1016/j.ejso.2015.03.030
ABSTRACTS adequate information either by surgeons or BCN and improve on written information. http://dx.doi.org/10.1016/j.ejso.2015.03.031
31. Advanced Nurse Practitioners e New roles and outcomes in symptomatic breast clinic Janice Brown, Diane Bonnington, Sheila Shokuhi, Monika Kaushik UHL, Leicester, UK Introduction: Advanced Nurse Practitioner (ANP) roles were introduced into a large training hospital’s clinic alongside medical colleagues. The breast unit receives approximately 7280 new referrals per year with a breast symptom. The need to ensure competence of clinical examination was essential to ensure safe practice. Effectiveness of the role needed to be measured to ensure ANPs were working autonomously. Methods: An audit was conducted and data was retrospectively collected from 485 patients’ medical notes post symptomatic clinic visit. Those that had a biopsy were re-audited to correlate the final histology of the biopsy with the overall differential diagnostic score following clinical examination. The inclusion criteria were patients aged 30 years and above, referred by GP with a breast lump. Results: The ANP Team’s clinical assessments were accurate with histology on 189 of 190 patients. The SPRs clinical assessments were accurate on 96 of 106 patients. The Clinical Assistants accurately assessed 102 of 108 patients examined. The Consultants examined 75 of 81 patients accurately. 38% of patients were seen by ANPs of which only 2.8% needed medical review. Conclusion: The audit findings concluded that The ANP role is safe and effective in the symptomatic breast clinic. The concordance of examination and finally histology measured a high level of accuracy. It also proved that ANPs can work autonomously as very few patients required a medical review after assessment by The ANP. http://dx.doi.org/10.1016/j.ejso.2015.03.032
30. Information on breast reconstruction for patients over the age 70. Have we got it right? Vanessa Hewick, Geeta Shetty Peterborough City Hospital, Peterborough, UK Background: Uptake of reconstruction varies across the UK and amongst different age groups. It is common knowledge that older women have a poor uptake. We conducted a survey to assess patients satisfaction with the information received on reconstruction who underwent a mastectomy over the age of 70, between 2011 and 2013. Methodology: An anonymised questionnaire with 18 structured questions was sent to patients who underwent mastectomy with no reconstruction. There is no standard to compare to but we aim to achieve 100% satisfaction. Results: 92 questionnaires were sent with a 56.7% (n51) response rate, average age being 78.5 years. 38 (74.5%) thought they were given the right amount of information about reconstruction before mastectomy but 8 (15.7%) felt it was not. 43 (84.3%) had discussions with either surgeons or breast care nurses (BCN) and 22 (43.1%) also had written information. Only 6 (11.8%) were shown pictures of reconstruction and 27 (52.9%) responded not. 19 (37.2%) said they were not offered the choice of immediate reconstruction and 22 (43.1%) chose not to have reconstruction when they were offered. For 27 (52.9%), cancer treatment was sole priority. 28 (54.9%) were not concerned about cosmetic appearance after mastectomy and 19 (37.2%) worried about the length of recovery and complications. Overall 58.8% (n30) were satisfied with the choices offered, however 6 (11.8%) were very dissatisfied. 38 (74.5%) felt overall care was excellent. Summary/Recommendation: Although 43 (84.3%) discussed reconstruction with surgeons or BCN, only 38 (74.5%) thought they received the right amount of information. We need to ensure all patients receive
32. Patient satisfaction with nurse-led telephone results clinic Jane Farrer, Steven Goh Peterborough and Stamford NHS Hospitals Foundation Trust, Peterborough, UK Introduction: Our unit started conducting breast care nurse (BCN)-led telephone results clinic (TRC) in March 2013. We described our experience and reported patient feedback with this new service. Method: Suitable patients with likely benign results were identified during initial outpatient visit. With the patient’s consent, a pre-determined time slot chosen by the patient was arranged. The telephone conversation was conducted in a quiet environment, with a designated office desk and computer access. Each patient was allocated a 10-minute time slot. A satisfaction survey was performed before the end of the telephone call. Appropriate documentation was completed and filed following the consultation. A patient letter and information leaflet were also posted on request. Results: 48 consecutive patients over a 3-month period were invited to participate in this prospective audit. There were 27 patients from the symptomatic service (56%), and 21 from breast screening (44%). 3 patients declined to participate in the survey. All the remaining 45 patients were completely satisfied with this format of results notification, and with the amount and quality of information given. Discussion: Patients appreciated the choice and convenience of TRC. They have reported savings in time off work, travelling expenses and childcare. Patients do no mind being rung by BCNs, and have a degree of control and flexibility with their appointment. On occasion patients were not contactable on the agreed time and had to be re-rung.
ABSTRACTS adequate information either by surgeons or BCN and improve on written information. http://dx.doi.org/10.1016/j.ejso.2015.03.031
31. Advanced Nurse Practitioners e New roles and outcomes in symptomatic breast clinic Janice Brown, Diane Bonnington, Sheila Shokuhi, Monika Kaushik UHL, Leicester, UK Introduction: Advanced Nurse Practitioner (ANP) roles were introduced into a large training hospital’s clinic alongside medical colleagues. The breast unit receives approximately 7280 new referrals per year with a breast symptom. The need to ensure competence of clinical examination was essential to ensure safe practice. Effectiveness of the role needed to be measured to ensure ANPs were working autonomously. Methods: An audit was conducted and data was retrospectively collected from 485 patients’ medical notes post symptomatic clinic visit. Those that had a biopsy were re-audited to correlate the final histology of the biopsy with the overall differential diagnostic score following clinical examination. The inclusion criteria were patients aged 30 years and above, referred by GP with a breast lump. Results: The ANP Team’s clinical assessments were accurate with histology on 189 of 190 patients. The SPRs clinical assessments were accurate on 96 of 106 patients. The Clinical Assistants accurately assessed 102 of 108 patients examined. The Consultants examined 75 of 81 patients accurately. 38% of patients were seen by ANPs of which only 2.8% needed medical review. Conclusion: The audit findings concluded that The ANP role is safe and effective in the symptomatic breast clinic. The concordance of examination and finally histology measured a high level of accuracy. It also proved that ANPs can work autonomously as very few patients required a medical review after assessment by The ANP. http://dx.doi.org/10.1016/j.ejso.2015.03.032
30. Information on breast reconstruction for patients over the age 70. Have we got it right? Vanessa Hewick, Geeta Shetty Peterborough City Hospital, Peterborough, UK Background: Uptake of reconstruction varies across the UK and amongst different age groups. It is common knowledge that older women have a poor uptake. We conducted a survey to assess patients satisfaction with the information received on reconstruction who underwent a mastectomy over the age of 70, between 2011 and 2013. Methodology: An anonymised questionnaire with 18 structured questions was sent to patients who underwent mastectomy with no reconstruction. There is no standard to compare to but we aim to achieve 100% satisfaction. Results: 92 questionnaires were sent with a 56.7% (n51) response rate, average age being 78.5 years. 38 (74.5%) thought they were given the right amount of information about reconstruction before mastectomy but 8 (15.7%) felt it was not. 43 (84.3%) had discussions with either surgeons or breast care nurses (BCN) and 22 (43.1%) also had written information. Only 6 (11.8%) were shown pictures of reconstruction and 27 (52.9%) responded not. 19 (37.2%) said they were not offered the choice of immediate reconstruction and 22 (43.1%) chose not to have reconstruction when they were offered. For 27 (52.9%), cancer treatment was sole priority. 28 (54.9%) were not concerned about cosmetic appearance after mastectomy and 19 (37.2%) worried about the length of recovery and complications. Overall 58.8% (n30) were satisfied with the choices offered, however 6 (11.8%) were very dissatisfied. 38 (74.5%) felt overall care was excellent. Summary/Recommendation: Although 43 (84.3%) discussed reconstruction with surgeons or BCN, only 38 (74.5%) thought they received the right amount of information. We need to ensure all patients receive
32. Patient satisfaction with nurse-led telephone results clinic Jane Farrer, Steven Goh Peterborough and Stamford NHS Hospitals Foundation Trust, Peterborough, UK Introduction: Our unit started conducting breast care nurse (BCN)-led telephone results clinic (TRC) in March 2013. We described our experience and reported patient feedback with this new service. Method: Suitable patients with likely benign results were identified during initial outpatient visit. With the patient’s consent, a pre-determined time slot chosen by the patient was arranged. The telephone conversation was conducted in a quiet environment, with a designated office desk and computer access. Each patient was allocated a 10-minute time slot. A satisfaction survey was performed before the end of the telephone call. Appropriate documentation was completed and filed following the consultation. A patient letter and information leaflet were also posted on request. Results: 48 consecutive patients over a 3-month period were invited to participate in this prospective audit. There were 27 patients from the symptomatic service (56%), and 21 from breast screening (44%). 3 patients declined to participate in the survey. All the remaining 45 patients were completely satisfied with this format of results notification, and with the amount and quality of information given. Discussion: Patients appreciated the choice and convenience of TRC. They have reported savings in time off work, travelling expenses and childcare. Patients do no mind being rung by BCNs, and have a degree of control and flexibility with their appointment. On occasion patients were not contactable on the agreed time and had to be re-rung.