- Email: [email protected]
O-158 Educating specialist lung cancer nurses
S48
Oml Sessions/The
Interdisciplinary
Team und Care oj’People with Lung Cancer
instrumental in introducing the use of Clinical Pathways, which allow early detection of problems. The rapport of the LN with patients has facilitated the recruitment of patients for Clinical Trials. The position of LN has now been made permanent as the Unit has been able to show a reduction in length-of-stay yet an increase in patient satisfaction following introduction of the position.
Developing Role of the Lung Cancer Nurse IYI0 157 Jane Clare Kellv’, Michele Carmel Golden’, Fliss Murtagh3. ‘Lung Nurse Specialist-Department of Palliative Care, London, UK; ‘Lung Nurse Specialist/Department Palliative Care, London, UK; 3 Department Palliative Care, London, UK Introduction: The United Kingdom (UK) National Cancer Plan (Department of Health, 2000) recommends multi-professional team working to enhance the care of lung cancer patients. The role of the nurse specialist is crucial to this team. The numbers of nurse specialists in this role are increasing in line with recent government recommendations (Calman-Hine, 1995), but the role has been little evaluated. Aim: To record and analyse the role of the nurse specialist in this team context. Objectives: 1. To describe the role of the nurse specialist in relation to these patientsa. To identify the specific contributions of the nurse specialist within the team3. To propose what this developing role has achieved for patient careMethod:A retrospective audit of the hospital Lung Cancer Database was undertaken to identify all patients seen by the team in the twelve months from January 2002. The amount and specific roles of the nurse specialist in relation to each patient contact was identified. Data was then synthesized to understand the different contacts undertaken, the nature of those contacts, and the contribution of this to overall team working and provision of a seamless service to the patient. Results: 340 patients were seen in this twelve month period in the Lung Cancer Clinic. of these, 172 had a confirmed diagnosis of Lung Cancer. 1748 patient contacts with the nurse specialist occurred. The nature and length of these contacts was analysed and will be presented, detailing the components of information-giving, information-gathering, team liaison, symptom control, psychosocial support and treatment facilitation. Conclusion: This audit provides evidence of the extensive and developing role of the nurse specialist as a vital member of the multi-disciplinary team. The role is key in ensuring the patient has a single point of contact to facilitate information flow between the patient and team. 0 158
Educating specialist Lung Cancer Nurses
I Paul Mitchell’, Annette Street’. ‘Austin and Repatriation Medical Centre, Melbourne, Australia; ‘La Trobe University, Melbourne, Australia This paper reports on an Australian initiative to provide lung cancer nurses with a distance educational program and relevant ongoing support and resources. The aim of the program is to improve the knowledge, attitudes and skills of nurses caring for people with lung cancer. The program derives from La Trobe University (LTU) Nursing Clinical School, Cancer and Palliative Care Studies Unit and the Cancer Council of Victoria (CCV). These organisations have previously conducted similar highly successful educational programs for breast care and prostate care. These courses have been evaluated by the CCV and found to meet the needs of nurses, with incidental feedback suggesting that they are also improving patient outcomes. The lung cancer course consists of ten modules conducted over a thirteen-week period. The primary objectives of this program are to prepare nurses to provide more targeted assessment, early detection of problems, provision of accurate information, an increased role in health promotion and provision of skilled nursing care to people and their families affected by lung cancer. The educational package includes study notes, relevant literature, a resource CD and on-line resources. Weekly assessment exercises enable the nurses to review their understanding of the content material and educational support is provide by email, teleconference and a one day orientation to the subject. The course material has been written by a range of specialists in the field and expert lung cancer nurse practitioners. The program is being evaluated to assess the overall impact on the knowledge and competencies of the nurses and the impact on the patient care. It is envisaged that a long-term outcomes of the program will be that nurses are equipped to pursue further education; the establishment of a lung cancer nurses network to foster participation in research, and that the network would provide support and mentorship.
I0
159
The McGill University Lung Cancer Nutrition and Rehabilitation Program: A Novel Interdisciplinary Approach
Sarah Thirlwell’, Mary-Ann Dalzel12, Antonio Vigano2, Harvey Kreisman3, David Smal14, Neil MacDonald*. ‘Sir Morlimer 9. Davis-Jewish Genera/ Hospital of Montreal, Department of Pulmonary Diseases, Montreal, Canada; a McGill University: Department of Oncology Monireal, Canada; 3 Sir Mortimer B. Davis-Jewish General Hospital, Deparhent of Pulmonary Diseases, Montreal, Canada; 4 Sir Mortimer D. Davis-Jewish General Hospital, Department of Pulmonary Diseases, Montreal, Canada Cachexia, anorexia and asthenia are commonly present in patients with advanced lung cancer and contribute directly to morbidity, mortality and impaired quality of life. We have instituted the McGill University Lung Cancer Nutrition and Rehabilitation Program for patients with advanced lung cancer. The interdisciplinary team includes two physicians, a physiotherapist, a clinical nurse specialist and a dietitian. The program is offered to those patients with loss of weight and/or function who are referred by the pulmonary oncology team. In 2002, 37 patients (21 males, 16 females) were seen. Almost all patients had stage 4 non-small cell lung cancer and all were receiving standard care including chemotherapy, radiotherapy or supportive care. Comprehensive evaluation included symptom, nutritional, functional, nursing and laboratory domains and was followed by counselling about nutrition and exercise. 57% of patients had decreased appetite and 63% had weight loss (mean 7 kg). Using the Edmonton Symptom Assessment System (ESAS), moderate to severe symptoms (score >4/10) were asthenia (61%), anorexia (48%), decreased quality of life (44%), dyspnea (40%), somnolence (39%), insomnia (37%), depression (33%), anxiety (32%), pain (32%), constipation (28%), nausea (14%) and vomiting (1%). 75% of patients reported decreased activity and fatigue with components of muscle fatigue (66%), motivational fatigue (42%), and cognitive fatigue (33%). The nutritional recommendations included a dietary pamphlet and education (75%), multivitamin supplementation (77%), eicosopentanoic acid supplementation (74%), and metoclopramide (53%). Appetite stimulants (12%), zinc for altered taste (7%) and mycostatin for oral candidiasis (4%) were used infrequently. Forty-one percent of those offered physiotherapy were followed either in a special clinic (19%) or via home visits (22%); 59% of patients declined to participate. Ten of 37 patients evaluated initially were seen in follow-up; of these, 7 maintained or increased their weight and noted increased strength, improved appetite, and/or decreased somnolence as measured by ESAS. Most did not return because of progression of disease and/or hospitalization. Conclusion: We established an interdisciplinary team with aggressive support of lung cancer patients through education, pharmacologic and physiotherapy intervention. These patients have multiple symptoms requiring attention and some of them may benefit from a comprehensive nutrition and rehabilitation program.
0 160
Erl
Multidisciplinary Team Working the Full Picture “Evaluation of Art Therapy intervention as an aid in the elevation of patients psychological and emotional distress following a diagnosis of advanced cancer”
Andrew Wilson, Francesca Moris. Marie Curie Cancer Care, Cardiff, UK
Background: Art Therapy is a psychodynamic
therapeutic approach used to respond to the emotional and psychological distress which can arise within an individual. The combination of the words “art” and “therapy” can create confusion for many individuals. However, when it is suggested that the creation of an image can give physical form to an emotion, which in turn, can be reflected upon, communicated with and processed into a manageable form within the presence of a qualified Art Therapist, an individual can begin to see the posPreliminary results Number of patients who: Completed an assessment Suitable for intervention Did not require intervention Refused assessment Refused intervention post assessment Have completed planned intervention Died prior to completion Did not complete intervention for any other reason Continuing to engage on planned intervention Number of sessions Mean Content analysis of questionnaire 100% overall improvement in their general well-being. 100% improvement in motivation levels. 75% improvement in ability to discuss their physical health with others. 100% improvement in ability to discuss their emotional health with others.
51 46 5 0 5 1 9 8 14 1-12 6
Oml Sessions/The
Interdisciplinary
Team und Care oj’People with Lung Cancer
instrumental in introducing the use of Clinical Pathways, which allow early detection of problems. The rapport of the LN with patients has facilitated the recruitment of patients for Clinical Trials. The position of LN has now been made permanent as the Unit has been able to show a reduction in length-of-stay yet an increase in patient satisfaction following introduction of the position.
Developing Role of the Lung Cancer Nurse IYI0 157 Jane Clare Kellv’, Michele Carmel Golden’, Fliss Murtagh3. ‘Lung Nurse Specialist-Department of Palliative Care, London, UK; ‘Lung Nurse Specialist/Department Palliative Care, London, UK; 3 Department Palliative Care, London, UK Introduction: The United Kingdom (UK) National Cancer Plan (Department of Health, 2000) recommends multi-professional team working to enhance the care of lung cancer patients. The role of the nurse specialist is crucial to this team. The numbers of nurse specialists in this role are increasing in line with recent government recommendations (Calman-Hine, 1995), but the role has been little evaluated. Aim: To record and analyse the role of the nurse specialist in this team context. Objectives: 1. To describe the role of the nurse specialist in relation to these patientsa. To identify the specific contributions of the nurse specialist within the team3. To propose what this developing role has achieved for patient careMethod:A retrospective audit of the hospital Lung Cancer Database was undertaken to identify all patients seen by the team in the twelve months from January 2002. The amount and specific roles of the nurse specialist in relation to each patient contact was identified. Data was then synthesized to understand the different contacts undertaken, the nature of those contacts, and the contribution of this to overall team working and provision of a seamless service to the patient. Results: 340 patients were seen in this twelve month period in the Lung Cancer Clinic. of these, 172 had a confirmed diagnosis of Lung Cancer. 1748 patient contacts with the nurse specialist occurred. The nature and length of these contacts was analysed and will be presented, detailing the components of information-giving, information-gathering, team liaison, symptom control, psychosocial support and treatment facilitation. Conclusion: This audit provides evidence of the extensive and developing role of the nurse specialist as a vital member of the multi-disciplinary team. The role is key in ensuring the patient has a single point of contact to facilitate information flow between the patient and team. 0 158
Educating specialist Lung Cancer Nurses
I Paul Mitchell’, Annette Street’. ‘Austin and Repatriation Medical Centre, Melbourne, Australia; ‘La Trobe University, Melbourne, Australia This paper reports on an Australian initiative to provide lung cancer nurses with a distance educational program and relevant ongoing support and resources. The aim of the program is to improve the knowledge, attitudes and skills of nurses caring for people with lung cancer. The program derives from La Trobe University (LTU) Nursing Clinical School, Cancer and Palliative Care Studies Unit and the Cancer Council of Victoria (CCV). These organisations have previously conducted similar highly successful educational programs for breast care and prostate care. These courses have been evaluated by the CCV and found to meet the needs of nurses, with incidental feedback suggesting that they are also improving patient outcomes. The lung cancer course consists of ten modules conducted over a thirteen-week period. The primary objectives of this program are to prepare nurses to provide more targeted assessment, early detection of problems, provision of accurate information, an increased role in health promotion and provision of skilled nursing care to people and their families affected by lung cancer. The educational package includes study notes, relevant literature, a resource CD and on-line resources. Weekly assessment exercises enable the nurses to review their understanding of the content material and educational support is provide by email, teleconference and a one day orientation to the subject. The course material has been written by a range of specialists in the field and expert lung cancer nurse practitioners. The program is being evaluated to assess the overall impact on the knowledge and competencies of the nurses and the impact on the patient care. It is envisaged that a long-term outcomes of the program will be that nurses are equipped to pursue further education; the establishment of a lung cancer nurses network to foster participation in research, and that the network would provide support and mentorship.
I0
159
The McGill University Lung Cancer Nutrition and Rehabilitation Program: A Novel Interdisciplinary Approach
Sarah Thirlwell’, Mary-Ann Dalzel12, Antonio Vigano2, Harvey Kreisman3, David Smal14, Neil MacDonald*. ‘Sir Morlimer 9. Davis-Jewish Genera/ Hospital of Montreal, Department of Pulmonary Diseases, Montreal, Canada; a McGill University: Department of Oncology Monireal, Canada; 3 Sir Mortimer B. Davis-Jewish General Hospital, Deparhent of Pulmonary Diseases, Montreal, Canada; 4 Sir Mortimer D. Davis-Jewish General Hospital, Department of Pulmonary Diseases, Montreal, Canada Cachexia, anorexia and asthenia are commonly present in patients with advanced lung cancer and contribute directly to morbidity, mortality and impaired quality of life. We have instituted the McGill University Lung Cancer Nutrition and Rehabilitation Program for patients with advanced lung cancer. The interdisciplinary team includes two physicians, a physiotherapist, a clinical nurse specialist and a dietitian. The program is offered to those patients with loss of weight and/or function who are referred by the pulmonary oncology team. In 2002, 37 patients (21 males, 16 females) were seen. Almost all patients had stage 4 non-small cell lung cancer and all were receiving standard care including chemotherapy, radiotherapy or supportive care. Comprehensive evaluation included symptom, nutritional, functional, nursing and laboratory domains and was followed by counselling about nutrition and exercise. 57% of patients had decreased appetite and 63% had weight loss (mean 7 kg). Using the Edmonton Symptom Assessment System (ESAS), moderate to severe symptoms (score >4/10) were asthenia (61%), anorexia (48%), decreased quality of life (44%), dyspnea (40%), somnolence (39%), insomnia (37%), depression (33%), anxiety (32%), pain (32%), constipation (28%), nausea (14%) and vomiting (1%). 75% of patients reported decreased activity and fatigue with components of muscle fatigue (66%), motivational fatigue (42%), and cognitive fatigue (33%). The nutritional recommendations included a dietary pamphlet and education (75%), multivitamin supplementation (77%), eicosopentanoic acid supplementation (74%), and metoclopramide (53%). Appetite stimulants (12%), zinc for altered taste (7%) and mycostatin for oral candidiasis (4%) were used infrequently. Forty-one percent of those offered physiotherapy were followed either in a special clinic (19%) or via home visits (22%); 59% of patients declined to participate. Ten of 37 patients evaluated initially were seen in follow-up; of these, 7 maintained or increased their weight and noted increased strength, improved appetite, and/or decreased somnolence as measured by ESAS. Most did not return because of progression of disease and/or hospitalization. Conclusion: We established an interdisciplinary team with aggressive support of lung cancer patients through education, pharmacologic and physiotherapy intervention. These patients have multiple symptoms requiring attention and some of them may benefit from a comprehensive nutrition and rehabilitation program.
0 160
Erl
Multidisciplinary Team Working the Full Picture “Evaluation of Art Therapy intervention as an aid in the elevation of patients psychological and emotional distress following a diagnosis of advanced cancer”
Andrew Wilson, Francesca Moris. Marie Curie Cancer Care, Cardiff, UK
Background: Art Therapy is a psychodynamic
therapeutic approach used to respond to the emotional and psychological distress which can arise within an individual. The combination of the words “art” and “therapy” can create confusion for many individuals. However, when it is suggested that the creation of an image can give physical form to an emotion, which in turn, can be reflected upon, communicated with and processed into a manageable form within the presence of a qualified Art Therapist, an individual can begin to see the posPreliminary results Number of patients who: Completed an assessment Suitable for intervention Did not require intervention Refused assessment Refused intervention post assessment Have completed planned intervention Died prior to completion Did not complete intervention for any other reason Continuing to engage on planned intervention Number of sessions Mean Content analysis of questionnaire 100% overall improvement in their general well-being. 100% improvement in motivation levels. 75% improvement in ability to discuss their physical health with others. 100% improvement in ability to discuss their emotional health with others.
51 46 5 0 5 1 9 8 14 1-12 6