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A.M. Tod



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    ITONF - International Thoracic Oncology Nursing Forum (ITONF) Workshop (ID 220)

    • Event: WCLC 2013
    • Type: Other Sessions
    • Track: Nurses
    • Presentations: 1
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      ITONF.05 - Positive Impact of Specialist Lung Cancer Nurses on Better Patient Outcomes (ID 4036)

      A.M. Tod

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    O26 - Support and Palliation II (ID 140)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      O26.01 - The impact of the lung cancer clinical nurse specialist on access to anti-cancer treatment (ID 1018)

      A.M. Tod

      • Abstract
      • Presentation
      • Slides

      Background
      The National Lung Cancer Audit (NLCA) (NHS Information Centre, 2011) reports annually on services provided to 38,000 lung cancer patients in the nited Kingdom (UK). The 2010 NLCA reported that only 58% of lung cancer patients in England and Wales received active treatment (chemotherapy, surgery and radiotherapy), with only 14% of patients receiving surgery. Lung Cancer Nurse Specialists (LCNS) make an important contribution to patient care and patient experience and their input is captured in the audit. The 2010 NLCA revealed a possible association between access to a LCNS and access to treatment: 64% of patients seen by a LCNS received anti-cancer treatment compared to 30% of those who did not (Ford, 2011, The Lancet 2011). The reason for this observation cannot be ascertained from the NCLA data. Thus investigation outside of the audit is required. This study begins that process using case study methodology. The study is funded by a grant from the General Nursing Council Trust. The aims of this study are to explore the role of the LCNS within the lung cancer multi-disciplinary team (MDT), identify ways the LCNS can increase treatment access for people with lung cancer and generaterecommendations for MDTs and for future research.

      Methods
      A collective case study, comprising four individual LCNS in four different lung cancer MDTs (McDonnell, 2012, Stake 1995). LCNS cases were selected on the basis of variation in access to treatment rates and access to a LCNS according to the NLCA data. The four LCNSs also had different models of working within the MDT and patient pathway. Methods included in-depth individual interviews with the LCNS and clinical lead plus four other MDT members, giving a total interview sample of 24. Observation of practice and documentary analysis were also used. Findings will be tested further in group interviews over the summer.

      Results
      These findings provide insight into how the LCNS works across the patient pathway to influence access to treatment, while maintaining patient preference as central to practice. The findings are presented here in four themes: practice approaches, people, places and facilitators, with illustrations of how factors combined to increase or decrease access to treatment. Approaches to LCNS practice identified in the study included negotiating, brokering and co-ordinating in order to maximise treatment access and maintain patient focus. The range of people and places the LCNS works with across different disciplines, services and health sectors means they become the lynchpin to clinical treatment decisions. The study indicates how workload, relationships, job security and organisational structures operate as key facilitators to effective treatment decision making

      Conclusion
      This in-depth qualitative study provides valuable insights into the complex landscape that MDTs operate within and helps to explain why the observed association between seeing a LCNS and access to treatment may occur. The study illustrates the value of qualitative research in understanding quantitative data such as that generated by national registries and audits. Recommendations for MDTs and data capture in the NLCA audit are considered.

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    P3.25 - Poster Session 3 - Nurses (ID 250)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Nurses
    • Presentations: 2
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      P3.25-001 - Increasing research utilisation and capacity in lung cancer nursing in the UK (ID 287)

      A.M. Tod

      • Abstract

      Background
      The National Lung Cancer Forum for Nurses (NLCFN) is a UK professional organization which has a membership of around 280 Lung Cancer Nurse Specialists (LCNS) who primarily with lung cancer patients. LCNSs are the multi-disciplinary team members who spend the most time with patients. Therefore they add a unique and valued contribution to the debate regarding research priorities in lung cancer. The NLCFN is committed to developing the evidence base to inform the effectiveness and quality of their clinical care. The NLCFN recognized a need to develop research skills and capacity amongst its membership and facilitate research collaborations between academics and practitioners. To this aim the NLCFN established a Research Interest Group (RIG) in 2009. This paper summarizes a research development project undertaken by the NLCFN to increase research utilisation and capacity in lung cancer nursing.

      Methods
      A structured approach was taken building on research into evidence utilisation in health. (Birdell et al, 2005, Tod et al 2004, Palfreyman et al 2003a/b). Research development activity focused on four key areas, roles and responsibilities, relevance, relationships and partnerships, and organisational culture.

      Results
      Over a four year period the NLCFN has successfully developed its research activity and the infrastructure to support subsequent growth. Roles: The RIG is chaired jointly by a Professor of Health Services Research and NLCFN Chair. All NLCFN members are encouraged to have a role by contributing to the critical discussion regarding evidence. However, a core group of research active members take responsibility to lead on research. The RIG has provided a mechanism for the NLCFN to liaise with key national lung cancer groups and committees regarding evidence for practice and new project development, for example a current national project exploring the contribution of lung nurse specialists to clinical trial recruitment. Research relevance is guided by an on-going research prioritisation exercise. Research partnerships have been developed through shared membership of the RIG between clinical and academic staff. The partnership has fostered five applications for research funding from a range of funding organisations, two of which have been successful, one is currently in review. Funded projects include an evaluation of the LCNS role in treatment access. Another is evaluating the use of support roles in lung multi-disciplinary teams. Current applications include an analysis of treatment and health outcomes using linked national data sources. In addition a new PhD studentship has been developed through a collaboration between the NLCFN and Sheffield Hallam University. Regular meetings, good communication, sharing of good practice and support provide a culture to allow research ideas to flourish.

      Conclusion
      In four years the NLCFN has made remarkable progress regarding research development and capacity building. By taking a structured and systematic approach the outcomes have been impressive. It has supported LCNSs to be a valued partner in research prioritisation and in generating evidence to support lung cancer practice at a local and National level. The foundations for research growth have been built and an infrastructure developed to enhance future nursing engagement in research at all levels from application to leadership.

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      P3.25-002 - The effects of the molecular targeted therapies in advanced lung cancer - focus group analysis (ID 1098)

      A.M. Tod

      • Abstract

      Background
      The development of molecular targeted therapies has provided many cancer patients with promising treatment options. Tyrosine kinase inhibitors (TKIs) are a group of biological molecules designed to block specific molecular targets within the cell. They are easily taken in tablet form but can have significant systemic side effects causing physical and psychological discomfort. The importance of preparing the patient before treatment starts, evaluating the toxicities carefully using various validated tools and implementing appropriate care is well recognised. This study aimed to examine the physical side effects and psychosocial experiences of patients with advanced lung cancer taking TKIs. By using the Medical Research Council (MRC) framework for developing and evaluating complex interventions, this study forms the first stage of data gathering to inform the design of subsequent research projects. The overall aim is to develop a more specific toxicity measurement tool. A grant was awarded from the National Lung Cancer Forum for Nurses Research Interest Group.

      Methods
      Clinical teams at 4 hospitals within the West Anglia Cancer Research Network approached patients with advanced lung cancer taking TKI therapy for 3 to 24 months. Written informed consent was taken prior to focus group meetings which were held in the comfort of a cancer support centre. Separate provision was made for carers. Conversation was captured using two digital recorders and transcribed verbatim. A topic guide shaped the conversation. Field notes were taken to describe the dynamics of the group. The transcripts were analysed using grounded theory techniques of constant comparison of the narrative, incorporating memos of the researchers thoughts during the recordings, and deviant case analysis. Data was analysed and coded independently by two researchers and the findings compared and discussed. The theories generated were validated by checking the findings against the original data demonstrating a systematic research process of rigour and transparency. Analysis was aided by the use of NVivo 10 software.

      Results
      Two focus groups including 3 and 4 patients respectively were conducted. Of the 7 participants 6 were female, average age 68 years (range 58 - 81 years). All were currently taking Gefitinib, average 13 months (range 5 - 23 months). Early analysis shows common themes emerging such as pragmatic acceptance about their situation, feelings of isolation, experiencing the inconsistency and variety of chronic physical toxicities, the necessity of self-management, the need for support and uncertainty about their future. Body image changes were a significant problem for females including hair and skin changes. It is clear from the data that there is an on-going and changing psychosocial and physical experience for the patient. The nature of this experience will be expanded upon with individual anonymous quotes.

      Conclusion
      The experience of taking TKI’s, over an indefinite period of time, for advanced lung cancer is complex. Using the MRC framework we aim to evaluate the themes identified, so assessing not only the quantitative physical toxicities of the treatment but also the qualitative issues, the provision of support and the patients’ understanding of the side effects and management of their treatment.