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D. Borthwick



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    O19 - Support and Palliation I (ID 138)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      O19.05 - Guidance for the Assessment of Patients following Palliative Radiotherapy for Lung Cancer (ID 112)

      10:30 - 12:00  |  Author(s): D. Borthwick

      • Abstract
      • Presentation
      • Slides

      Background
      Palliative radiotherapy to the thorax is very effective at managing symptoms and improving quality of life but can also have significant toxicity. Dosing decisions are a balance between potential benefit and toxicity in patients whose prognosis and performance status is poor and who are likely to have multiple co-morbidities and complex causation of symptoms. Observations made by the members of the Uinted Kingdom National Lung Cancer Forum for Nurses (NLCFN) raised concerns that this group of patients may not be receiving optimal intervention and support following palliative radiotherapy. The NLCFN has therefore produced Guidance for the Assessment of Patients following Palliative Radiotherapy for Lung Cancer to aid Lung Cancer Nurse Specialists (LCNS) in the assessment and intervention of patients undergoing low dose palliative radiotherapy for symptoms related to lung cancer and side effects from treatment.

      Methods
      A NLCFN working group was created to analyse the observation of sub-optimal care following palliative radiotherapy. A literature review was undertaken to identify current best evidence and practice. A survey was undertaken to question LCNS, Clinical Oncologists, as well as Radiographers who could provide whether there was a need for such a guideline. 53 responses were received. Following analysis of the survey and discussion within the working group the Guidance for the Assessment of Patients following Palliative Radiotherapy for Lung Cancer was produced. The guidance aims to aid LCNS in the assessment and intervention of patients undergoing low dose palliative radiotherapy for symptoms related to lung cancer and side effects from treatment. Table 1 Figure 1Figure 2Figure 3

      Results
      Following the literature review, although there was significant evidence of toxicity profiles and effects of treatment, there were no examples of how to address the support needs of patients following palliative radiotherapy to the thorax. Of the 53 responses, 75% said that there was a need for the service, 54% were not aware of current practice in radiotherapy follow up support, with 55 % stating that a review should take place between 1 and 2 weeks after treatment. The working group produced the guideline following discussion in relation to these outcomes.

      Conclusion
      The Guidance for the Assessment of Patients following Palliative Radiotherapy for Lung Cancer aims to guide LCNS and the treating teams in the assessment and intervention of patients undergoing low dose palliative radiotherapy for symptoms related to lung cancer. The guideline contains flow charts with recommended interventions together with documentation proforma and Common Toxicity Criteria. In the UK patients are treated in Cancer Centres and often repatriated to secondary care for review and follow-up. The formal assessments provided in the Guidance can be implemented either in the clinic, telephone or home visit. The guideline could be adapted for use in other health care systems other than the UK and can be found at http://www.nlcfn.org.uk/NLCFN-guidelines.htm

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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)

      16:15 - 17:45  |  Author(s): D. Borthwick

      • 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: 1
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      P3.25-001 - Increasing research utilisation and capacity in lung cancer nursing in the UK (ID 287)

      09:30 - 16:30  |  Author(s): D. Borthwick

      • 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.