Virtual Library

Start Your Search

Caitlin Broderick

Moderator of

  • +

    MS 10 - Evidence Based Care: Interpreting the Research and Enhancing Practice (ID 532)

    • Event: WCLC 2017
    • Type: Mini Symposium
    • Track: Nursing/Palliative Care/Ethics
    • Presentations: 5
    • +

      MS 10.01 - Radiotherapy Management (ID 7689)

      15:45 - 17:30  |  Presenting Author(s): Mary Duffy

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

    • +

      MS 10.02 - Interpreting Published Research (ID 7690)

      15:45 - 17:30  |  Presenting Author(s): Angela Mary Tod

      • Abstract
      • Presentation
      • Slides

      Abstract:
      Background The Evidence-Based Practice (EBP) or Evidence-based Healthcare (EBHC) movement has revolutionised health care in the last 20 years by promoting research appraisal, interpretation and implementation.[1] EBP has been the cornerstone of practice development and service improvement. The most common definition of EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”[2] This presentation will reflect on EBP relating to interpreting published research to enhance practice. In lung cancer this is an opportune time as evidence regarding new treatments, services and professional roles is growing. Some of the recent changes and challenges to EBP that influence how we interpret research will first be considered. Second, tools that can support lung cancer practitioners in interpreting published research will be discussed. Finally the presentation will reflect on the contribution of creative, methods of co-production to mobilize knowledge and published evidence to improve practice. The future application and contribution of these methods is considered Evidence-Based Practice: Changes and Challenges Much has changed since 1996 in terms of EBP and the environment in which it operates. Now EBP is considered to comprise 3 components, ‘Best Research Evidence’, ‘Clinical Expertise’ and ‘Patient Values, Experience and Preferences’.[3] Critically, the much quoted definition Sacket definition of EBP[1,2 ]misses the third vital element, which is, the integration of patient values, experiences and preferences. In addition, the initial emphasis in EBP was on medicine and applying evidence to practice regarding individual patients care and treatment. However, EBP has now evolved into Evidence-Based Healthcare (EBHC), where evidence is mobilized to change practice at a policy, organisation or service level. To address this change in emphasis a change to research methodologies is required, as well as a rethink regarding the hierarchy of evidence. The Randomised Controlled Trial is not always adequate. Mixed-methods approaches are more commonly employed and the value placed on qualitative, patient experience methods has increased. Whilst meta-analysis and randomised controlled trial methodologies remain the gold standard to generate evidence of effectiveness, EBH questions have become more complex and diverse. These questions require different research approaches and tools to generate answers. Finally, EBP is only as good as the evidence it’s based on.[4] We therefore need to be aware of the limitations of current evidence, for example, the influence of vested interest (e.g. industry and managers), not publishing negative trial results, cherry picking findings to report, over-inflation of claims from trials, the overwhelming volume of evidence, and the critical gaps in evidence.[4,5,6] In addition, policy across the globe demands more patient and public involvement in the identification of research priorities and the conduct of research. There have also been huge methodological developments in terms of applying research to practice for example, service improvement and quality improvement methodologies, such as Microsystems. More recently there has also been a growth in interest in knowledge mobilisation, co-production and co-design. These enable people working in health care to work in equal partnership with people receiving healthcare in order to generate, appraise and use research to develop creative solutions to current problems with health services, care and treatment.[7,8] Tools to support research interpretation and application A key task in EBP is to interpret published research. Over the years a proliferation of strategies, tools and resources have been developed to support clinicians, researchers and academics in appraising, interpreting and applying evidence to enhance practice.[3,5] Broadly a 5 stage EBP process is advocated, Ask, Acquire, Appraise, Apply, Assess, each with its own strategies and tools. The purpose of each of these stages will be explained and implications for interpreting research will be summarised. A brief summary of some of the current tools will be presented including online training courses, critical appraisal tools and quality assurance criteria. The role of co-production in interpreting and applying research The recent interest in co-production and knowledge mobilisation (KM) will potentially change how we interpret and use published research. Greater emphasis has been placed on creative approaches to knowledge generation through co-production, co-creation and co-design.[7] These approaches change the role of traditional published evidence in changing practice and service development. This change raises the importance of “blurring the boundaries between knowledge creation and knowledge use through integrating multiple stakeholders’ perspectives in research and implementation activity. It also supports the notion that such approaches should be iterative and incremental.”[8] Embracing a co-production approach to research generation, interpretation and application means rejecting a reliance on Mode 1 knowledge, where research knowledge is created by university-based scientists and then interpreted packaged and processed in a way that makes it accessible and usable to non-academics. In preference Mode 2 knowledge is espoused, where knowledge and research is collaboratively generated in its field of application with a range of stakeholders.[7] The co-production process in healthcare will be summarized with reference to key literature, examples [7-10 ]and evidence of impact.[10 ]Finally the relevance of this for research interpretation in lung cancer is considered. Conclusion There are limitations to published research to inform lung cancer treatment and practice. Published research is never going to tell you enough to support change. Need to incorporate patient and public view. Co-production in KM provides a way forward to think differently in interpreting evidence and developing services and care.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

    • +

      MS 10.03 - Community Outreach - Engaging in Primary Care (ID 7691)

      15:45 - 17:30  |  Presenting Author(s): Lavinia Dobrea

      • Abstract
      • Presentation
      • Slides

      Abstract:
      Background/Objective: Lung cancer clinical trials are critical to advancing our understanding of disease characteristics, diagnostic criteria and treatment options. With evolving molecular testing and immunotherapies, clinical trials are increasingly complex and challenging to conduct at the site level. This report highlights the role of the Lung Cancer Clinical Research Nurse (LC-CRN) as vital to supporting patient participation and physician involvement for lung cancer trials. We also review new challenges with immunotherapies, nuances of sending tissue for molecular testing and importance of managing patient and family expectations. Methods: The St. Joseph community hospital multidisciplinary Thoracic Oncology Program was established in 2004, averaging 150 lung cancer patients annually. Since 2013, we facilitated efforts to increase participation in research studies. Strategies included (1) streamlining practices within the internal program structure and catalyzing efforts to acquire novel trials, (2) training a specialized LC-CRN to efficiently screen patients to exclusion criteria, and (3) enhancing enrollment and retention practices. Results: To streamline our portfolio, we closed stagnant trials and prioritized non-competing trials with novel agents of interest to our providers that address particular needs of our community population. Since 2013, lung studies open to accrual have tripled and patient enrollment continues to increase in both clinical trials and donations to our tissue biorepository. Current lung trials include diverse standard-of-care options alongside immunotherapies, genomic profiling, tissue biorepository, a tumor device and liquid biopsy trial. Responsibilities of the LC-CRN are to engage physicians, identify and accrue patients, coordinate specimen requirements, ensure protocol and ethics compliance, and communicate readily with study team and sponsors. At our site, specialized LC-CRN training included NCCN guideline review, sponsor visits for protocol training, creating and utilizing simple recruitment and screening tools, flyers and worksheets. The LC-CRN provides routine education about available and upcoming trials at weekly thoracic tumor boards, using visual aids to simplify comparisons of patient entry criteria across multiple studies. In partnership with study investigators, LC-CRNs are uniquely skilled to simplify clinical trial summaries to patients and communicate study content and patient commitment. LC-CRNs must have a robust understanding of disease processes and standard oncology treatment guidelines, including mutation testing. The LC-CRN must also be well acquainted with lung research protocols to advise providers of required tests/procedures, treatment/dosing, and management of adverse reactions. During the consent review, study visits and follow-ups, the LC-CRN must address patient concerns and assess key areas for further education. Effective communication with study sponsors include proper charting and documentation, data entry and responses to queries, as well as record submissions for billing/insurance processes unique to the study or healthcare setting. We implemented recruitment and retention processes supported by literature to ensure a majority of new and recurrent lung cancer patients are considered for clinical trials. Patient cases are presented at multi-disciplinary tumor boards and lung program meetings for group discussions. A recent publication noted higher physician engagement at tumor boards correlated with increased patient accrual and satisfactory prognostic outcomes (Kehl et al., 2015). The LC-CRN also cross-collaborates with navigators, genetics counselors, infusion nurses, radiation staff and others to identify and manage study patients. Literature noted early and repeated presentation of trial information during patient visits boosted trial participation to over 50% of 309 patients with thoracic malignancies (Logan et al., 2017). The close relationship of the LC-CRN to patients and their care team may avoid patient dropout, which often occurs due to misinformation or non-compliance to complex oncology study protocols (McCarthy-Keith et al., 2010). Routine clinical guidance throughout treatment remains important for research engagement and addressing specialized needs of lung cancer patients (Islam et al., 2014; Mosher et al., 2017). Common challenges with immunotherapies include identifying immunotherapy adverse events (IrAEs), fulfilling tissue requirements for molecular testing, and managing patient/family expectations. Research teams ensure ongoing dialogue and education with patients to promptly address IrAEs. We conduct a protocol “dry run” with the clinic staff, pharmacist, hospital facilities director and safety manager to ensure compliance of agent preparation, delivery, spill preparedness and IrAE management. We also oversee tissue acquisition and processing, as it can be a significant barrier to enrollment and retention (Lim et al., 2016). Fresh tissue, via core or excisional biopsies, is often required over archived tissue at study entry, progression or change of treatment. Collaborations with our pathologist, interventional radiologist, finance team and technicians ensure timeliness and correct acquisition methods over multiple time points. With the emergence of personalized immunotherapies come high hopes, but also fears and misconceptions about drug capabilities and efficacy in treatment regimens. The LC-CRN can readily distinguish and manage family and patient expectations by conducting extensive and ongoing teaching about medical use, potential benefits and dangerous side effects. In one setting, 85% of 40 lung and esophageal cancer patients were satisfied with trial participation following a positive experience with a study navigator (Cartmell et al., 2016). Strategies utilizing dedicated staff members, such as a LC-CRN, are necessary in guiding and educating patients about research concerns and processes. Overall, the LC-CRN and thoracic oncology care team are intimately involved in addressing patient expectations and care management to maximize research participation and patient outcomes in oncology care. Conclusion: The landscape of lung cancer diagnosis and treatment is quickly shifting. A durable and flexible research infrastructure includes having an active multidisciplinary thoracic team with dedicated staff advocating for patient access to clinical trials. The role of the LC-CRN in supporting participation in lung cancer trials is vital. With proper education and training, the LC-CRN is best positioned to support patient participation, physician involvement and patient/sponsor expectations in lung cancer trials. REFERENCES Cartmell KB, Bonilha HS, Matson T, Bryant DC, Zapka JG, Bentz TA, Ford ME, Hughes-Halbert C, Simpson KN, Alberg AJ. Patient participation in cancer clinical trials: A pilot test of lay navigation. Contemp Clin Trials Commun. 2016 Aug 15;3:86-93. PMID: 27822566 Islam KM, Opoku ST, Apenteng BA, Fetrick A, Ryan J, Copur M, Tolentino A, Vaziri I, Ganti AK. Engaging patients and caregivers in patient-centered outcomes research on advanced stage lung cancer: insights from patients, caregivers, and providers. J Cancer Educ. 2014 Dec;29(4):796-801. doi: 10.1007/s13187-014-0657-3. PMID: 24744120 Kehl KL, Landrum MB, Kahn KL, Gray SW, Chen AB, Keating NL.Tumor board participation among physicians caring for patients with lung or colorectal cancer. J Oncol Pract. 2015 May;11(3):e267-78. doi: 10.1200/JOP.2015.003673. Epub 2015 Apr 28. PMID: 25922221 Lim C, Sung M, Shepherd FA, Nouriany N, Sawczak M, Paul T, Perera-Low N, Foster A, Zawisza D, Feld R, Liu G, Leighl NB. Patients with Advanced Non-Small Cell Lung Cancer: Are Research Biopsies a Barrier to Participation in Clinical Trials? J Thorac Oncol. 2016 Jan;11(1):79-84. doi: 10.1016/j.jtho.2015.09.006. PMID: 26762742 Logan JK, Tang C, Liao Z, Lee JJ, Heymach JV, Swisher SG, Welsh JW, Zhang J, Lin SH, Gomez DR. Analysis of Factors Affecting Successful Clinical Trial Enrollment in the Context of Three Prospective, Randomized, Controlled Trials. Int J Radiat Oncol Biol Phys. 2017 Mar 15;97(4):770-777. doi: 10.1016/j.ijrobp.2016.11.035. Epub 2016 Nov 27. PMID: 28244413 McCarthy-Keith D, Nurudeen S, Armstrong A, Levens E, Nieman, LK. Recruitment and Retention of Women for Clinical Leiomyoma Trials. Contemp Clin Trials. 2010 January; 31(1): 44. doi:10.1016/j.cct.2009.09.007. Mosher CE, Ott MA, Hanna N, Jalal SI, Champion VL. Development of a Symptom Management Intervention: Qualitative Feedback From Advanced Lung Cancer Patients and Their Family Caregivers. Cancer Nurs. 2017 Jan/Feb;40(1):66-75. PMID: 26925990

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

    • +

      MS 10.04 - Pre-Operative Support (ID 7692)

      15:45 - 17:30  |  Presenting Author(s): Melissa Culligan

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

    • +

      MS 10.05 - Immunotherapy: The Latest (ID 7693)

      15:45 - 17:30  |  Presenting Author(s): Beth Eaby-Sandy

      • Abstract
      • Presentation
      • Slides

      Abstract:
      Immunotherapy: The Latest Immunotherapy agents are now a prominent drug class in the management of NSCLC. It is important for oncology nurses to understand the drugs that are approved as well as the management of the toxicities. There are currently 3 drugs approved for use in several scenarios for NSCLC, listed in table1.

      DRUG INDICATION TYPE IMMUNOTHERAPY
      Atezolizumab 2[nd] line NSCLC PD-L1 inhibitor
      Nivolumab 2[nd] line NSCLC PD-1 inhibitor
      Pembrolizumab 1[st] line NSCLC -single agent in PD-L1 > 50% -in combination with pemetrexed and carboplatin regardless of PD-L1 expression 2[nd] line NSCLC in patients with PD-L1 > 1% PD-1 inhibitor
      Table 1. Immunotherapy drugs still under investigation for NSCLC include durvalumab, another PD-L1 inhibitor. Also, anti-CTLA 4 drugs such as ipilumumab and tremelimumab are being studied in combination with PD-1 or PD-L1 inhibitors. Finally, early stage studies are beginning to look at the utility of CAR-T cell therapy in NSCLC. Follow up data from the Checkmate studies in NSCLC as well as the Keynote trials will give more up to date survival statistics for nivolumab and pembrolizumab, respectively. Toxicity management for these immunotherapy drugs has been at time challenging. The toxicities are very different from traditional chemotherapy used in NSCLC. When caught early, these toxicities can be managed and many times, treatment can be continued. However, if severe or identified late, toxicities from immunotherapy can be life-threatening. Immune-mediated toxicities reported in trials of NSCLC such as pneumonitis, colitis, endocrinopathies, nephritis, hepatitis are some of the toxicities that can become life-threatening if not managed properly. Other than the endocrinopathies, most of these toxicities must be managed with high dose corticosteroids and tapered slowly under close supervision. More common adverse events of the immunotherapies such as fatigue, rash, nausea, diarrhea, arthralgia can be expected and managed without using corticosteroids, instead, using more standard supportive care medications.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.



Author of

  • +

    MS 14 - QOL Evaluation in Practice from the Viewpoint of Physicians and Nurses (ID 536)

    • Event: WCLC 2017
    • Type: Mini Symposium
    • Track: Nursing/Palliative Care/Ethics
    • Presentations: 1
    • +

      MS 14.04 - Whole Person Care (ID 7709)

      11:00 - 12:30  |  Presenting Author(s): Caitlin Broderick

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    WS 03 - ITONF Lung Cancer and Mesothelioma Workshop (Ticketed Session) (ID 751)

    • Event: WCLC 2017
    • Type: Workshop
    • Track: Mesothelioma
    • Presentations: 2
    • Invitation / Session Details: Click here to view PDF
    • Moderators:
    • Coordinates: 10/15/2017, 12:15 - 17:55, Room 313
    • +

      WS 03.02 - Local Therapies for Lung Cancer and Mesothelioma (ID 10946)

      12:15 - 17:55  |  Presenting Author(s): Caitlin Broderick

      • Abstract

      Abstract not provided

    • +

      WS 03.14 - Targeted Therapies: Case Studies and Experience from Different Regions Q&A (ID 10892)

      12:15 - 17:55  |  Presenting Author(s): Caitlin Broderick

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.