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Andrea Serena



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    ES02 - Quality Care in Lung Cancer (ID 770)

    • Event: WCLC 2018
    • Type: Educational Session
    • Track: Nursing and Allied Professionals
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/25/2018, 10:30 - 12:00, Room 206 BD
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      ES02.05 - Structured Approach For Developing and Implementing and Advanced Practice Nursing Role in Lung Cancer (Now Available) (ID 11360)

      11:30 - 11:45  |  Presenting Author(s): Andrea Serena

      • Abstract
      • Presentation
      • Slides

      Abstract

      Background: Lung cancer patients experience significant physical symptoms, psychological distress and have many supportive care needs impacting their quality of life. In recognition of the complex health needs of patients with lung cancer and the European Partnership for Action Against Cancer recommendations, the University Hospital of Lausanne (CHUV) (Switzerland) aimed to integrate an Advanced Practice Nurse in Lung Cancer (APNLC) within the specialized Multidisciplinary Team (MDT) of the Thoracic Cancer Center. To date, there are limited data on the effectiveness of APNLC interventions for improving lung cancer patient outcomes. Introducing a new Advanced Practice Nursing (APN) role is a complex process and the full integration of this role depends both on successful role development and implementation. International recommendations for developing APN roles recommend pilot testing to assess the feasibility and acceptability of novel APN roles prior to formally assessing the effectiveness of the these roles for patients, providers and organizations. This study aimed to 1) develop and implement an APNLC role within the context of the CHUV Thoracic Cancer Center, 2) explore the acceptability of the new APNLC role from the perspective of a MDT and patients cared for by the APNLC, 3) assess the feasibility of the APNLC consultations and the ability to collect patient-reported outcome measures (PROMs) during first-line treatment, 4) describe changes in self-efficacy for managing lung cancer-related symptoms, symptom intensity/burden and unmet supportive care needs of APNLC patients during first-line treatment.

      Methods: To develop and implement the APNLC role we employed the first 7 phases of the “The Participatory, Evidence-based, Patient-focused process for APN role development, implementation, and evaluation” (PEPPA framework). Focus groups were conducted with nurses (n=5 nurses) and physicians (n=6 physicians) to explore the acceptability of the APNLC role. Additionally, semi-structured interviews were conducted with lung cancer patients (n=4) and the APNLC. The others aims were addressed using a convenience sample of newly diagnosed lung cancer patients receiving systemic therapy with/without radiotherapy. In order to assess the feasibility of the APNLC consultations and the ability to collect PROMs, an exact single-stage phase II design was applied. The study was considered as feasible if at least 55% of patients received all the scheduled APNLC-led consultations and completed PROMs assessments at the three time-points [Baseline, T1 (between day 4-50) and T2 (between day 71-95)]. Descriptive statistics were used to summarize the data and mixed effect models was applied to explore changes in perceived self-efficacy for managing lung cancer-related symptoms, symptom intensity/burden and unmet supportive care needs during first-line treatment.

      Results: Following the first seven phases of the PEPPA framework, the APNLC role was designed based on consensus of key stakeholders within the MDT. The APNLC role focused on providing psychological support, enhancing symptom self-management as well as providing therapeutic education and information about disease/treatments to patients and families. The APNLC role is also tasked with facilitating communication and information exchange within the MDT to improve collaboration and promote continuity of care. The designed APNLC-led intervention included four systematic, alternate face-to-face/telephone consultations with lung cancer patients during first-line treatment. Three main themes emerged describing the acceptability of the APNLC role: “role identification”, “role-specific contributions” and “providing flexible service”. Physicians and patients alike clearly recognized the APNLC role and emphasized the contribution to continuity of care, providing psycho-social support and enabling symptom self-management. Oncology nurses within the MDT perceived the APNLC role as overlapping with their own role and they expressed concern about losing part of their traditional role. Flexibility in providing care was seen as strength of the APNLC role yet this also posed organizational challenges related to work-load. Among the 46 patients enrolled in the feasibility study, 35 met the feasibility criteria receiving the four APNLC consultations (76%, 95% CI: 0.61-0.87) and 26 completed PROMs assessments at the three timepoints (56%, 95% CI: 0.41-0.71). These initial findings were promising for the feasibility of APNLC consultations and the ability to collect PROMs during first-line treatment. Longitudinal analysis of patient outcomes showed a trend towards improved patient self-efficacy for managing symptoms between baseline and T1, which remained stable at T2. Notably, the intensity of predominant symptoms increased over time yet unmet information needs decreased significantly between baseline and T2 (OR= 0.15 [95% CI: 0.03-0.68] p<0.01).

      Discussion/Conclusions: For the first time in Switzerland, we describe the development process of an APNLC role within a multidisciplinary thoracic cancer team. Findings highlight the applicability and the utility of the PEPPA framework as a structured approach for developing and implementing new APNLC roles - particularly in the context of the Swiss health care system where APN roles are yet in early stages of development. Barriers identified during the implementation of the APNLC role were primarily related to intra-professional rather than inter-professional factors. In light of these observations of intra-professional tension, study results underscore the importance of developing a national definition of APN role and regulations guiding APN roles to support their expansion in the country and enhance acceptability of these roles. Initial results were promising in terms of feasibility suggesting that APNLC-led consultations were appropriate and perceived as beneficial for many patients. Indeed, implementation of the APNLC role in the MDT seems to contribute to the improvement and maintenance of patient’s perceived self-efficacy for managing symptoms and decreased unmet supportive care needs. However, to better support lung cancer patients in their symptoms self-management and decrease their symptom burden, findings of this research point to adjustments that could be made to improve the effectiveness of the APNLC role. First, we propose to adjust the dose of APNLC intervention by increasing the frequency and intensity of consultations. Second, we propose to develop an interdisciplinary approach involving joint APNLC-physicians consultations for managing complex lung cancer patients.

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    WS05 - ITONF Workshop: Excellence in Thoracic Oncology Care (ID 889)

    • Event: WCLC 2018
    • Type: Workshop
    • Track: Nursing and Allied Professionals
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/23/2018, 12:00 - 18:00, Room 206 BD
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      WS05.07 - Global Issues in Lung Cancer and Mesothelioma in 2018 (Now Available) (ID 14690)

      14:30 - 15:00  |  Presenting Author(s): Andrea Serena

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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