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Jenny Mitchell



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    MA17 - New Methods to Improve Lung Cancer Patients Outcomes (ID 918)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Nursing and Allied Professionals
    • Presentations: 2
    • Now Available
    • Moderators:
    • Coordinates: 9/25/2018, 13:30 - 15:00, Room 205 AC
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      MA17.05 - Development of a Telephone Clinic for Patients Undergoing Long Term Follow-Up After Thoracic Surgery (Now Available) (ID 12598)

      14:00 - 14:05  |  Presenting Author(s): Jenny Mitchell

      • Abstract
      • Presentation
      • Slides

      Background

      Patients undergoing long term follow-up after lung cancer surgery in our institution follow an imaging based follow-up programme. Protocol led CT imaging followed by an out-patient appointment is undertaken every 6 months for two years after surgery then annually until year 5. Feedback from patients indicated they find two trips to the hospital burdensome and they frequently requested results of surveillance imaging over the telephone. Limited capacity in the thoracic surgery clinics led to long waits for an appointment to be informed of imaging results. To address these issues, we developed a model of nurse led telephone follow-up after surveillance imaging.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A proposal to hold one telephone clinic per week was made to commissioners in the autumn of 2016. Following approval, the telephone clinic commenced in April 2017. Patients are triaged by the specialist nurse when CT results are available and allocated to the telephone clinic if appropriate. They are given a timed appointment and the telephone number they will be contacted on is confirmed prior to the appointment. A database is completed during the appointment, a record of the consultation is made in both paper and electronic patient records and a letter is sent to the GP and other teams who have contact with the patient. Patients with significant abnormalities on CT imaging are referred for discussion by the multidisciplinary team and seen in a face to face clinic.

      4c3880bb027f159e801041b1021e88e8 Result

      In the first twelve months (April 2017 to March 2018) there were 254 patient appointments in 51 telephone clinics. Average call length is 10 minutes with a range of 3 to 22 minutes. One patient scheduled for a telephone appointment was not contactable at the appointed time (0.4%). Satisfaction with the clinic is high with 98% of patients requesting their next follow-up appointment in the telephone clinic. Clinic capacity was increased at reduced cost to commissioners as a telemedicine appointment is charged at £25.34 compared to £70.16 for a face to face appointment.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Early results suggest nurse led telephone clinics are an effective way of providing follow-up to patients on an imaging based follow-up programme after surgery. They are well received by patients. We aim to introduce an online tool to objectively assess symptoms in this patient group. Further evaluation of patient experience in this clinic would be beneficial, along with an evaluation of the impact of introduction of telephone follow-up on the rest of the service.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      MA17.11 - Multi-Centred, Prospective, Audit to Identify Readmission Causes and Complications Within 30 of Primary Lung Cancer Surgery (Now Available) (ID 11916)

      14:40 - 14:45  |  Author(s): Jenny Mitchell

      • Abstract
      • Presentation
      • Slides

      Background

      Surgery remains the first choice of curative treatment, for patients with non-small lung cancer, the proportion of patients undergoing surgery has risen in recent years. Post-operative complications are well recognised following curative lung cancer surgery but there is limited data on readmission rates and causes . The UK Thoracic Surgery Group (TSG), a subgroup of the National Lung Cancer Forum (NLCNF) conducted a multicentre audit to assess readmission potential causes and patient experience.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The audit involved 6 UK thoracic surgical centres with prospective data collection over 3 months from primary lung cancer resection patients. Patients were contacted 1 month post discharge by telephone. Data collection included demographics, socioeconomic, smoking status, comorbidities, surgery, postoperative recovery, discharge satisfaction and readmission details.

      4c3880bb027f159e801041b1021e88e8 Result

      268 patients underwent thoracic surgery, the overall readmission rate was 11% (30), with variable readmission rate across the centres (range 3-24%), most readmission occurred within 7 days of discharge 47% (14) with patients being readmitted to a hospital that did not performed the procedure 43%(17). The most common cause of readmission was mainly pulmonary related with chest infections being largest cause, pain, wound infection and pneumothorax were also common. Length of stay following readmission was longer than initial surgical stay median 8 (range 0-94) vs 5 (range 2-27).Type of surgical approach had no impact on readmission. However readmission was associated with smoking, post-operative complications, discharge with drain, length of stay post-surgery and the patient’s readiness for discharge (see table 1).

      table 1.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      This audit provides a broad overview of the pattern and trend of readmissions rates within 30 days post discharge following lung cancer resection. Whilst not every readmission can be avoided, there is opportunity to identify and prevent patient readmission. Listening to patient’s assessment of their readiness for discharge is crucial to facilitating patient compliance with discharge and confidence in community carers.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.07 - Nursing and Allied Professionals (Not CME Accredited Session) (ID 973)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.07-11 - Survivorship After Lung Cancer Surgery – SOLACE – A Macmillan Funded Project (ID 11875)

      12:00 - 13:30  |  Author(s): Jenny Mitchell

      • Abstract
      • Slides

      Background

      Lung cancer remains the leading cause of cancer related death worldwide. Surgery is the mainstay of curative therapy for lung cancer. However, 75% of patients present over the age of 65yrs, many with co-morbidities which impact on the resection rate. Post treatment many cancer survivors experience fatigue, reduced physical capacity and quality of life.

      We have established a Macmillan funded service at our institution. Our aim is to optimise the patient pre-operatively, encourage self-management post operatively and extend the role of recovery beyond the immediate post-operative period and establish survivorship as the goal.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Each referred patient is offered a key worker and a tailored pre and post operative programme based on individual needs, which may incorporate some or all of the following; opportunity to discuss concerns, education regarding their condition, smoking cessation, healthy eating, pre and post-operative exercises. Baseline and follow up data is collected regarding the patient’s current health status, respiratory parameters and qualitative data about patient experiences.

      4c3880bb027f159e801041b1021e88e8 Result

      249 patients (as of March 2018) have been referred since the service was established in September 2016. The level of contact these patients have received is summarised below:

      Level of Intervention

      Numbers of patients

      Level 1 – No direct involvement with patient, advice via telephone or email provided

      37

      Level 2 – Single face to face consultation, to assess requirements and receive information, advice and referral to another health profession

      93

      Level 3 – More than one intervention involving advice on specific issues, for example provided with home exercise DVDs

      90

      Level 4 – Multiple contacts with the patient and/or carer over a long term period. Of these patients 16 attended pre- operative exercise classes

      29

      212 (85%) of patients met with either the ANP or ATP, 56% of those engaged in further support. Early evaluation of the project indicates that there are challenges in gaining patient engagement with the exercise classes. The reasons are multi factorial and include patients perceiving their current level of activity is sufficient and the need for multiple attendances (time, cost and difficulty parking) acting as deterrents. A home based exercise programme and exercise DVD is offered to address this challenge.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The project has had a positive start; changes have been made based on our early experiences. Work continues to develop the service; ensuring patients receive a tailored programme to meet their needs.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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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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      WS05.08 - UPDATE: Advances in Local Treatments for Lung Cancer and Mesothelioma (Radiation and Surgery) (Now Available) (ID 14691)

      15:00 - 15:45  |  Presenting Author(s): Jenny Mitchell

      • 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.

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