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Jennifer Harris

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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: 1
    • Moderators:
    • Coordinates: 9/25/2018, 13:30 - 15:00, Room 205 AC
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      MA17.09 - Remote Symptom Reporting for Tele-Nursing Team in Thoracic Oncology Clinics: Environmental Scan and Stakeholder Engagement (ID 12226)

      14:30 - 14:35  |  Author(s): Jennifer Harris

      • Abstract
      • Presentation
      • Slides


      50+% of cancer-related toxicities are under-reported. A real-time Remote (i.e., at-home) Symptom Reporting (RSR) system could help patients seek help when symptoms exceed thresholds, mitigating unplanned clinic/emergency room visits. A RSR system for solid-tumor patients undergoing chemotherapy is associated with improved health-related quality of life and survival (Basch et al, 2017). Adapting RSR into the thoracic cancer clinic environment requires assessments of potential implementation barriers, and tailoring of the RSR-system.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Over a five month period, we performed an environmental scan to determine readiness of RSR implementation in our comprehensive thoracic oncology outpatient clinic. A qualitative assessment of potential RSR integration into the telephone triage environment was performed through one-on-one interviews and focus groups, followed by thematic analysis. Discussions were held with multiple stakeholders; key implementation champions were identified. We utilized the Canadian Institutes of Health Research Knowledge-to-Action Framework, Steps 2-4 as our guide.

      4c3880bb027f159e801041b1021e88e8 Result

      In the environmental scan, 125 telephone triage calls were logged over randomly-chosen days in a 6-week period. The mean ± SEM call duration was 5.4 ± 0.62 minutes. Mean time until response was 44.4 ± 3.8 minutes. Nurses spent on average 2.7 ± 0.2 minutes documenting into the electronic-patient-record. The mean duration from initial contact to completion was 24.1 ± 4.5 minutes. Resolution of the triage calls involved telephone advice alone (87%; n=109), unplanned clinic visits (6%; n=8), and emergency visits (6%; n=7).

      In the qualitative analyses, top stakeholder-identified issues were: lack of assessment standardization; wasted time transcribing paper triage notes to electronic records; and a high patient/family burden in terms on understanding when to seek help. There was universal interest in adopting a RSR system from administrative assistants, nursing administration, clinic nurses, physicians and trainees. Perceived benefits of RSR were: standardized, focused telephone assessments; tailored symptom assessments in the thoracic setting (i.e., dyspnea, coughing, hemoptysis); patient empowerment; and improved efficiency in patient contact, intra-team communication, and documentation. Key stakeholder RSR features were: a phone/web application that assesses symptom severity and indicates when to contact the triage team; one-touch feature to reach team; longitudinal symptom trend display for tele-nursing team; and embedding of the COSTaRS framework to facilitate tele-nursing interventions and documentation.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Integration of a RSR system integration was perceived favorably by stakeholders to increase nursing efficiency and improve health related patient outcomes, but success hinges on an identified set of key requirements.


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