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Doris Howell
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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): Doris Howell
- Abstract
- Presentation
Background
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.
6f8b794f3246b0c1e1780bb4d4d5dc53Only 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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MA18 - Modelling, Decision-Making and Population-Based Outcomes (ID 920)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 13:30 - 15:00, Room 201 F
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MA18.07 - Awareness of the Harms of Continued Smoking Among Lung Cancer (LC) Survivors (ID 12024)
14:05 - 14:10 | Author(s): Doris Howell
- Abstract
- Presentation
Background
Continued smoking after a LC diagnosis is associated with poorer cancer outcomes including increased risk of treatment-related side-effects, reduced treatment efficacy and poorer prognosis. Smoking cessation is an integral part of LC survivorship by improving both cancer and non-cancer outcomes. To enhance survivorship education, clinicians should understand patient awareness of the harms of continued smoking.
a9ded1e5ce5d75814730bb4caaf49419 Method
LC survivors from Princess Margaret Cancer Centre, Toronto (2014-2017) were surveyed with respect to self-awareness of the harms of continued smoking on cancer-related outcomes. Univariable and multivariable logistic regression models assessed factors associated with awareness and whether awareness was associated with cessation among current smokers at diagnosis.
4c3880bb027f159e801041b1021e88e8 Result
Of 553 patients, 181 were lifetime never-smokers. Among those smoking during the peri-diagnosis period (n=177), 65% quit after diagnosis. Among all, few patients were aware that smoking negatively impacts treatment-related outcomes [complications from cancer surgery (only 41% aware), radiation side-effects (30%), quality-of-life on chemotherapy (44%) and treatment efficacy (36%)]; half were aware that smoking negatively impacts cancer prognosis (51% aware) and risk of developing second primaries (50%). Compared to ex-smokers/never-smokers at diagnosis, current smokers at diagnosis were less aware of the impact of smoking on radiation side-effects (22% vs 31% aware, P=0.01), prognosis (44% vs 55%, P=0.02) and risk of second primaries (42% vs 55%, P=0.007). Among sociodemographic variables, only those speaking English at home were consistently found more likely unaware that smoking negatively impacts these outcomes (ORs=1.52-2.20, P<0.04). Patients with early stage disease were more likely unaware that smoking negative impacts radiation side-effects (OR=1.60, 95%CI[1.09-2.35], P=0.02); while patients on curative treatment (OR=1.53[1.08-2.17], P=0.02) and those exposed to second-hand smoke (SHS) were more likely unaware that smoking impacts quality-of-life on chemotherapy (OR=1.64[1.05-2.58], P=0.03). Exposure to SHS, treatment intent and stage were not associated with awareness of impact on prognosis or second primaries (P>0.11). Among smokers in the peri-diagnosis period, awareness of the impact of smoking on surgical complications (aOR=2.09 [0.96-4.54], P=0.06), quality-of-life while receiving chemotherapy (aOR=2.60[1.17-5.79], P=0.02) and on treatment efficacy (aOR =2.24[0.97-5.20], P=0.06) were each associated with subsequent quitting, adjusted for marital status, pack-years, self-rated health and SHS exposure.
8eea62084ca7e541d918e823422bd82e Conclusion
Many LC patients are unaware of the harms of continued smoking on cancer outcomes, particularly those smoking at diagnosis. Awareness of some of these outcomes was associated with subsequent tobacco cessation. Patient education on the health benefits of smoking cessation may increase quit rates and improve outcomes for LC patients.
6f8b794f3246b0c1e1780bb4d4d5dc53Only 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.
