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Smith S, Brand M, Harden S, Briggs L, Leigh L, Brims F, Brooke M, Brunelli VN, Chia C, Dawkins P, Lawrenson R, Duffy M, Evans S, Leong T, Marshall H, Patel D, Pavlakis N, Philip J, Rankin N, Singhal N, Stone E, Tay R, Vinod S, Windsor M, Wright GM, Leong D, Zalcberg J, Stirling RG. Development of an Australia and New Zealand Lung Cancer Clinical Quality Registry: a protocol paper. BMJ Open 2022; 12:e060907. [PMID: 36038161 PMCID: PMC9438055 DOI: 10.1136/bmjopen-2022-060907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Lung cancer is the leading cause of cancer mortality, comprising the largest national cancer disease burden in Australia and New Zealand. Regional reports identify substantial evidence-practice gaps, unwarranted variation from best practice, and variation in processes and outcomes of care between treating centres. The Australia and New Zealand Lung Cancer Registry (ANZLCR) will be developed as a Clinical Quality Registry to monitor the safety, quality and effectiveness of lung cancer care in Australia and New Zealand. METHODS AND ANALYSIS Patient participants will include all adults >18 years of age with a new diagnosis of non-small-cell lung cancer (NSCLC), SCLC, thymoma or mesothelioma. The ANZLCR will register confirmed diagnoses using opt-out consent. Data will address key patient, disease, management processes and outcomes reported as clinical quality indicators. Electronic data collection facilitated by local data collectors and local, state and federal data linkage will enhance completeness and accuracy. Data will be stored and maintained in a secure web-based data platform overseen by registry management. Central governance with binational representation from consumers, patients and carers, governance, administration, health department, health policy bodies, university research and healthcare workers will provide project oversight. ETHICS AND DISSEMINATION The ANZLCR has received national ethics approval under the National Mutual Acceptance scheme. Data will be routinely reported to participating sites describing performance against measures of agreed best practice and nationally to stakeholders including federal, state and territory departments of health. Local, regional and (bi)national benchmarks, augmented with online dashboard indicator reporting will enable local targeting of quality improvement efforts.
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Affiliation(s)
- Shantelle Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Margaret Brand
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Susan Harden
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lisa Briggs
- Victorian Lung Cancer Registry, Monash University, Clayton, Victoria, Australia
| | - Lillian Leigh
- Victorian Lung Cancer Registry, Monash University, Clayton, Victoria, Australia
| | - Fraser Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Mark Brooke
- Lung Foundation Australia, Milton, Queensland, Australia
| | - Vanessa N Brunelli
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Collin Chia
- Department of Respiratory Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Paul Dawkins
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, University of Waikato, Hamilton, Waikato, New Zealand
- Strategy and Funding, Waikato District Health Board, Hamilton, New Zealand
| | - Mary Duffy
- Lung Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sue Evans
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Tracy Leong
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Henry Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Dainik Patel
- Department of Medical Oncology, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Nick Pavlakis
- Medical Oncology, Genesis Care and University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Philip
- Department of Medicine, Univ Melbourne, Fitzroy, Victoria, Australia
| | - Nicole Rankin
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nimit Singhal
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Emily Stone
- School of Clinical Medicine, University NSW, Sydney, Victoria, Australia
| | - Rebecca Tay
- Department of Medical Oncology, The Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Morgan Windsor
- Department of Thoracic Surgery, Prince Charles and Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - Gavin M Wright
- Department of Surgery, Cardiothoracic Surgery Unit, St Vincent, Victoria, Australia
| | - David Leong
- Department of Medical Oncology, John James Medical Centre Deakin, Canberra, Australian Capital Territory, Australia
| | - John Zalcberg
- Cancer Research Program, Monash University, Melbourne, Victoria, Australia
| | - Rob G Stirling
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
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Alessy SA, Davies E, Rawlinson J, Baker M, Lüchtenborg M. Clinical nurse specialists and survival in patients with cancer: the UK National Cancer Experience Survey. BMJ Support Palliat Care 2022:bmjspcare-2021-003445. [PMID: 35450864 DOI: 10.1136/bmjspcare-2021-003445] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine whether having a better care experience with a clinical nurse specialist (CNS) is associated with better overall survival of patients with cancer in England. METHODS We identified 99 371 patients with colorectal, lung, breast and prostate cancer who reported their care experience with CNS from the National Cancer Patient Experience Survey (2010-2014) and English cancer registration linked dataset. We categorised patients' experiences into three groups (excellent, non-excellent and no CNS name was given), across three aspects of CNS care: the ease of contacting their CNS, feeling that a CNS had listened to them and the degree to which explanations given by a CNS were understandable. We used univariable and multivariable Cox proportional hazards regression analyses to estimate HRs with 95% CIs by patient experience for each cancer adjusting for patients' sociodemographic and disease stage at diagnosis. RESULTS Among the three compared groups, patients who reported not being given a CNS name had the lowest survival. In the adjusted Cox regression analysis, the results show that among those who reported not being given a CNS name, the highest risk of death was in those with colorectal, breast and prostate cancers only (colorectal HR: 1.40; 95% CI: 1.32 to 1.84; breast HR: 1.34; 95% CI: 1.25 to 1.44; prostate HR: 1.09; 95% CI: 0.99 to 1.13). However, this association seemed reversed among patients with lung cancer, although attenuated when accounting for potential confounders. CONCLUSION These findings provide new evidence of the vital contribution CNS may make to cancer survival and suggest CNS input and support should be available to all patients after the diagnosis.
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Affiliation(s)
- Saleh A Alessy
- Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
- Centre for Cancer, Society & Public Health, Comprehensive Cancer Centre, King's College London, London, UK
| | - Elizabeth Davies
- Centre for Cancer, Society & Public Health, Comprehensive Cancer Centre, King's College London, London, UK
| | | | - Matthew Baker
- Consumer Forum, National Cancer Research Institute, London, UK
| | - Margreet Lüchtenborg
- Centre for Cancer, Society & Public Health, Comprehensive Cancer Centre, King's College London, London, UK
- National Cancer Registration and Analysis Service, NHS Digital, Leeds, UK
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Stewart I, Leary A, Khakwani A, Borthwick D, Tod A, Hubbard R, Beckett P, Tata LJ. Do working practices of cancer nurse specialists improve clinical outcomes? Retrospective cohort analysis from the English National Lung Cancer Audit. Int J Nurs Stud 2020; 118:103718. [PMID: 32859375 DOI: 10.1016/j.ijnurstu.2020.103718] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cancer nurse specialists are advanced practitioners who offer continuity of care and expert support for people diagnosed with specific cancers. Health Education England's Cancer Workforce Plan prioritises expansion of cancer nurse specialist numbers by 2021 as part of the Cancer Taskforce Strategy for England. OBJECTIVE To assess whether working practices of advanced practice specialist nurses are associated with clinical outcomes for people with lung cancer. METHODS Adults with non-small cell lung cancer followed from 30 days post-diagnosis in English secondary care were obtained from the English National Lung Cancer Audit, 2007 to 2011. A national survey of lung cancer nurse specialists provided information on self-reported working practices. Mortality and unplanned admissions from 30 days to 12 months post diagnosis were respectively analysed using Cox and Poisson regression. Outcomes were assessed according to patients' receipt of initial assessments by a lung cancer nurse specialist and according to trust-level reported working practices. Regression models were adjusted for individual sociodemographic and clinical characteristics, error adjusted for intracorrelations within regional cancer networks, and presented separately according to patients' treatment pathways (surgery, chemotherapy, radiotherapy, or no anti-cancer therapy). RESULTS Data for 108,115 people with lung cancer were analysed and associations with mortality and unplanned admissions were infrequent. Among people receiving only radiotherapy, however, the hazard for death was 17% lower among those who received an assessment by a lung cancer nurse specialist, compared with no assessment (hazard ratio = 0.83, 95% confidence interval 0.73-0.94; p = 0.003). The hazard was also lower among those receiving surgery (hazard ratio = 0.91, 0.84-0.99; p = 0.028). Among those receiving radiotherapy, nurse specialists' reported confidence within multidisciplinary team settings was associated with a lower risk of death (hazard ratio = 0.88, 0.78-1.00; p = 0.049) and a lower rate of unplanned cancer-related admissions (incidence rate ratio = 0.83, 0.73-0.95; p = 0.007). Lung cancer nurse specialist assessments before/at diagnosis, were associated with a 5% lower rate of unplanned admissions, compared to when assessments occurred after diagnosis. CONCLUSION The contribution of nurse specialist working practices was occasionally associated with better outcomes for people with lung cancer. These were not limited to a single treatment pathway, but do indicate discrete relationships within pathways. Our study provides initial measures of overall lung cancer nurse specialist working practices at trusts, however, more detailed studies with longitudinal measurement of lung cancer nurse specialist-patient interaction are needed to better ascertain impacts on long-term patient outcomes. The findings highlight opportunities for potential improvement in effectiveness of service and care management.
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Affiliation(s)
- Iain Stewart
- Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB, UK; NIHR Biomedical Research Centre, University of Nottingham, NG5 1PB, UK.
| | - Alison Leary
- London South Bank University, Division of Primary and Social Care, SE1 0AA, UK
| | - Aamir Khakwani
- Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB, UK
| | - Diana Borthwick
- Western General Hospital, Edinburgh Cancer Centre, EH4 2JT, UK
| | - Angela Tod
- University of Sheffield, School of Nursing and Midwifery, S10 2LA, UK
| | - Richard Hubbard
- Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB, UK
| | - Paul Beckett
- Derby Teaching Hospitals NHS Foundation Trust, DE22 3NE, UK
| | - Laila J Tata
- Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB, UK
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Nursing pay by gender distribution in the UK - does the Glass Escalator still exist? Int J Nurs Stud 2019; 93:21-29. [DOI: 10.1016/j.ijnurstu.2019.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 02/03/2019] [Accepted: 02/06/2019] [Indexed: 11/23/2022]
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Adizie JB, Khakwani A, Beckett P, Hubbard R, Navani N, Harden SV, Woolhouse I. Impact of organisation and specialist service delivery on lung cancer outcomes. Thorax 2019; 74:546-550. [PMID: 30661021 DOI: 10.1136/thoraxjnl-2018-212588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Data from the National Lung Cancer Audit (NLCA) often show variation in outcomes between lung cancer units which are not entirely explained by case mix. We explore the association between the organisation of services and patient outcome. METHODS Details of service provision were collected via an electronic survey in June 2017. An overall organisational score derived from eleven key service factors from national lung cancer commissioning guidance was calculated for each organisation. The results for each hospital were linked to their patient outcome results from the 2015 NLCA cases. Multivariate logistic regression analysis was used to link the organisational score to patient outcomes. RESULTS Lung cancer unit organisational audit scores varied from 0 to 11. Thirty-eight (29%) units had a score of 0-4, 64 (50%) had a score of 5-7 and 27 (21%) had a score of 8-11. Multivariate regression analysis revealed that, compared with an organisational score of 0-4, patients seen at units with a score of 8-11 had higher 1-year survival (adjusted OR (95% CI)=2.30 (1.04 to 5.08), p<0.001), higher curative-intent treatment rate (adjusted OR (95% CI)=1.62 (1.26 to 2.09), p<0.001) and greater likelihood of receiving treatment within 62 days (adjusted OR (95% CI)=1.49 (1.20 to 1.86), p<0.001). CONCLUSION National variation in the provision of services and workforce remain. We provide evidence that adherence to the national lung commissioning guidance has the potential to improve patient outcomes within the current service structure.
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Affiliation(s)
- Jana Bhavani Adizie
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aamir Khakwani
- Care Quality Improvement Department, Royal College of Physicians, London, UK
| | - Paul Beckett
- Care Quality Improvement Department, Royal College of Physicians, London, UK
| | - Richard Hubbard
- Care Quality Improvement Department, Royal College of Physicians, London, UK
| | - Neal Navani
- Care Quality Improvement Department, Royal College of Physicians, London, UK
| | - Susan V Harden
- Care Quality Improvement Department, Royal College of Physicians, London, UK
| | - Ian Woolhouse
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Care Quality Improvement Department, Royal College of Physicians, London, UK
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Stewart I, Leary A, Tod A, Borthwick D, Khakwani A, Hubbard R, Beckett P, Tata LJ. Barriers to delivering advanced cancer nursing: A workload analysis of specialist nurse practice linked to the English National Lung Cancer Audit. Eur J Oncol Nurs 2018; 36:103-111. [DOI: 10.1016/j.ejon.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/29/2018] [Accepted: 07/23/2018] [Indexed: 11/25/2022]
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Are working practices of lung cancer nurse specialists associated with variation in peoples’ receipt of anticancer therapy? Lung Cancer 2018; 123:160-165. [DOI: 10.1016/j.lungcan.2018.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/16/2018] [Indexed: 11/20/2022]
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Irish Respiratory Clinical Nurse Specialists' Experiences of Their Role: A Qualitative Exploration. CLIN NURSE SPEC 2018; 32:240-248. [PMID: 30095523 DOI: 10.1097/nur.0000000000000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM AND OBJECTIVES The aim of this study was to explore respiratory clinical nurse specialists' (CNSs') experiences of their role. BACKGROUND Respiratory illnesses are currently 1 of the top 3 causes of mortality resulting in 1 in 5 deaths and are associated with significant human burden. Respiratory CNSs play a vital role in the management of respiratory disease through supporting improvements in quality of life, reduction of exacerbations, and subsequent hospital admission. While published literature exists regarding the CNS role, there is a dearth of published literature on the respiratory CNS role. DESIGN A qualitative descriptive design allowed the researcher to elicit respiratory CNSs' experiences of their role. METHODS Ethical approval was obtained, CNSs were purposively sampled (n = 10), and data were collected by semistructured interviews, transcribed, and analyzed using content thematic analysis. RESULTS Three themes were identified within the findings: "multidimensional role," "interacting and collaborating," and "advancing the role." CONCLUSIONS Overall the study highlights that respiratory CNSs are active in the role as clinical experts, advocators, educators, collaborators, consultants, and health promoters. These findings recognize the importance of evaluating and building on the current CNS workforce in respiratory care and evaluating future development of the CNS role in specialized aspects of respiratory care in line with population and service needs.
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Using patient-reported outcome measures to deliver enhanced supportive care to people with lung cancer: feasibility and acceptability of a nurse-led consultation model. Support Care Cancer 2018; 26:3729-3737. [DOI: 10.1007/s00520-018-4234-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 04/26/2018] [Indexed: 01/10/2023]
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Leary A, Maclaine K, Trevatt P, Radford M, Punshon G. Variation in job titles within the nursing workforce. J Clin Nurs 2017; 26:4945-4950. [PMID: 28880423 DOI: 10.1111/jocn.13985] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES/BACKGROUND The work of specialist nursing has been under scrutiny for many years in the UK due to a perception that it is not cost-effective. A common issue is the lack of consistency of job titles, which causes confusion to the public, employing organisations, colleagues and commissioners of services. Lack of consistency has implications for the wider perception of advanced specialist practice in the worldwide community and the workforce more generally. This study aims to understand the variation in job titles in the UK population. METHODS A pre-existing data set of accrued studies into the work of nurses working in specialisms was mined for insight (N = 17,960). This study used knowledge discovery through data and descriptive statistics to perform secondary analysis. RESULTS Mining these data revealed 595 job titles in use in 17,960 specialist posts once the specialism had been removed. The most commonly used titles were Clinical Nurse Specialist, Nurse Specialist/Specialist Nurse, Advanced Nurse Practitioner and Nurse Practitioner. There were three other primary groupings. These were variants with a specialist or technical prefix of suffix, for example Nurse Endoscopist, variants of seniority such as trainee, senior nurse for [specialism] or variants of function such as Nurse Prescriber. The clustering was driven primarily by pay band. A total of 323 posts were recorded as holding titles such as Advanced Nurse Practitioner or Specialist Nurse who were not registered with the Nursing & Midwifery Council. RELEVANCE TO CLINICAL PRACTICE In this data set, there is a large array of titles, which appear to have little relationship with other factors like education. This is confusing to the public, employers and those commissioning services. It also demonstrates that the previous assumptions by Council for Healthcare Regulatory Excellence that advanced practice labels are associated with career progression are unsound and should be addressed by the regulator.
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Affiliation(s)
| | - Katrina Maclaine
- London South Bank University, London, UK.,Association of Advanced Practice Educators, London, UK
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