1
|
Nash J, Leong T, Dawkins P, Stone E, Marshall H, Brims F. The TSANZ and Lung Foundation Australia 2023 landscape survey of lung cancer care across Australia and Aotearoa New Zealand. Respirology 2024; 29:405-412. [PMID: 38431910 DOI: 10.1111/resp.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND OBJECTIVE Unwarranted variations in lung cancer care have been well described in both Australia and Aotearoa New Zealand, with shortfalls in hospital-based workforce and infrastructure previously demonstrated. A survey of lung cancer clinicians was performed to gain an updated understanding of current workforce and infrastructure. METHODS An online Qualtrics survey included questions on institutional demographics, estimated lung cancer case load, multidisciplinary team (MDT) characteristics including workforce and local infrastructure. We sought to obtain one response from every institution treating lung cancer in Australia and Aotearoa New Zealand. RESULTS Responses were received from 89 institutions, estimated to include 85% centres treating lung cancer in Australia and 100% of public hospitals in Aotearoa New Zealand. Lung cancer nurse specialist and Nuclear Medicine are poorly represented in multidisciplinary teams (MDTs) with just 34/88 (38%) institutions fulfilling recommended core workforce for MDT meetings. Case presentation is low with 32/88 (36%) regularly discussing all lung cancer patients at MDT. Metropolitan institutions appear to have a more comprehensive range of services on site, compared to non-metropolitan institutions. Few (4/88) institutions have embedded smoking cessation services. Compared to the previous 2021 Landscape Survey, thoracic surgery representation and core MDT workforce have improved, with modest change in specialist nurse numbers. CONCLUSION This wide-reaching survey has identified persistent deficiencies and variations in lung cancer workforce and gaps in infrastructure. Multidisciplinary collaboration and care coordination are needed to ensure all patients can access timely and equitable lung cancer care.
Collapse
Affiliation(s)
- Jessica Nash
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Tracy Leong
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Dawkins
- Middlemore Hospital, Auckland, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Henry Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The University of Queensland Thoracic Research Centre, Brisbane, Queensland, Australia
| | - Fraser Brims
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Institute for Respiratory Health, Perth, Western Australia, Australia
| |
Collapse
|
2
|
Chung H, Hyatt A, Crone E, Milne D, Aranda S, Gough K, Krishnasamy M. Clinical Utility Assessment of a Nursing Checklist Identifying Complex Care Needs Due to Inequities Among Ambulatory Patients With Cancer: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e48432. [PMID: 37943601 PMCID: PMC10667971 DOI: 10.2196/48432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Disparities in cancer incidence, complex care needs, and poor health outcomes are largely driven by structural inequities stemming from social determinants of health. To date, no evidence-based clinical tool has been developed to identify newly diagnosed patients at risk of poorer outcomes. Specialist cancer nurses are well-positioned to ameliorate inequity of opportunity for optimal care, treatment, and outcomes through timely screening, assessment, and intervention. We designed a nursing complexity checklist (the "Checklist") to support these activities, with the ultimate goal of improving equitable experiences and outcomes of care. This study aims to generate evidence regarding the clinical utility of the Checklist. OBJECTIVE The primary objectives of this study are to provide qualitative evidence regarding key aspects of the Checklist's clinical utility (appropriateness, acceptability, and practicability), informed by Smart's multidimensional model of clinical utility. Secondary objectives explore the predictive value of the Checklist and concordance between specific checklist items and patient-reported outcome measures. METHODS This prospective mixed methods case series study will recruit up to 60 newly diagnosed patients with cancer and 10 specialist nurses from a specialist cancer center. Nurses will complete the Checklist with patient participants. Within 2 weeks of Checklist completion, patients will complete 5 patient-reported outcome measures with established psychometric properties that correspond to specific checklist items and an individual semistructured interview to explore Checklist clinical utility. Interviews with nurses will occur 12 and 24 weeks after they first complete a checklist, exploring perceptions of the Checklist's clinical utility including barriers and facilitators to implementation. Data describing planned and unplanned patient service use will be collected from patient follow-up interviews at 12 weeks and the electronic medical record at 24 weeks after Checklist completion. Descriptive statistics will summarize operational, checklist, and electronic medical record data. The predictive value of the Checklist and the relationship between specific checklist items and relevant patient-reported outcome measures will be examined using descriptive statistics, contingency tables, measures of association, and plots as appropriate. Qualitative data will be analyzed using a content analysis approach. RESULTS This study was approved by the institution's ethics committee. The enrollment period commenced in May 2022 and ended in November 2022. In total, 37 patients with cancer and 7 specialist cancer nurses were recruited at this time. Data collection is scheduled for completion at the end of May 2023. CONCLUSIONS This study will evaluate key clinical utility dimensions of a nursing complexity checklist. It will also provide preliminary evidence on its predictive value and information to support its seamless implementation into everyday practice including, but not limited to, possible revisions to the Checklist, instructions, and training for relevant personnel. Future implementation of this Checklist may improve equity of opportunity of access to care for patients with cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48432.
Collapse
Affiliation(s)
- Holly Chung
- Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Amelia Hyatt
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Elizabeth Crone
- Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Donna Milne
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
- Skin and Melanoma Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sanchia Aranda
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Karla Gough
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
- Victorian Comprehensive Cancer Centre Alliance, Victoria, Australia
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Effects of ADOPT-Based Breathing Training Combined with Continuous Nursing on Quality of Life, Mental Health, and Self-Efficacy in Lung Cancer Patients Undergoing Chemotherapy: Based on a Retrospective Cohort Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4164771. [PMID: 35495891 PMCID: PMC9046005 DOI: 10.1155/2022/4164771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 11/17/2022]
Abstract
Objective Considering the poor effect of routine nursing program on patients with lung cancer after chemotherapy, a retrospective cohort study was conducted to elucidate the effects of respiratory training based on ADOPT mode combined with continuous nursing on quality of life, mental health, and self-efficacy in patients undergoing lung cancer chemotherapy. Methods Sixty patients with lung cancer admitted in our hospital from January 2019 to April 2021 were selected. Patients in both groups received ADOPT breathing training. Patients who underwent routine nursing were assigned into control group (n = 30) and patients with continuous nursing were set as study group (n = 30). The differences in nursing satisfaction, self-management efficacy, quality of life score, mental health, family care index, and self-transcendence scale scores of patients with lung cancer were determined. Results First of all, we compared the baseline data of the two groups, and there was no statistical difference. In the comparison of nursing satisfaction between the two groups, 24 cases in the study group were very satisfied, 5 cases were satisfied, 1 case was general, and the satisfaction rate was 100%, whereas in the control, 14 cases were very satisfied, 8 cases were satisfied, 4 cases were not satisfied, and the satisfaction rate was 86.67%. Compared to the control, the nursing satisfaction was higher in the study group (P < 0.05). There exhibited no significant difference in the sense of self-management efficacy between the two on the day of admission (P > 0.05). After nursing, the scores of self-management efficacy were higher in the study group, compared to the control (P < 0.05). In contrast to control, the scores of self-management efficacy at discharge and 1, 3, and 6 months after discharge were higher in the study group (P < 0.05). In terms of the scores of quality of life of patients with lung cancer, on the day of admission, no significant difference exited (P > 0.05). The scores of quality of life at discharge and 1, 3, and 6 months after discharge of the study group were higher compared to the control (P < 0.05). In the comparison of mental health, there was no significant difference between the two groups on the day of admission (P > 0.05), but the scores of anxiety and depression in the two groups decreased after nursing, and the scores of anxiety and depression in the study group at discharge and 1 month, 3 months, and 6 months after discharge were lower than those in the control group (P < 0.05). In terms of the family care index, there was no significant difference between the two groups at admission (P > 0.05), but after nursing, the family care index of the two groups increased, and the family care index at discharge and 1, 3, and 6 months after discharge was greater in the study group (P < 0.05). In terms of the score of self-transcendence scale, there exhibited no significant difference on the day of admission (P > 0.05), but the score of self-transcendence scale of the two groups increased after nursing. Furthermore, compared to the control, the score of self-transcendence scale at discharge and 1 month, 3 months, and 6 months after discharge in the study group was higher (P < 0.05). Conclusion Patients undergoing lung cancer chemotherapy using ADOPT-based breathing training combined with continuous nursing can effectively facilitate the overall quality of life of lung cancer chemotherapy patients, promote the mental health and self-efficacy of patients with lung cancer chemotherapy, and then reduce the medical burden of patients. The nursing model based on ADOPT breathing training combined with continuous nursing is worthy to be applied in the rehabilitation of patients with lung cancer.
Collapse
|
5
|
Brims FJH, Kumarasamy C, Nash J, Leong TL, Stone E, Marshall HM. Hospital-based multidisciplinary lung cancer care in Australia: a survey of the landscape in 2021. BMJ Open Respir Res 2022; 9:9/1/e001157. [PMID: 35039312 PMCID: PMC8765035 DOI: 10.1136/bmjresp-2021-001157] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Lung cancer is the leading cause of cancer death in Australia and has the highest cancer burden. Numerous reports describe variations in lung cancer care and outcomes across Australia. There are no data assessing compliance with treatment guidelines and little is known about lung cancer multidisciplinary team (MDT) infrastructure around Australia. Methods Clinicians from institutions treating lung cancer were invited to complete an online survey regarding the local infrastructure for lung cancer care and contemporary issues affecting lung cancer. Results Responses from 79 separate institutions were obtained representing 72% of all known institutions treating lung cancer in Australia. Most (93.6%) held a regular MDT meeting although recommended core membership was only achieved for 42/73 (57.5%) sites. There was no thoracic surgery representation in 17/73 (23.3%) of MDTs and surgery was less represented in regional and low case volume centres. Specialist nurses were present in just 37/79 (46.8%) of all sites. Access to diagnostic and treatment facilities was limited for some institutions. IT infrastructure was variable and most sites (69%) do not perform regular audits against guidelines. The COVID-19 pandemic has driven most sites to incorporate virtual MDT meetings, with variable impact around the country. Clinician support for a national data-driven approach to improving lung cancer care was unanimous. Discussion This survey demonstrates variations in infrastructure support, provision and membership of lung cancer MDTs, in particular thoracic surgery and specialist lung cancer nurses. This heterogeneity may contribute to some of the well-documented variations in lung cancer outcomes in Australia.
Collapse
Affiliation(s)
- Fraser J H Brims
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia .,Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Chellan Kumarasamy
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Jessica Nash
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Tracy L Leong
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Emily Stone
- Department of Respiratory Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Henry M Marshall
- Thoracic Research Centre, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
6
|
Berghmans T, Lievens Y, Aapro M, Baird AM, Beishon M, Calabrese F, Dégi C, Delgado Bolton RC, Gaga M, Lövey J, Luciani A, Pereira P, Prosch H, Saar M, Shackcloth M, Tabak-Houwaard G, Costa A, Poortmans P. European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Lung cancer. Lung Cancer 2020; 150:221-239. [PMID: 33227525 DOI: 10.1016/j.lungcan.2020.08.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/24/2022]
Abstract
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Lung cancer is the leading cause of cancer mortality and has a wide variation in treatment and outcomes in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must only be carried out in lung cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
Collapse
Affiliation(s)
- Thierry Berghmans
- European Organisation for Research and Treatment of Cancer (EORTC); Thoracic Oncology Clinic, Institut Jules Bordet, Brussels, Belgium
| | - Yolande Lievens
- European Society for Radiotherapy and Oncology (ESTRO); Radiation Oncology Department, Ghent University Hospital, Belgium
| | - Matti Aapro
- European Cancer Organisation; Genolier Cancer Center, Genolier, Switzerland
| | - Anne-Marie Baird
- European Cancer Organisation Patient Advisory Committee; Central Pathology Laboratory, St James's Hospital, Dublin, Ireland
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Fiorella Calabrese
- European Society of Pathology (ESP); Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | - Csaba Dégi
- International Psycho-Oncology Society (IPOS); Faculty of Sociology and Social Work, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Roberto C Delgado Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR); University of La Rioja, Logroño, La Rioja, Spain
| | - Mina Gaga
- European Respiratory Society (ERS); 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Andrea Luciani
- International Society of Geriatric Oncology (SIOG); Medical Oncology, Ospedale S. Paolo, Milan, Italy
| | - Philippe Pereira
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK-Kliniken, Heilbronn, Germany
| | - Helmut Prosch
- European Society of Radiology (ESR); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Marika Saar
- European Society of Oncology Pharmacy (ESOP); Tartu University Hospital, Tartu, Estonia
| | - Michael Shackcloth
- European Society of Surgical Oncology (ESSO); Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | | | - Philip Poortmans
- European Cancer Organisation; Iridium Kankernetwerk and University of Antwerp, Wilrijk-Antwerp, Belgium
| |
Collapse
|
7
|
Hoon SN, Lawrie I, Qi C, Rahman N, Maskell N, Forbes K, Gerry S, Monterosso L, Chauhan A, Brims FJH. Symptom Burden and Unmet Needs in Malignant Pleural Mesothelioma: Exploratory Analyses From the RESPECT-Meso Study. J Palliat Care 2020; 36:113-120. [PMID: 32791881 DOI: 10.1177/0825859720948975] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Malignant Pleural Mesothelioma (MPM) has a poor prognosis and high symptom burden. RESPECT-Meso was a multicenter randomized study examining the role of early specialist palliative care (SPC) on quality of life (QoL) with MPM. This is a post-hoc exploratory analysis of the symptom burden and unmet needs identified from RESPECT-Meso participants. METHODS Exploratory analysis from 174 participants using the General Health Status (GHS) measure (from the EORTC QLQ-C30 QoL questionnaire) and 87 participants using validated assessment questionnaires in those randomized to SPC. Eligibility for the study included confirmed MPM with diagnosis <6 weeks prior, performance score (PS) 0 or 1, no significant physical or psychological comorbidity. Cox proportional hazards models were derived to examine for relationships with survival. Free text was assessed using content analysis, looking for common themes and words. RESULTS Participants were predominantly male (79.9%), mean age 72.8 years, PS was 0 in 38%, 78% of MPM was epithelioid. At least 3 symptoms were reported in 69.8% of participants, including fatigue (81%), dyspnea (73.3%), pain (61.2%), weight loss (59.3%). Anxiety was reported by 54.7% of participants, 52.3% low mood and 48.8% anhedonia symptoms. After multivariable adjustment, only pain remained statistically significant with a hazard ratio (HR) 2.9 (95% CI 1.3-6.7; p = 0.01). For each 1 unit increase in GHS score, the HR for death was 0.987 (0.978-0.996; p = 0.006), indicating a worse reported QoL is related to shorter survival. Unmet needs were common: 25.9% wanted more information about their condition, 24.7% about their care and 21.2% about their treatment. 79.1% were concerned about the effect of their illness on family. CONCLUSION There is a high symptom burden in mesothelioma despite good baseline performance status. A worse QoL is associated with a worse survival. Unmet needs are common, perhaps highlighting a need for improved communication and information sharing.
Collapse
Affiliation(s)
- Siao Nge Hoon
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Curtin Medical School, 1649Curtin University, Perth, Western Australia, Australia
| | - Iain Lawrie
- Department of Palliative Medicine, North Manchester General Hospital, Manchester, United Kingdom.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Cathy Qi
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Najib Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Nick Maskell
- Department of Respiratory Medicine, University of Bristol, Bristol, United Kingdom
| | - Karen Forbes
- Department of Palliative Medicine, University of Bristol, Bristol, United Kingdom
| | - Stephen Gerry
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Leanne Monterosso
- School of Nursing and Midwifery, University of Notre Dame, Fremantle, Australia.,School of Nursing and Midwifery, Edith Cowan University.,St John of God Murdoch Hospital, Murdoch, Australia
| | - Anoop Chauhan
- Department of Respiratory Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.,Research & Innovation Department, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.,School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, United Kingdom
| | - Fraser J H Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Curtin Medical School, 1649Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|