Nurse re-assessment clinic - Holistic nursing assessment for patients completing initial lung cancer treatments
Category: Follow-Up and End-of-Life Care
The problem identified
An earlier needs analysis highlighted the issue of patient abandonment on the completion of lung cancer treatments. It became apparent from this in depth study that patients with lung cancer needed to re-establish contact with the lung CNS where a detailed assessment of the patient and carer's physical, psychological, social & financial needs could take place. At the time of the pilot there was no lung cancer nursing support on the hospital site where patients received chemotherapy and radiotherapy.
The intervention made to change the problem
A nurse-led re-assessment clinic for eligible lung cancer patients was piloted known as nurse re-assessment clinic (NRAC). Appointments were offered to all suitable patients over a 16 week period to have an opportunity for a detailed nurse assessment upon completion of this initial lung cancer treatment. 71 patients were offered an appointment during the pilot phase. Only 21 received the nurse re-assessment. 50 patients did not attend. Crucially 24 patients felt that they did not require the input of a lung CNS at this time which raised the question how can we capture a significant proportion of patients that have no nursing needs at the end of treatment, but are likely to develop needs in the coming months.
How it changed my practice
The NRAC clinic concept was poorly received; sadly only 21 patients underwent a nurse re-assessment. In terms of both uptake and time the clinic concept was not time or cost effective, although evidence from our own local study supported by wider literature demonstrates that patients with lung cancer can have many unmet needs which are often exacerbated at the end of treatments. Of those that did attend the feedback was positive. Following discussion with the local clinical and medical oncologist it was felt that they would benefit enormously from lung CNS input in their post treatment clinics where the detailed assessment could be undertaken if required at each of the patients follow up visits if required. Therefore the team have changed working practice and established themselves twice weekly in the oncology department on the hospital site where patients receive their treatment.