Nurse-led virtual lung cancer clinic transforms patient, staff experience
BARCELONA — Virtual clinics led by lung cancer nurse specialists facilitated timely service and increased job satisfaction among staff while providing patient-centered care, according to a presentation at International Association for the Study of Lung Cancer World Conference on Lung Cancer.
In 2014, researchers in the U.K. developed a virtual clinic, for which a lung cancer nurse specialist conducted a telephone-based holistic assessment of suspicious CT scans taken in the community and offered an investigative plan. U.K. National Lung Cancer Optimal Pathway guidance adopted this model of care in 2017.
“By 2014, we observed a definite need for change, as diagnostics, treatments and inventions had expanded, opening up opportunities for patients who were previously deemed untreatable,” Andrea V. McIver, of the Liverpool Lung Cancer Unit at Liverpool Heart & Chest Hospital and Royal Liverpool and Broadgreen University Hospitals NHS Trust in the U.K., said during the presentation. “We changed our service significantly, introducing ‘straight to CT,’ which meant patients would have their CT whilst under the care of their family doctor, and virtual clinics replaced our [prior model of] rapid-access clinics. Although these changes were daunting, they’d been tested before we took that final step.”
A radiology process informs the clinic’s physicians when the community scans are done. The physicians then review the scans in a timely manner — often on the same day — and devise a diagnostic plan, which is emailed to the clinical nurse specialist team. A nurse specialist then calls the patients to introduce the hospital team and to explain that the results of CT scan require further investigation. Patients are offered a choice between attending a medical appointment or having a nurse-led virtual telephone assessment. In the case of an urgent finding, nurses facilitate a home visit or hospital admission.
During the virtual clinic, nurses first explore what led to the patient undergoing the CT scan, and then assess the patient’s understanding of possible cancer. The nurses conduct a holistic assessment that includes both physical and mental health history, current symptoms, medication use, smoking and job history, and family and social situation, and they score the patient’s performance status through questions about their daily activities.
“Throughout, we build a picture of the person, making a decision as to whether they can tolerate the tests that we are proposing,” McIver said. “If we conclude the patient is fit for the test, then we can explain what is involved, suggest when it can be done to suit them, and what preparation is needed. If patients are not fit or accepting of the test, we can make an alternative plan.”
After establishing this virtual clinic model, researchers sought to assess patient and staff perceptions of the new lung cancer care pathway by analyzing data from 2016 to 2018.
During that time, 1,498 patients with suspicious CT findings were referred to the clinic, 75% of whom were subsequently diagnosed with cancer.
Among the patients who received a cancer diagnosis, 75% were diagnosed via the outpatient service and 88% chose the virtual clinical for initial assessment and diagnostic test facilitation.
Researchers administered questionnaires to assess how patients perceived the virtual service.
“Year after year, the feedback has been overwhelmingly positive,” Nicola Maddock, also of the Liverpool Lung Cancer Unit, said during the presentation. “Ninety-eight percent of the patients were happy to receive the telephone call in 2014, which in the most recent survey [in 2019] had increased to 100%.”
Factors that influenced this result include timeliness, ability to stay home, and avoiding traffic and parking fees.
Researchers also asked patients when they would like to receive the call, and most (2014, 91%; 2019, 100%) indicated they preferred to receive the call within 4 days of the CT scan. Thirty-nine percent stated they would like same-day contact.
When asked whether the information given during the call prepared them for the next test, 79% of patients in 2014 responded they felt fully prepared, which increased to 100% in 2019.
“This suggests to us nurses that the information we give has gotten better,” Maddock said.
Clinic staff who were surveyed stated that the virtual services facilitated timely holistic assessments and interventions, reduced emotional and physical stress, and provided home supportive care instead of hospital-based care.
Staff also indicated the clinic increased job satisfaction, as they were able to utilize their specialist skills and knowledge, impact patient outcomes and develop therapeutic relationships with patients.
“The challenges today are similar to those when we started this process,” Maddock said. “We are faced with difficult questions and emotional reactions, while at the same time having to make decisions. What’s different today is that we do it with more confidence based on the feedback and outcomes that we’ve seen.
“We are able to understand our patients’ needs much earlier on with comprehensive assessments that influence interventions,” she added. “We are there to support patients through their emotional and physical distress. In turn, this gives us great job satisfaction. We are able to influence and support the interventions that we know can make such a difference to patient outcomes.” – by Alexandra Todak
McIver A, et al. Abstract OA05.05. Presented at: International Association for the Study of Lung Cancer World Conference on Lung Cancer; Sept. 7-10, 2019; Barcelona.
Disclosures: The authors report no relevant financial disclosures.