Specialist nurses add efficiency, continuity to follow-up after lung cancer resection
BARCELONA — Nurse-led follow-up programs for patients with resected lung cancer increased efficiency, decreased waiting time for appointments and facilitated continuity of care, according to results of an analysis presented at International Association for the Study of Lung Cancer World Conference on Lung Cancer.
The role of specialist nurses within thoracic surgery centers in the U.K. is specific to each center and evolves to meet the needs of the local service.
Jenny Mitchell, advanced nurse practitioner in thoracic surgery at Oxford University Hospitals NHS Foundation Trust, said during her presentation that after establishing the nurse practitioner role at Oxford when she was appointed in 2011, “one of the areas I identified for improvement was our follow-up service, specifically our surgical surveillance program.”
Previously, patients were seen postoperatively by junior physicians in the clinic, which limited continuity of care and frequently presented challenges in following up abnormal results.
Mitchell and colleagues first developed a nurse-led early follow-up clinic, then implemented a nurse-led CT follow-up program for patients receiving long-term surgical follow-up after lung cancer resection.
The CT follow-up program, based on a review of international guidelines and developed in collaboration with a lung cancer multidisciplinary team, provides CT scans of the chest, abdomen and pelvis every 6 months for 2 years and CT scans of the chest, abdomen and pelvis at 3, 4 and 5 years after surgery. Each scan is followed by an appointment to discuss imaging results.
This follow-up regimen is indicated for all patients who have undergone lung cancer resection, if adjuvant treatment is not recommended or declined.
CT results are triaged by a specialist nurse.
Patient feedback indicated that the additional face-to-face clinic visit presented an inconvenience, so the Oxford team established a nurse-led telephone follow-up service to discuss imaging results. To qualify for the telephone service, the patient’s CT scans must show no abnormalities or minor changes that would necessitate a repeat CT chest scan in 3 months. Additionally, patients must have no cognitive impairment and be able to communicate sufficiently over the telephone and hear phone conversations.
Between 2013 and 2017, there were 546 nurse-led face-to-face appointments for 285 patients with primary lung cancer in 189 clinics. The telephone follow-up service, which began in April 2017, conducted 254 patient appointments from 51 telephone clinics in its first 12 months and 350 appointments in its second year of operation, Mitchell said.
In both follow-up clinics, the specialist nurse’s involvement has improved clinic capacity and productivity, decreased waiting time for appointments, promoted junior medical training and facilitated continuity of care. The telephone clinic has enabled patients to receive results without having to make another trip to the hospital. Additionally, it allows clinicians to see patients with abnormal scans within a week of a care plan being developed by the multidisciplinary team.
“It’s a very positive experience for our patients,” Mitchell said. “They like the continuity of care, they see the same person all the way through the program and if they have a problem, they know who to phone.”
The skills required by a specialist nurse in this setting are outside the scope of a standard nursing program, Mitchell noted. She said most U.K. universities offer master’s level courses in advanced nursing practice. These programs train nurses in advanced history-taking and clinical examination, diagnostic reasoning, nonmedical prescribing, imaging interpretation, lung cancer pathology and prognosis, radiation protection, approved radiology requesting protocol and support of the multidisciplinary team.
“In conclusion, nurse-led follow-up after lung cancer resection is an effective way of ensuring high-quality care for this group of patients,” Mitchell said. “This model of care can also be used for patients having other modalities of treatment.” – by Jennifer Byrne
Mitchell J and Belcher E. Abstract PL03.01. 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.