1. Developing a Lung CNS Service at a Tertiary Specialist Oncology Centre
Authors: Neal, Hilary1; Eaton, Marie2; Fenemore, Jackie3; McEntee, Delyth4; Wray, Delwyn5 Cooper, Victoria6; Mellor, Fran7
Introduction
Results .
The UK sees more than 39,000 diagnoses of lung cancer a year. It is the leading cause of cancer deaths in women and it affects smokers and never smokers (NICE 2011). There is increasing evidence in support of the role of the clinical nurse specialist (CNS) and the value that they are able to add to the patient experience and pathway (RCN 2010).
In addition, there is a growth of support for the role of the CNS within leadership and quality improvement (Fickleman 2013).
The Christie Hospital NHS Foundation Trust has seen a steady rise in the number of lung cancer patients referred to them resulting in an increase in Lung Oncologists by 66%. The Lung Cancer consultants expressed a keenness to establish more CNS involvement in their patients care. This created a case to develop the size of the team and initiate an improvement project to enhance the way in which patients receive care for lung cancer through a more integrated and proactive CNS team.
The project is at the end of its first year. So far we have seen an increase in patient access to, and contact from a CNS by 200% (fig 1). Calls to the Support line have doubled (fig 2), with the greatest number of contacts being made by Health Care Professionals (fig 3).
Figure 1
Figure 2
Methods
A partnership was set up between Macmillan and the Christies Lung Cancer CNS Team. The primary aim was to review and improve the current patient pathways across the network and the critical points at which CNS input is required. This objective included an analysis of the gaps in the current provision.
A two year project plan was developed with the addition of a Project Manager funded by Macmillan. Objectives included:
To develop a more defined handover/transition point in the patient pathway for the transfer of CNS support from local hospital to the Christie to ensure a more consistent, appropriate and seamless pathway the lung cancer patient population.
To align the CNS team with Greater Manchester sectors and establish communication with local teams within each sector.
To analyse the current lung cancer nurse team workload e.g. telephone work to optimise efficiencies was undertaken to ensure specialist skills are utilised and assess where they can deliver the most benefit to patients.
To explore innovative ways of communicating with patients throughout their treatment pathway, through the use of digital and telephony media.
Figure 3
The CNS team has doubled in size from 2 FTE to 4 FTE which has enabled the team to align to the four Greater Manchester Sectors. Communication between the local CNS teams and the Christie has been established which has enhanced the transition of information and care for patients.
Year/Phase 2 Project Objectives
Develop a project with patients with extensive stage small cell lung cancer using Patient Related Outcomes (PROs) to prevent adverse events.
Develop a Risk Assessment Matrix Tool to identify the specific needs of patients along their treatment pathway.
Recruit a Service User Co-Ordinator to engage with users and the community/third sector care to ensure user involvement and improved information/support for patients.
Formalise the use of the Macmillan eHNA to assess the patients needs at various points along the National Optimal Lung Cancer Pathway.
Establish and develop Nurse Led assessment clinic for patients receiving oral therapies and concurrent chemo/radiotherapy treatments.
NE Sector
Royal Oldham
North Manchester
Fairfield (Bury)
NW Sector
Royal Bolton
Wigan & Wrightington
Salford Royal
Central Sector
Manchester Royal Infirmary
Stepping Hill
Tameside
South Sector
Leighton
Macclesfield
Wythenshawe
1 ,2, 3,4,5 The Christie NHS Foundation Trust, 6,7 Macmillan Cancer Support