Providing Quality Healthcare to Different Patient Populations

High-Risk Patients

In the first study, Michele Gaguski, MSN, RN, AOCN®, CHPN, NE-BC, APN-C, of the Sidney Kimmel Cancer Center in Sewell, NJ, and colleagues discussed the creation of the Lung Program Executive Committee (LPEC) to better identify high-risk patients with lung cancer who meet the criteria for low-dose computed tomography and how to assess and manage patients in whom nodules are found. They established a lung nodule center (LNC) implemented a multidisciplinary model that focused on the development, integration, and promotion of evidence-based guidelines and algorithms for use in clinical practice. 

As part of the program, a multidisciplinary care conference brought together pulmonologists, thoracic surgeons, radiation and medical oncologists, pathologists, radiologists, nurses, and tumor registrars to discuss each patient case. Patients were also evaluated by pulmonologists and thoracic surgeons. The model included a nurse navigator who collaborated with the physicians and office staff to streamline appointments and support the care conference and patient visits. The model also provided onsite access to tobacco cessation counseling, pulmonary function tests, and fast tracking for cardiac clearance to quickly schedule interventions or surgery when needed.

LPEC developed customized patient education materials about lung nodules and follow-up care, a patient satisfaction survey, and quality metrics for tracking outcomes. It also implemented an intense marketing plan and recognition program for physician practices who referred and supported the LNC.

“This innovative model demonstrates the collaborative efforts of the cancer care team to establish a LPEC and a designated LNC to effectively manage patients with high-risk lung nodules,” the researchers concluded. They said that outcomes included positive patient satisfaction scores and reduced turnaround time for abnormal nodule findings to patient evaluation and subsequent procedures or surgeries.

Homeless Patients

Loril Garrett, MS, BSN, RN, OCN^®, CBCN^®, CMOM, of Spectrum Health Cancer Center in Grand Rapids, MI, and colleagues discussed their work in providing cancer prevention education and screening recommendations to the homeless community using telehealth technology. The “Knock Out Cancer” program—a partnership between Mel Trotter Ministries and Spectrum Health—used oncology nurses and telehealth technology to meet with individuals at Mel Trotter’s homeless shelter. They provided a flier to explain the program and services and scheduled weekly 30-minute appointments. Oncology nurses developed a script for each visit that included cancer risk reduction guidelines from the American Cancer Society. The nurses recorded the length of visits and services provide.

At the time of presentation, 39 guests received cancer screening guidelines and risk reduction education on diet and nutrition, physical activity, family cancer history, smoking cessation, limiting alcohol, weight maintenance, and reporting health changes.

“The goal with each visit is to empower patients to take ownership of their health and thus reduce their risk of getting cancer in the process,” the researchers noted. More than 50% of patients verbally indicated that they would make a lifestyle or behavioral change based on the education provided, and most participants stated that the information was helpful.

“Using current infrastructure and partnering with already effective community-based organizations are effective strategies to provide cancer prevention education and health education to reach more individuals in the communities we serve,” the researchers concluded.

Outpatient Care

In the next study, Elizabeth Malosh, MSN, RN, NE-BC, of Froedtert and the Medical College in Milwaukee, WI, and colleagues described the clinical and operational development of a 24-hour outpatient oncology symptom management clinic. Often, patients with cancer who experience complications outside of office hours must use the emergency department (ED), which can lead to increased costs and decrease oncology-specific care.

The outpatient clinic provided lab draws, fluid and electrolyte infusions, blood product transfusions, and radiology services. It addressed common patient concerns such as nausea, pain, and dehydration. The clinic offered four patient treatment areas, which were adjacent to the inpatient oncology unit and staffed by oncology nurses trained in both inpatient and outpatient care. The clinic provider is an experienced oncology advanced practice provider, with medical oversight of an attending oncology physician.

At the time of presentation, ED use decreased 10.7%, which translated to a decrease cost in patient care (approximately $1,500 to $2,500, according to the researchers). Clinic volumes also grew quickly, averaging 130–140 patient visits per month. Patient satisfaction—measured by the Clinician and Group Consumer Assessment of Healthcare Providers and Systems—was 92%.

Older Adults

Peggy Burhenn, MS, RN-BC, AOCNS, of City of Hope National Medical Center in Duarte, CA, and colleagues discussed the final study, which was a national pilot survey of oncology nurses to highlight gaps in gerontology knowledge.

Nurses attended a 2.5-day educational conference with a multidisciplinary, interactive, and targeted curriculum and then received a survey at baseline and 12 months postconference to report on their skill, organization preparation, and comfort level in geriatric care.

Thirty-four oncology nurse teams attended the course in 2016: Each team consisted of a manager, an educator, and a direct care nurse. At 12 months post-conference, there were significant improvements in all three areas, according to the researchers:

• The level of preparedness increased from 6.12 to 6.93 (p = 0.02).
• The self-rated level of skill in caring for older adults with cancer increased from 6.15 to 7.92 (p < 0.001).
• The comfort level in managing geriatric syndromes increased from 5.55 to 7.47 (p < 0.001).

“The results demonstrated that nurses felt more skilled, their organizations more prepared, and they experienced a greater comfort level in managing geriatric syndromes after attending the conference,” the researchers concluded.