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Coordinating nurses improve quality of life, satisfaction with lung cancer care
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The presence of a “pivot nurse” to provide continuity of care significantly improved satisfaction and quality of life for patients with advanced lung cancer, according to data from a study presented at the European Lung Cancer Congress.
“Introduced to oncology clinics in 2001, the position of the pivot nurse was enshrined by the Ministry of Health and Social Services of Quebec in 2005 as part of its Fight Against Cancer campaign,” Elie Kassouf, MD, hematologist and medical oncologist at Centre Hospitalier de Lanaudiere in Saint-Charles-Borromee, Canada, said in a press release. “In over 15 years of existence, however, very little has been collected about its impact on patients’ lives. Our study’s main goal was, therefore, to determine whether the continuity of nursing care has tangible benefits to patients treated for lung cancer, as compared [with] the usual standard of care without a coordinating nurse.”
The analysis included 65 patients treated for advanced lung cancer at the Hôpital Notre-Dame in Montreal. Researchers selected patients from a list of outpatient admissions 3 months after beginning treatment.
Kassouf and colleagues divided patients into two cohorts: the continuity of care cohort (82%) — in which patients were accompanied by a pivot nurse — and the usual care cohort (18%), who underwent standard treatment with hospital oncology staff. Each pivot nurse cared for 50 to 60 patients and scheduled follow-up appointments with physicians when new tests results became available. Patients also could call the nurse with symptoms, and for severe symptoms the nurses could arrange a physician visit without the patient going through the emergency system.
Both groups completed the Princess Margaret Hospital Patient Satisfaction with Doctor Questionnaire, the FACT-L Scale assessment for quality of life, and questions that evaluated patients’ understanding of their disease and health status. The continuity of care group responded to an additional 10 questions specific to the Quebec health care system and nursing care.
Patients in the continuity of care group showed superior outcomes for quality of life, information exchange and empathy, according to the Princess Margaret satisfaction survey (P < .001). Results from the FACT-L questionnaire indicated they had superior physical, social, family, emotional and functional well-being which, overall, translated into better satisfaction when researchers compared the two cohorts (P < .0001).
Patients aided by a pivot nurse reported that they found the role adequately fulfilled, except for in what researchers described as “matters of an intimate nature.”
“The Princess Margaret Hospital Patient Satisfaction with Doctor Questionnaire that we used in the study covers four dimensions of a patient’s relationship with his physician: interpersonal skills, empathy, information exchange and quality of time,” Kassouf said. “The score difference we saw between the two cohorts was huge across the board: not because the usual care group scored poorly — their results were similar to those in other studies based on the same questionnaire — but because the continuous care cohort produced exceptionally high scores.”
Kassouf added that the difference in outcomes on the FACT-L scale appeared less pronounced.
Patients should be satisfied with the entire care setting, as well as with their doctors, according to Anja Kroner, PhD, nurse in oncology and a member of the management team at the Comprehensive Cancer Centre in Zurich, who wasn’t involved with the study.
“It would be interesting to take the research further by framing patient satisfaction more broadly, as well as considering other outcomes alongside quality of life, such as patients’ ability to carry their own weight, or to work, throughout the process,” Kroner said. “In light of the financial pressure faced by many health care systems today, it would also be worth exploring whether pivot nurses can reduce the cost of cancer, as another study has already suggested.” – by Andy Polhamus
Reference:
Kassouf E, et al. Abstract 231P_PR. Presented at: European Lung Cancer Congress; April 11-14, 2018; Geneva.
Disclosures: Kassouf reports personal fees from Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly and Sanofi Canada outside the submitted work. Please see the abstract for all other authors’ relevant financial disclosures. HemOnc Today could not confirm disclosures for Kroner at the time of publication.