DAY IN THE LIFE
Lung cancer clinical nurse specialist Jo Dunbar
S4
by the Macmillan Cancer Support Survivorship Programme (Macmillan Cancer Support, 2015) and are finding this identifies issues that perhaps patients were previously reluctant to broach. Working across two trusts brings its own challenges, but they are outweighed by the advantages such as easy access to specialist tests and investigations, as well as to specialist personnel like consultant thoracic radiologists, specialist palliative care staff, thoracic surgeons and oncologists, not to mention wider team members including a lung cancer occupational therapist and social worker. LLCU was established 14 years ago with inpatient referrals made directly to the lung cancer CNS following a chest X-ray that may indicate lung cancer. However, the team recently questioned the effectiveness of this model; we were seeing the number of inappropriate referrals increase on a yearly basis and therefore the percentage of patients diagnosed with lung cancer falling. We were using valuable time and resources on patients who did not have lung cancer. A radical rethink was required and in 2013 a new referral system was introduced. For inpatients, new referrals are now directed to respiratory medical staff who review radiological images and inform one of the CNSs if they feel cancer is likely. That referral is only accepted if the patient has a CT scan that is suggestive of lung cancer. A further change to the inpatient referral system is that any CT scan suggestive of lung cancer has a code applied so the CNS receives notification of it, enabling us to find patients in the hospital at the earliest opportunity. With regard to the outpatient service, when a GP organises a chest X-ray the patient is
informed they may be recalled for a CT scan, and at the time of the CT scan radiology staff explain that he or she may be contacted by the lung cancer CNS or GP and will have the results within a couple of days. Patients with CT scans not suggestive of cancer are managed/ reassured by the GP in a timely manner, avoiding unnecessary hospital outpatient appointments and tests. If a scan is suggestive of lung cancer, the patient is referred to the lung cancer team. At this point the physician makes a provisional plan of investigation that is communicated to the patient via a CNS telephone clinic. We use specialist communication and assessment skills when contacting patients. It has certainly been a challenge, but the service has been well received by patients who feel reassured even when cancer is a possibility, and well prepared for the next event as they are given high-quality information. As a CNS I am able to address symptoms and concerns at the earliest opportunity, which leads to increased job satisfaction as you feel that you are really making a difference. The change to the referral process has led to a reduction of inappropriate referrals and a higher ratio of subsequent lung cancer diagnoses. This means that we can focus on those patients highly likely to have malignancy, leading to earlier CNS interventions and more therapeutic patient relationships. It also facilitates a lung cancer CNS being present at diagnosis, which is a key performance indicator and is associated with better outcomes. Patients are identified earlier via the coded CT system, which facilitates early review and earlier discharge for those well enough to have outpatient investigations. My patients and their families are my main focus. I am lucky to be part of a dedicated and dynamic team who share the ethos in aiming to deliver patient-centred high-quality care. BJN Cancer Research UK (2014) Lung cancer incidence statistics. http://tinyurl.com/otsf2zg (accessed 19 May 2015) Faulkner A, Maguire P (1994) Talking to cancer patients and their relatives. Oxford Medical, Oxford Macmillan Cancer Support (2015) Survivorship http://tinyurl. com/qaeycno (accessed 18 May 2015) National Institute for Health and Care Excellence (2004) Improving Supportive and Palliative Care for Adults with Cancer. http://tinyurl.com/pyreub2 (accessed 18 May 2015)
Jo Dunbar
Lung Cancer Clinical Nurse Specialist, LLCU The Royal Liverpool and Broadgreen University Hospital Trust, The Liverpool Heart and Chest Hospital Foundation Trust
© 2015 MA Healthcare Ltd
S
ince qualifying as a registered nurse in 1996, I have worked with patients undergoing diagnostics or treatment for lung cancer, firstly as a newly qualified nurse on a cardiothoracic surgical ward, then as a clinical nurse practitioner developing a pre-assessment service for patients having surgical investigations and treatment and now in my current post as a lung cancer clinical nurse specialist (CNS). I am proud to work for a unit (Liverpool Lung Cancer Unit, LLCU) that is unique in that it is a partnership between two hospital trusts, one being a busy inner city district general hospital where the inpatient service is based, and the other a regional tertiary cardiothoracic foundation trust that houses the outpatient service. Lung cancer is the second most common cancer diagnosed in the UK, with the North of England and Scotland having the highest number of cases in the UK (Cancer Research UK, 2014). LLCU diagnoses around 400 patients a year. I am one of four lung cancer CNSs working for the unit and am based at the Royal Liverpool University Hospital Trust. My role is therefore predominantly concerned with supporting patients admitted to the hospital and their families while they undergo diagnostic investigations for suspected lung cancer. However, if my patients are subsequently discharged from hospital and transferred to the outpatient service, I follow them up and will review them for tests or clinic appointments. I act as their key worker, described by the National Institute for Health and Care Excellence (2004) as a single named person who is the first point of contact for support, information and onward referral. I also work closely with medical colleagues to coordinate investigations to ensure that they are done in a timely manner with no unnecessary delays. I attend the lung cancer multidisciplinary team meetings on a weekly basis and take an active role, acting as an advocate for my patients. It is well recognised that being diagnosed with cancer can be an extremely difficult and emotive time for patients (Faulkner and Maguire, 1994) so I have completed a number of communication courses as well as psychology training so that I am able to offer my patients and their families the support they need at this difficult and uncertain time. We have recently started completing Holistic Needs Assessments with our newly diagnosed patients as advocated
British Journal of Nursing, 2015 (Oncology Supplement), Vol 24, No 10
British Journal of Nursing. Downloaded from magonlinelibrary.com by 129.180.001.217 on March 21, 2016. For personal use only. No other uses without permission. . All rights reserved.
Lung cancer clinical nurse specialist Jo Dunbar
S4
by the Macmillan Cancer Support Survivorship Programme (Macmillan Cancer Support, 2015) and are finding this identifies issues that perhaps patients were previously reluctant to broach. Working across two trusts brings its own challenges, but they are outweighed by the advantages such as easy access to specialist tests and investigations, as well as to specialist personnel like consultant thoracic radiologists, specialist palliative care staff, thoracic surgeons and oncologists, not to mention wider team members including a lung cancer occupational therapist and social worker. LLCU was established 14 years ago with inpatient referrals made directly to the lung cancer CNS following a chest X-ray that may indicate lung cancer. However, the team recently questioned the effectiveness of this model; we were seeing the number of inappropriate referrals increase on a yearly basis and therefore the percentage of patients diagnosed with lung cancer falling. We were using valuable time and resources on patients who did not have lung cancer. A radical rethink was required and in 2013 a new referral system was introduced. For inpatients, new referrals are now directed to respiratory medical staff who review radiological images and inform one of the CNSs if they feel cancer is likely. That referral is only accepted if the patient has a CT scan that is suggestive of lung cancer. A further change to the inpatient referral system is that any CT scan suggestive of lung cancer has a code applied so the CNS receives notification of it, enabling us to find patients in the hospital at the earliest opportunity. With regard to the outpatient service, when a GP organises a chest X-ray the patient is
informed they may be recalled for a CT scan, and at the time of the CT scan radiology staff explain that he or she may be contacted by the lung cancer CNS or GP and will have the results within a couple of days. Patients with CT scans not suggestive of cancer are managed/ reassured by the GP in a timely manner, avoiding unnecessary hospital outpatient appointments and tests. If a scan is suggestive of lung cancer, the patient is referred to the lung cancer team. At this point the physician makes a provisional plan of investigation that is communicated to the patient via a CNS telephone clinic. We use specialist communication and assessment skills when contacting patients. It has certainly been a challenge, but the service has been well received by patients who feel reassured even when cancer is a possibility, and well prepared for the next event as they are given high-quality information. As a CNS I am able to address symptoms and concerns at the earliest opportunity, which leads to increased job satisfaction as you feel that you are really making a difference. The change to the referral process has led to a reduction of inappropriate referrals and a higher ratio of subsequent lung cancer diagnoses. This means that we can focus on those patients highly likely to have malignancy, leading to earlier CNS interventions and more therapeutic patient relationships. It also facilitates a lung cancer CNS being present at diagnosis, which is a key performance indicator and is associated with better outcomes. Patients are identified earlier via the coded CT system, which facilitates early review and earlier discharge for those well enough to have outpatient investigations. My patients and their families are my main focus. I am lucky to be part of a dedicated and dynamic team who share the ethos in aiming to deliver patient-centred high-quality care. BJN Cancer Research UK (2014) Lung cancer incidence statistics. http://tinyurl.com/otsf2zg (accessed 19 May 2015) Faulkner A, Maguire P (1994) Talking to cancer patients and their relatives. Oxford Medical, Oxford Macmillan Cancer Support (2015) Survivorship http://tinyurl. com/qaeycno (accessed 18 May 2015) National Institute for Health and Care Excellence (2004) Improving Supportive and Palliative Care for Adults with Cancer. http://tinyurl.com/pyreub2 (accessed 18 May 2015)
Jo Dunbar
Lung Cancer Clinical Nurse Specialist, LLCU The Royal Liverpool and Broadgreen University Hospital Trust, The Liverpool Heart and Chest Hospital Foundation Trust
© 2015 MA Healthcare Ltd
S
ince qualifying as a registered nurse in 1996, I have worked with patients undergoing diagnostics or treatment for lung cancer, firstly as a newly qualified nurse on a cardiothoracic surgical ward, then as a clinical nurse practitioner developing a pre-assessment service for patients having surgical investigations and treatment and now in my current post as a lung cancer clinical nurse specialist (CNS). I am proud to work for a unit (Liverpool Lung Cancer Unit, LLCU) that is unique in that it is a partnership between two hospital trusts, one being a busy inner city district general hospital where the inpatient service is based, and the other a regional tertiary cardiothoracic foundation trust that houses the outpatient service. Lung cancer is the second most common cancer diagnosed in the UK, with the North of England and Scotland having the highest number of cases in the UK (Cancer Research UK, 2014). LLCU diagnoses around 400 patients a year. I am one of four lung cancer CNSs working for the unit and am based at the Royal Liverpool University Hospital Trust. My role is therefore predominantly concerned with supporting patients admitted to the hospital and their families while they undergo diagnostic investigations for suspected lung cancer. However, if my patients are subsequently discharged from hospital and transferred to the outpatient service, I follow them up and will review them for tests or clinic appointments. I act as their key worker, described by the National Institute for Health and Care Excellence (2004) as a single named person who is the first point of contact for support, information and onward referral. I also work closely with medical colleagues to coordinate investigations to ensure that they are done in a timely manner with no unnecessary delays. I attend the lung cancer multidisciplinary team meetings on a weekly basis and take an active role, acting as an advocate for my patients. It is well recognised that being diagnosed with cancer can be an extremely difficult and emotive time for patients (Faulkner and Maguire, 1994) so I have completed a number of communication courses as well as psychology training so that I am able to offer my patients and their families the support they need at this difficult and uncertain time. We have recently started completing Holistic Needs Assessments with our newly diagnosed patients as advocated
British Journal of Nursing, 2015 (Oncology Supplement), Vol 24, No 10
British Journal of Nursing. Downloaded from magonlinelibrary.com by 129.180.001.217 on March 21, 2016. For personal use only. No other uses without permission. . All rights reserved.
