TRAINING PROGRAM TO DELIVER NURSE-LED CARE COORDINATION FOR CHEMOTHERAPY PATIENTS
Background and Rationale: Cancer treatment is often accompanied by distressing symptoms yet most therapy is administered in outpatient settings where patients have intermittent access to healthcare providers. Evidence suggests that care can be fragmented and costly. Inadequate care related to symptoms, psychological support, and access to information has been reported. Early recognition, triage and, response to symptoms may prevent conditions from progressing. In addition, complex care needs of cancer patients are often provided across multiple settings and provider specialists. Successful delivery of care coordination (CC) supports early identification of potential complications or treatment-related side effects, efficient and timely communication between providers, and the ability to mobilize meaningful and ongoing support systems. Nurse CC has demonstrated benefits in other chronic conditions such as diabetes and heart disease, but little research exists on application of these models in oncology. Nurse-directed cancer CC aims to improve care and quality of life for patients undergoing chemotherapy treatment. Rigorous training was required to introduce this new model of care delivery.
Description of the Project: Evidence-informed symptom protocols developed using systematic reviews to identify international symptom guidelines and evaluated by Canadian nurse researchers served as the platform for guiding this feasibility study. Weekly training was led by an oncology nurse and oncology social worker, and overseen by an interdisciplinary research team including oncology-experienced professionals and a Canadian who was involved in leading the development of the protocols. Training methods included: 1) orientation to and use of the 13 Canadian symptom assessment and response protocols (e.g. nausea/vomiting, fatigue, fever and depression); 2) development of two additional protocols for management of pain and sleep disturbances, based on existing literature and guidelines; 3) development of patient vignettes using varying symptom constellations and severity; and, 4) application of the 15 protocols to simulated patient interactions. Training included role-play as both the patient and the nurse. Protocol fidelity was evaluated in real-time with appropriate feedback, guidance, and re-training as needed. Additional CC training included attention to communication skills, relationship-building, health coaching, and, orientation to community support services. A strong emphasis was placed on ensuring that all interactions were patient/family-centered, with attention to identification and monitoring of shared goals. Finally, the nurse was also trained in a mobile health technology to support CC.
Outcomes Achieved: 1) Training manual development for nurses to provide chemotherapy care coordination; 2) Preliminary evidence of acceptability and effectiveness of these training methods based on initial experience which is being expanded to include additional trainees; 3) Interprofessional support for methods and outcomes of this training.
Implications: This study contributes to a growing understanding for the need for, and methods to deliver, evidence-based cancer care coordination. This training is an essential step toward developing models of CC that provide early recognition and appropriate intervention for managing treatment-related side effects, tailor locally available sources of information and support to patient needs, and enhance the cancer care experience.