Nurse Led Clinics: Involvement in Patient Management and Follow Up

Abstract

An increase in available oral anti-cancer medicines has enhanced treatment and prognosis for many patients. Studies suggest oral anti-cancer medicines are often the preferred option for patients due to reduced hospital attendances. International literature highlights concerns regarding a lack of processes to support and monitor patients to ensure they take oral anti-cancer medicines correctly, stop self medicating and contact clinicians when side effects occur. An emerging body of literature suggests some cancer patients may intentionally not adhere with self medication thus reducing drug efficacy. This presentation will describe the development and evaluation of patient centered nurse and pharmacist led clinics which aim to enhance patient self management and thus adherence with oral anti-cancer medicines. Focus will be on a pilot study of an intervention for patients prescribed an oral Tyrosine-Kinase Inhibitor (TKI) for metastatic renal cancer, which included education and consent, medicines reconciliation, on-treatment review, prescribing and pro-active telephone monitoring. Data were collected from seven patients who received the intervention and from eight patients who received standard care. Data sources included a 25 item patient survey, clinician reviews and patient records. Patient satisfaction appeared high across the intervention and control groups. However, patient experience of managing the TKI appeared enhanced within the intervention group due to identification of potential drug interactions, through medicines reconciliation and identification of an increased number of symptoms (average 3.1 versus 1.8). Furthermore, patients in the intervention group appeared more confident about when to report symptoms and more inclined to report these to nurses. Patients were proactively telephoned weekly and this aspect of the service appeared to be of most benefit in managing side effects and concerns during the first two treatment cycles. Independent working was facilitated through initial close medical support and acquirement of advanced assessment and non-medical prescribing qualifications. All patients prescribed oral anti-cancer medicines are now supported by a pharmacist or nurse and the pilot model has been extended to patients with other cancer diagnoses.