19
Geriatric Oncology: the role of the specialist nurse Janette Prouse MNSc Royal Adelaide Hospital

Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Embed Size (px)

DESCRIPTION

 

Citation preview

Page 1: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Geriatric Oncology: the role of the specialist nurse

Janette Prouse MNScRoyal Adelaide Hospital

Page 2: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Introduction

> The Royal Adelaide Hospital Cancer Centre (RAHCC) established the first geriatric oncology program in Australia that specifically caters for patients ≥70 years age with cancer.

> There are currently two geriatric oncology nurses> Janette Prouse RN – 1.0 FTE> Wendy McGahey EN – 0.6 FTE

Page 3: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Introduction

The critical functions of the RAHCC geriatric oncology registered nurse is to ensure that a coordinated response is implemented to optimise the cancer journey of the older adult.

Ideally this requires the nurse to:

> Hold a relevant postgraduate qualification in cancer nursing> Possess extensive clinical experience> Demonstrate effective communication skills> Be an active participant in multidisciplinary teams> Participate in ongoing quality improvements of their practice> Contribute to research activities

Page 4: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Introduction

The role of the geriatric oncology nurse has three key components:

> Clinical practice

> Education

> Research

Page 5: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Clinical practice - duties

> Mail out the self administered questionnaire to all new medical oncology patients ≥ 70 years.

> Prepare assessment questionnaire and scoring sheet for the weekly multidisciplinary team meeting.

> Coordinate weekly multidisciplinary team meeting – casenotes, clinical summaries, IT etc

> Actively participate in MDT

> Contact each patient to discussed the outcomes of the MDT and whether activation of indicated supportive services is warranted and/or desired.

Page 6: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Clinical practice

Monitoring and follow-up of patients is recognised as the cornerstone of the Geriatric Oncology Program.

Follow-up of this group of patients is a monumental task therefore, careful management is crucial.

Currently our aim is to visit patients during each medical oncology visit or if having chemotherapy the beginning of each cycle (2-3 weekly).

Page 7: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Clinical practice

Questions that remain in debate are:> How often should each patient be contacted/visited?

> When does a patient become ‘inactive’?

> Should or when do we reassess patients? Before, midway and/or on completion of active treatment? At fixed points of time?

Page 8: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Case Study

Profile72 year old lady from Kapunda with metastatic melanoma

History of Cancer:> Primary melanoma left foot 2005. Had further groin

dissection in August 2005> 2008 - repeat left groin pelvic dissection for recurrence> 2009 - multiple excisions of melanoma deposits and

radiotherapy to the neck and also to the right arm nodule.

> Now has further subcutaneous nodules which are not suitable for resection

Past Medical History:> Osteoporosis> Macular degeneration

Page 9: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

January 2009 March 2010

Charlson score 0 0

Memory No concern No concern

Vision No concern Impaired

Nutrition Nil weight loss Nil weight loss

Falls Nil Nil

IADLs No concern (7/21) No concern (10/21)

Physical function Impairment (14/30) Severe impairment (28/30)

KPS 100% 60%

Social support Nil concern Nil concern

Psychological support No concern (10/45) No concern (13/45)

Distress scale 0/10 7/10

Pain scale 2/10 5/10

Exhaustion 2/8 4/8

Community services nil nil

Category Fit Vulnerable

Referrals None Palliative Care, Clinical Psychology (refused), social worker

Page 10: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Clinical Practice – data management

Responsible for entering all data (excel sheet) concerning the completed questionnaire and scoring sheets; referrals post MDT.

Currently assisting with the development/modification of an access data base used by Clinical Practice Consultants in RAH ie breast care nurse, gynaeoncology nurse and the colorectal nurse. This will aid the follow up of patients by detailing demographics, treatments, referral patterns, encounters, complications etc.

Investigating the possibility of modifying a database developed as an initiative by the Statewide Cancer Clinical Network for MDTs.

Page 11: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Education

The geriatric oncology nurse requires to initiate education amongst oncology nurses in formal and informal settings within the RAH and at national and state level.

There is a need for oncology nurses to understand what geriatric oncology practice involves such as understanding why the care of young adults differs to older adults.

Page 12: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Education > Clinical Oncological Society of Australia Annual Scientific

Meeting: (Gold Coast, 2009):Invited speaker - Geriatric assessment: the role of the specialist nurse

> The International Society of Geriatric Oncology - 10th SIOG Meeting Berlin (Germany 2009) -poster presentation: Janette Prouse, Nimit Singhal, Jude Lees, Sigourney Troyano, Melissa Bond, Robert Prowse. Acceptance of supportive care interventions by older patients with cancer: an audit

> Oncology Graduate Diploma - presentation (2009): Invited speaker - “Cancer and the older person”

> In-service education discussing nurse-sensitive issues of older cancer adults RAHCC

Page 13: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Education – future directions

> Possibility of stand alone nursing short course 1-2 days

OR> Chemotherapy short course (RAH) additional tutorials

in established course• Tutorials covering topics

Introduction into age-related physiological changes Aspects of health assessment – impact of comorbidities,

functional reserve and social network deficits Principles of geriatric assessment Symptom management

Page 14: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Education – future directions

Establishment of a advance traineeship for geriatric oncology nurse practitioners.

This would require:> Funding> An appropriate level of professional support > Investigation into the sustainability of the role> Needs assessment

Page 15: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Research

Nursing research requires to provide informative data for understanding the effects of nursing therapeutics. This then would link the process of care delivery with patient outcomes.

Oncology nursing research often focuses on:• Experience of wellness and illness• Clinical therapeutics under the control of nurses• Systems designed to deliver cancer care• Outcomes directly attributed to nursing interventions

Page 16: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Research – nursing

The effects of a Geriatric Oncology pre-chemotherapy education on the ability to recall potential side effects and their related self care strategies in the older cancer patient: A Randomised Controlled Trial.

> Prior to chemotherapy an interventional nurse will explain and discuss the chemotherapy treatment, potential side effects, self care strategies and treatment frequency in a quite environment.

> Issues of concern for the patient or attending support person can

be raised and incorporated in the education session. A completed Geriatric Assessment Questionnaire will be utilised as a source of additional information for the nurse.

Page 17: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

Publications

> Singhal N, Prouse J, Lees J, Peterson M, Boyce A, Willoughby M, Guthrie S, Garbett Smith C, Prowse R. Geriatric Oncology program at Royal Adelaide Hospital- Analysis of first 100 patients. Asia-Pac J Clin Oncol 2008;4(suppl 2):A412.

Page 18: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide

It is the vision of our team to optimise the journey for older people affected by cancer by means of supplying timely and appropriate interventions using a proactive approach.

The geriatric oncology service aims to assist patients and clinicians to make insightful and collaborative treatment decisions through the philosophy of ‘screening for all and intervention for select’.

Page 19: Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide