Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide ...


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Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide ...

  1. 1. Geriatric Oncology: the role of the specialist nurse Janette Prouse MNSc Royal Adelaide Hospital
  2. 2. 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
  3. 3. 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
  4. 4. Introduction The role of the geriatric oncology nurse has three key components: > Clinical practice > Education > Research
  5. 5. 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.
  6. 6. 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).
  7. 7. 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?
  8. 8. Case Study Profile 72 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
  9. 9. 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
  10. 10. 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.
  11. 11. 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.
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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.
  17. 17. 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.
  18. 18. 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’.