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Case History

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Image not available. A 72-year-old woman with increasing back pain attended a planned appointment in the rheumatology outpatient department on a Friday morning. A previously requested CT scan identified multiple bone metastases, and the rheumatology specialist registrar advised direct admission via the acute medical unit for further investigation and management. The admissions unit referred the patient to the acute oncology service.

How do acute oncology nursing services differ between district general hospitals and cancer centres?

How would your service respond to this patient?

How would you develop the nursing role in acute oncology?

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Background

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Acute oncology nursing: a district general hospital perspective

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Image not available. St Helens and Knowsley Teaching Hospitals NHS Trust (SHK) is a district general hospital working in partnership with Clatterbridge Cancer Centre (CCC) providing local delivery of care to patients receiving chemotherapy for solid tumours in the Merseyside and Cheshire area.

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Historically, in many district general hospitals (DGH) oncology services are delivered by a limited number of oncology outpatient department and chemotherapy clinics. Inpatients requiring oncology assessment were reviewed on an ad hoc basis depend on the availability of oncology consultants and their awareness of the patient's admission. Treatment by site-specific cancer nurse specialists also fell into the same model. This often resulted in avoidable admission and delayed management, with frustration for both the patient and the ward team. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD)1 and the National Chemotherapy Advisory Group (NCAG)2 recognized that rapid management of acute oncology conditions was often poor, and recommended service improvement and implementation of acute oncology teams.

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Acute oncology nursing in a DGH is a unique and flexible role that provides the opportunity to develop a service driven by the needs of the local organization to support patients and generalist physicians in primary and secondary care.

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The patient described above required multidisciplinary input and coordination, which previously was only achieved following hospital admission. In this instance, the patient was referred to oncology at the point of admission and reviewed the same day by the acute oncology cancer nurse specialist, who:

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  • discussed the CT findings with the patient and her family

  • discovered that the patient wanted to go home - she was celebrating her grandson's 18th birthday and her husband's 70th birthday that weekend

  • facilitated palliative care referral for assessment the same day

  • facilitated district nurse referral for pain management over the weekend

  • discharged the patient home safely that same day

  • organized an oncology outpatient clinic for the following Monday.

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The patient attended her family gatherings and attended clinic on the Monday with her family to discuss her future management.

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This case illustrates effective collaboration between multiple departments and professionals. The family were supported in taking some control, and, most importantly, the patient attended two very important family gatherings. In the past this ...

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