ABSTRACT
Introduction: Patient and Public Involvement (PPI) refers to the involvement of patients, public, service users and lay people in research. It means that research is designed, conducted and disseminated with patients or other people with relevant experience. PPI is a fundamental component of healthcare research in the UK and evidence shows PPI can improve the research process. In 2020 the Mesothelioma UK Research Centre in Sheffield established a PPI panel for mesothelioma. Here, we aim to summarise a year of PPI activity and reflect on some of the key successes, and some of the challenges, with PPI in mesothelioma. Method: Over a 12-month period data were collated on the number of projects that were supported by the PPI panel and the different types of support they provided. A narrative account of key successes and challenges is also provided. Results: Over one year the PPI panel contributed to eleven research projects or funding applications in mesothelioma. The role of the PPI panel in these projects included: reviewing and revising funding applications;advising on development of research questions and methods;membership of steering committees;ethical review;developing recommendations from research;advising on dissemination. The PPI panel have improved the design and conduct of research within the Mesothelioma UK Research Centre and have contributed to a culture which supports active patient involvement in research. Challenges have included remote working due to COVID-19 and managing discussion around research on sensitive issues related to the terminal nature of mesothelioma. Conclusion: PPI contributions to research have expanded over recent years. The experiences of the Mesothelioma UK Research Centre support evidence which suggests that public involvement can make positive contributions to research. Disclosure: No significant relationships.
ABSTRACT
Introduction: Patients with mesothelioma and their families have palliative care needs throughout the trajectory of their illness. In the UK, Mesothelioma UK clinical nurse specialists (MCNS’s) are key providers of generalist palliative care. The aim of this study is to explore the palliative care needs of people with mesothelioma and their families, and to explore the role of MCNS’s in supporting patients with palliative care needs. Methods: The study used a mixed methods design involving two workstreams. Workstream one comprised a systematic review and secondary data analysis. Workstream two involved a cross sectional study of MCNS’s using quantitative and qualitative data collection methods. Findings: Eight key findings were generated from the research: (1) Patients with mesothelioma and (2) their families have significant palliative care needs, from early in the disease trajectory;(3) MCNS’s are highly skilled at providing palliative care, the majority have received training or education in palliative care;(4) There is an important distinction between ‘specialist’ palliative care and ‘generalist’ palliative care in mesothelioma;(5) Good partnership working between MCNS’s and specialist palliative care is crucial to ensure patients receive seamless care;(6) A co-ordinated approach to a patients care is crucial;(7) Patients and families can be reluctant to accept palliative care due to preconceptions about the term ‘palliative’;(8) COVID-19 has presented significant challenges to both patients and healthcare professionals. Conclusion: This study provides valuable insights into palliative care needs in mesothelioma, and the role of Mesothelioma UK clinical nurse specialists and others in meeting these palliative care needs. A range of recommendations have been developed for practice, further research and policy which focus on acknowledging and supporting the MCNS role in palliative care provision, integrated working with specialist palliative care and identifying/supporting patient and family needs in a timely way. Disclosure: No significant relationships.
ABSTRACT
SETTING AND PARTICIPANTS: Three second-year internal medicine residents and primary care-based nurses providing telephone triage at a large, urban academic practice participated in a pilot program in which they were colocated in clinic once weekly for a half-day session over a 6-week period. This setting allowed for direct in-person communication between residents and nurses in real time to address clinical questions and concerns. DESCRIPTION: The ability to triage patient needs is an essential skill in ambulatory medicine. Telephone-based triage has become increasingly important as practices have experienced high volumes of patient calls during the ongoing COVID-19 pandemic and more limited access to care. Though triage is felt to be a critical skill, few internal medicine programs have formalized training in non-face-to-face triage, leading to residents' lack of confidence in their ability to triage outpatient needs and feeling inadequately prepared to engage in triage activities (Flannery et al, 1995). At our institution, primary care residents learn triage skills while participating in off-hour telephone call responsibilities. However, there is little formal training or evaluation of this experience. With aims to strengthen residents' triage skills, as well as foster enhanced interprofessional relationships and bidirectional learning opportunities between residents and other clinical staff, we piloted a program in which primary care residents participated in triage activities alongside experienced triage nurses. Residents offered just-in-time orders and answers to clinical questions, with the ability to engage an attending level physician if needed. EVALUATION: We collected anonymous baseline and post-intervention burnout surveys as well as weekly surveys from nurses and residents about their experiences and the impact of resident involvement in triage. We collected resident feedback on the experience and their confidence in triage skills preand post-experience, as well as triage nurse feedback on the impact of the pilot on interprofessional collaboration and communication with resident physicians. DISCUSSION / REFLECTION / LESSONS LEARNED: We identified the development of ambulatory medicine triage skills as an unmet need in resident medical education, and successfully piloted an intervention to improve resident skill in managing phone-based triage as well as promote interprofessional collaboration and bidirectional learning among residents and triage nurses. The intervention co-located primary care residents with nurses, allowing in-person communication about patient questions and needs as well as just-in-time answers to clinical questions. While further evaluation is ongoing, preliminary data demonstrates positive responses for both triage nurses and residents, who felt the experience was a valuable learning opportunity and benefitted patient care. We hope to gain information that will allow us to modify this pilot program and determine best approaches for teaching and evaluating triage skills in resident education.
ABSTRACT
Background: Thousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning. Aim: To understand the views of general practitioners and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic. Methods: A web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks during September and October 2020. Responses were analysed using descriptive statistics and an inductive thematic analysis. Results: Valid responses were received from 559 individuals (387 community nurses, 156 General Practitioners (GPs) and 16 unspecified role), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-oflife care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress. Conclusion: Primary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.