An integrated care model for the management of patients receiving oral anti-cancer agents (OAM) by an advanced nurse practitioner (ANP): Planning and development process

ABSTRACT

Background: Oncology has been experiencing an increase in oral anti-cancer medications over the last ten years or more. Due to the potential toxicity of OAMs the monitoring of such patients has largely remained within hospitals. The COVID-19 pandemic expedited changes in healthcare and since March 2020, in one Oncology Department in Ireland, there has been a shift to an ANP-led model of care which utilises virtual assessments. To further improve patient experiences’ and to increase hospital capacity this study aims to transition this patient cohort to an ANP-led integrated model of care in the community setting. Methods: A scoping review was performed to determine clinical practices for the monitoring of patients receiving OAM. This review and additional analysis of international guidelines identified recommendations for clinical practice which were collated and a best practice standard was developed. This standard enabled a benchmarking activity to be performed to measure the current level of adherence to best practice by the ANP. To determine the acceptability of ANP-led care and possible transition to an integrated care model, a qualitative study was performed using telephone interviews with patients (n=9) and focus groups via Zoom™ with health care professionals (n=24). Results: Using thematic analysis four themes were generated from the data. Reflection on the pre-COVID-19 system demonstrated universal agreement that this should not be reverted to. The ANP was perceived as being ideally placed to deliver care for this cohort of patients. It was recognised that robust communication with patients and with the multi-disciplinary team was vital for OAM care delivery. There was agreement that an integrated model of ANP-led care had significant benefits and various infrastructural requirements for this model to be effective were identified. Conclusions: Results demonstrate that the current ANP-led model has already positively impacted patients’ experience with safe care evident in the benchmarking activity. Collating the results enabled development of an integrated model for OAM care. It is anticipated that by piloting this model, patient experiences could be further improved upon. Legal entity responsible for the study The authors. Funding: Irish Cancer Society, National Cancer Control Programme (Ireland), Health Research Board (Ireland) & Office of the Nursing and Midwifery Services Director (Ireland). Disclosure All authors have declared no conflicts of interest.