Evaluating the Feasibility of a Nurse-Driven Telephone Triage Intervention for Patients With Cancer in the Ambulatory Setting.

OBJECTIVES: To explore the feasibility of a nurse-driven telephone triage intervention to improve the symptom experience of patients with cancer receiving treatment in the ambulatory setting. SAMPLE & SETTING: 90 patients in three ambulatory centers (breast, head and neck, and sarcoma) receiving active treatment at a National Cancer Institute-designated comprehensive cancer center. METHODS & VARIABLES: Patients received 4-18 triage calls from a nurse during a period of as many as six months dependent on their diagnosis and treatment. Feasibility was defined as the completion of 70% of triage calls. Symptom experience was measured using the MD Anderson Symptom Inventory. RESULTS: The overall call completion rate was 78%. Interference (p = 0.002) and severity (p < 0.001) scores were significantly different among patients in the three centers and gradually decreased over time. IMPLICATIONS FOR NURSING: Outcomes suggest that a telephone triage intervention is feasible to support patients receiving treatment. Future research can evaluate whether proactive triage affects symptom intensity during the course of the treatment trajectory.

The Role of Oncology Nurses as Ethicists: Training, Opportunities, and Implications for Practice.

Ethical challenges are inherent in oncology clinical practice. Ranging from transitions in care to code status and treatment decisions, these ethical challenges can have an acute effect on nurses, with well-established connections to moral distress and other psycho-emotional sequelae. The availability of a nurse ethicist can provide invaluable resources to support nurses in awareness of ethical challenges and support for ethical decision making in practice.

Tools to expedite the development of treatment plans.

Quality improvement strategies can be used to modify existing health care processes to reduce patient wait times. We undertook a quality improvement project to reduce the time between new patients' initial visits and the finalization of their treatment plans. Initiation of treatment of new patients at the MD Anderson Sarcoma Medical Oncology Clinic can take up to 2 weeks from their initial consultation. Treatment delays result in increased costs and anxiety for the patient, adversely affecting the quality of care provided. We performed detailed process mapping and a cause-and-effect analysis to identify and prioritize opportunities for improvement. Process improvements addressed 2 key causes of delay to develop a finalized treatment plan: (1) insufficient data for decision making at the time of new patient visit and (2) delays in obtaining diagnostic imaging. After implementing our process improvements, the median time to develop a treatment plan decreased by 89% from 70.5 to 7.6 hours. Our process changes involved minimal additional work and had the secondary outcome of resulting in time savings for the clinic team.