Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2021

Evaluating a shared care pathway intervention to reduce chemotherapy outpatients' unplanned presentations to hospital: A randomised controlled trial (RCT) (#64)

Kate White 1 , Heather McKenzie 1 , Lillian Hayes 1 , Jodi McLeod 2 , Judith Fethney 1 , Judy Simpson 3 , Janette Vardy 4 , Natalie Cook 5 , Simon Willcock 6 , Lisa Horvath 7 , Keith Cox 7 , Chantale Boustany 1 , Louise Acret 1 , Bora Kim 1
  1. Sydney Nursing School, Cancer Nursing Research Unit, The University of Sydney, Sydney
  2. Sydney District Nursing, Sydney Local Health District, Sydney
  3. Sydney School of Public Health, The University of Sydney, Sydney
  4. Concord Repatriation General Hospital, Sydney
  5. Healthdirect Australia, Sydney
  6. Primary Care, Macquarie University Hospital, Sydney
  7. Chris O'Brien Lifehouse, Sydney

Background/Aim

Transition of systemic chemotherapy administration to outpatient settings has resulted in patients and carers managing physical and psychological effects at home. Inadequate side effect management may result in unplanned presentations to hospital, and reduced quality of life. This RCT sought to determine if a shared care intervention utilising targeted community nurse (CN) home visits could reduce unplanned presentations and improve physical and psychosocial health.

Methods

Participants were randomised to receive either the shared care CN intervention or usual care.  The intervention consisted of home visits by CN on days three and five following each of the first three treatment cycles. CNs conducted symptom assessment, provided care as appropriate, referred patients to services as required and transferred patient information to treating cancer centres and general practitioners. Unplanned hospital presentations and patient reported outcomes (PRO) were compared between intervention and usual care groups. Qualitative interviews were conducted with all stakeholders. Target sample size for this multi-centre RCT was 326.

 

Results

A total of 346 patients were available for analysis. There was a 12% (95% CI: -23%, 36%; P = 0.46) relative reduction in unplanned presentations to hospital in the intervention group compared to the usual care group. Differences in PRO measures were not statistically significant, except for patient self-efficacy, which was higher in the intervention group (P= 0.02). 

Qualitative findings from patient interviews demonstrated strong support for CN visits. Clinicians identified this model of care informed their clinical decisions, benefited patients and recommended the model for patients with high care needs.

Conclusion

The shared care CN intervention led to a reduction in unplanned presentations to hospital, though this was not statistically significant. The intervention increased patients’ self-confidence to manage treatment related symptoms. The intervention was positively received by clinicians, CN and patients.