NURS-03. DEVELOPMENT OF A PATIENT-HELD TREATMENT SUMMARY FOR PAEDIATRIC CNS TUMOUR PATIENTS

BACKGROUND Following the Scottish Government Cancer Plan 2012–15(1) ‘End of Treatment’ summaries for paediatric oncology patients treated in SE Scotland have been successfully implemented. However, it became evident that the particular needs of patients with CNS tumours were not adequately captured on the standardised documentation. METHODS In view of these difficulties an alternative document was prepared specifically for this patient cohort by the multi-disciplinary team, including Nurse Specialists, Paediatric Neuro-oncology and Neuro-psychology. This was designed to be a flexible, fluid summary to be used for all such patients regardless of tumour grade or treatment modality and included those undergoing surveillance only. OUTCOMES: The document is primarily completed by the Neuro-Oncology Nurse Specialist alongside the patient and family, usually following initial treatment and is used alongside their holistic needs assessment. The document is circulated to all involved professionals, including Primary Care, and a copy is retained by the patient. This then provides a concise source of information detailing diagnosis and treatment, any specific ongoing sequelae and details of red flag symptoms to alert patients and health professionals to the potential of relapse or other associated significant health problems. These treatment summaries are currently being piloted and have been well received thus far. They will be formally audited in due course with the aim to use nationally throughout Scotland in future.

The potential of peer support to extend the reach of digital health

BackgroundPeer support groups have proliferated since the 1960s, providing safe, informal environments where peers share experiences and information. A common model is for those who have progressed further along a care pathway or in dealing with a particular medical condition or psycho-social problem, to encourage those at an earlier stage of recovery, either within a group or one to one. Online support now co-exists with face to face models, providing an additional resource for those with digital access and competence.The paradigm of health care has moved towards the incorporation of health promotion, patient empowerment, self-management and community engagement. This has led to a broadening of activities and roles within health systems. The role of peer supporter has been incorporated in a range of behaviour change interventions promoting engagement and adherence. Increasingly these are delivered online. While this aims to extend their reach, it leaves those without digital access at a disadvantage in terms of the ability to make use of online health resources.Main textThough peer support has been used to maintain adherence to online programmes, its potential in assisting with access and thus widening participation has remained unknown.We successfully piloted the use of a paid peer supporter to help men without experience of IT to take part in an online intervention involving a prostate specific holistic needs assessment. Lessons were learnt in relation to training needs and support for the supporter and around data security, confidentiality and safeguarding.Alternative models of voluntary peer support maybe appropriate, particularly in the implementation phase of an intervention and require exploration. A framework for best practice in relation to Digital Health interventions is needed to guide future development of the role.ConclusionHealth services are predicted to increasingly rely on digital technologies over the next decade. Research into the impact of these technologies must include participants’ representative of the entire population. Efforts are needed to include those who are currently underrepresented in research such as the elderly and other disadvantaged groups. Innovative designs involving peer support in a research project may be valuable in addressing the current barriers to participation.

Erectile dysfunction after robotic radical prostatectomy: Real-life impact of vacuum erection device clinic

Introduction: Post-radical prostatectomy erectile dysfunction (post-RPED) is a common and potentially devastating complication. The role of PDE5-inhibitors (PDE5-Is) in post-RPED is controversial and invasive pharmacological treatments are associated with poor long-term compliance. Vacuum erection devices (VEDs) are a non-pharmacological alternative. Little data regarding VED efficacy and associated patient satisfaction in post-RPED exists. This study aimed to investigate the outcomes of VED therapy in a post-robot assisted radical prostatectomy (post-RARP) population. Methods: All men who underwent RARP at a single centre between February 2015 and October 2017 attended a nurse-led holistic-needs-assessment (HNA) appointment at 10 weeks post-RARP. All men identifying ED as a concern at HNA were offered dedicated nurse-led post-RPED clinic and VED clinic appointments. A cross-sectional survey of patient reported outcomes in these men was performed. Results: In total 137/539 (25%) men reported ED as a concern at HNA. All 137 men attended the VED clinic, 124/137 (90%) responded to the survey. Commonest reason for choosing VED therapy was for combined psychological, penetration and lengthening purposes (48%). Median time from RARP to VED clinic and from VED clinic to survey was 122 days (range 56–595) and 462 days (range 66–932) respectively. At survey 88/124(70.9%) reported continued use of VED, 69/88 (78%) of this group perceived VED treatment to be successful. Of those who had stopped using VED, 7/36 (19%) felt it had been successful. Key reasons for discontinuation were either because men felt it ineffective (13/36 (37%)) or disliked the device (10/36 (29%)). Conclusion: VED therapy is an effective treatment for men with post-RARP ED that is well tolerated with good short- to medium-term compliance. Up to two-thirds of men may find overall satisfaction with their post-RPED after VED therapy. Level of Evidence: 3

The patient needs assessment in cancer care: identifying barriers and facilitators to implementation in the UK and Canada

Purpose Personalised information and support can be provided to cancer survivors using a structured approach. Needs assessment tools such as the Holistic Needs Assessment (HNA) in the UK and the Comprehensive Problem and Symptom Screening (COMPASS) questionnaire in Canada are recommended for use in practice; however, they are not widely embedded into practice. The study aimed to determine the extent to which nurses working in cancer care in the UK and Manitoba value NA and identify any barriers and facilitators they experience. Method Oncology nurses involved in the care of cancer patients in the UK (n = 110) and Manitoba (n = 221) were emailed a link to an online survey by lead cancer nurses in the participating institutions. A snowball technique was used to increase participation across the UK resulting in 306 oncology nurses completing the survey in the UK and 116 in Canada. Results Participants expressed concerns that these assessments were becoming bureaucratic “tick-box exercises” which did not meet patients’ needs. Barriers to completion were time, staff shortages, lack of confidence, privacy, and resources. Facilitators were privacy for confidential discussions, training, confidence in knowledge and skills, and referral to resources. Conclusion Many busy oncology nurses completed this survey demonstrating the importance they attach to HNAs and COMPASS. The challenges faced with implementing these assessments into everyday practice require training, time, support services, and an appropriate environment. It is vital that the HNA and COMPASS are conducted at optimum times for patients to fully utilise time and resources.

The potential of peer support to extend the reach of digital health

Background Peer support groups have proliferated since the 1960s, providing safe, informal environments where peers can share experiences and information. A common model for the group is for those who have progressed further along a care pathway or in dealing with a particular medical condition or psycho-social problem, to encourage those at an earlier stage of recovery. Online support groups now co-exist with face to face models, providing a complementary or alternative resource for those with digital access and competence. As the paradigm of health care has moved towards the incorporation of health promotion, patient empowerment and self-management, peer support has extended to include more focussed activities. In particular peer support is included in a range of behaviour change interventions to promote engagement and adherence. Increasingly these interventions are delivered online. While this aims to extend their reach, it leaves those without digital access disadvantaged in terms of the ability to make use of online health resources.Main text Though peer support has been used to maintain adherence to online programmes, its potential in assisting with access and thus widening participation has remained unknown. We successfully piloted the use of a paid peer supporter to help men without experience of IT to take part in an online intervention involving a prostate specific holistic needs assessment. Lessons were learnt from this innovation in relation to training needs and support for the supporter and around data security, confidentiality and safeguarding. Alternative models of voluntary peer support maybe appropriate, particularly in the implementation phase of an intervention and require exploration. Additionally a specific framework for best practice in relation to Digital Health interventions is needed to guide future development of the role. Conclusion Health services are predicted to increasingly rely on digital technology over the next decade. Research into the impact of these seek to include participants representative of the entire population. Efforts must be made to include those who are currently underrepresented in research such as the elderly and other disadvantaged groups. Innovative research designs involving peer support in a research project may be valuable in addressing the current barriers to participation.