Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
availability of psycho-social treatment, to the patient who needs it in the
proper time, and the development of required resources, still in many cases
underutilised, is the next challenge. This, despite proven ethical, emotional as
well as economic benefits of psycho-social treatment. Conclusion:The nurse is
playing one of the crucial roles in comprehensive treatment of lung cancer
patients. She is indispensable in providing psycho-social support to the lung
cancer patients, preparing to enter treatment. She is providing the basic
psycho-social support, such as patient’s need for relevant information, basic
emotional support, communication, screening for needs on an ongoing basis,
symptom management. She is also pivotal in recognizing patients,
experiencing more profound distress or has more unmet needs and can run a
screening programme.References: 1. Missel M, Pedersen JH, Hendriksen C,
Tewes M, Adamsen L. Diagnosis as the First Critical Point in the Treatment
Trajectory: An Exploration of Operable Lung Cancer Patients’ Lived
Experiences. Cancer Nurs. 2015;38(6):E12-21. 2. Pujol J-L, Mérel J-P, Roth C. How
preconceptions about lung cancer treatment interact with medical discourse
for patients who accept chemotherapy? Psychooncology. 2016 Jul 23 [cited
2016 Aug 21]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/27449209
Accessed August 20, 2016 3. Temel JS, Greer JA, Muzikansky A, Gallagher ER,
Admane S, Jackson VA, et al. Early palliative care for patients with metastatic
non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–42. 4. Hutchison SD,
Steginga SK, Dunn J. The tiered model of psychosocial intervention in cancer: a
community based approach. Psychooncology. 2006;15(6):541–6. 5. Brebach R,
Sharpe L, Costa DSJ, Rhodes P, Butow P. Psychological intervention targeting
distress for cancer patients: a meta-analytic study investigating uptake and
adherence. Psychooncology. 2016;25(8):882–90. 6. Walling AM, Keating NL,
Kahn KL, Dy S, Mack JW, Malin J, et al. Lower Patient Ratings of Physician
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7. Janssens A, Kohl S, Michielsen T, Van Langendonck S, Hiddinga BI, van
Meerbeeck JP. Illness understanding in patients with advanced lung cancer:
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Gray JE. Survivorship issues for patients with lung cancer. Cancer Control.
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Keywords: psychosocial support, nurses, Preparing for treatment
NU02: PREPARING PATIENTS FOR TREATMENT
MONDAY, DECEMBER 5, 2016 - 16:00-17:30
NU02.02 PREOPERATIVE THORACIC SURGERY PATIENT EDUCATION
PROGRAM DEVELOPMENT
Katherine Kuhns
Thoracic Surgery/nursing, Penn Presbyterian Medical Center, Philadelphia/PA/
United States of America
Purpose: To develop a cost-effective preoperative patient teaching program
that includes a patient teaching video along with written material that
improves patient satisfaction, decreases patient anxiety, decreases
readmission rates associated with post-operative complications, and
optimizes overall outcomes of thoracic surgery patients. Overview: Patients
undergoing surgery usually have little knowledge of what to expect during
the preoperative, postoperative, and recovery period following thoracic
surgery. Multiple studies have shown that good quality preoperative
teaching increases patient satisfaction, improves patient outcomes, and
decreases patient readmission rates following surgery. Although the benefit
of preoperative education is widely recognized in the literature, finding
the resources available to provide efficient and effective teaching is a
challenge. Patients who are diagnosed with a suspicious lung nodule or lung
cancer are usually overwhelmed when attempting to navigate through the
health care system. During the initial surgical visit a battery of studies and
often additional diagnostic procedures are ordered for staging and surgical
clearance. The details of the surgery are discussed and the surgical consent
is obtained. The patient and family are inundated with so much information
that pre-operative teaching is not effective at this time. Further, in outpatient
health care settings there is a finite amount of time within a visit for a
provider to promote all of the pre-operative patient education. It has been the
experience of this thoracic surgery practice that providing the patients and
families an opportunity to undergo pre-operative teaching in another setting,
such as in their own homes, typically results in increased retention of the
information, and patients do better not only in the pre-operative period but
in the post-operative and recovery stages as well. Developing a well-designed
preoperative teaching program requires a multidisciplinary approach and
utilization of resources already available to build upon and promote better
programs that optimize patient and caregiver learning and retention. Preoperative
education and teaching is not just to provide information, but
also to help patients acquire the knowledge needed to change behaviors and
to promote better health. Individuals within the care team with particular
interest in patient education should be utilized in helping to develop an
effective preoperative teaching program. Collaborating with nurses and
advanced practice providers across the care continuum is ideal: these
members of the team have both the knowledge base and the access to
patients and their families needed to provide effective patient education.
Method: “A Patient’s Guide to Thoracic Surgery” is a thoracic teaching manual
that was customized to fit our thoracic patient population. It was developed
by a group of nurses and advanced practice providers who were interested in
developing thoracic patient education at our institution. The booklet includes
basic information concerning how to prepare for thoracic surgery, as well as
what to expect before and after the surgery. Our thoracic team saw the need
for additional education and developed a patient education video, “A Patient’s
Guide to Thoracic Surgery Video” that includes pre-operative teaching, what
to expect after surgery, and after discharge. The video was funded by a grant
that our hospital provides annually, funding various projects that support
research, education, and clinical care. The team wrote a script and worked
with the hospital IT department to create the video. Patients receive both
the pre-operative teaching booklet and video during the initial office visit
and the major points of the teaching material are reviewed at this time. The
patient is instructed to read through the information and watch the video at
their convenience. They are also encouraged to call the office to discuss what
they learned and answer any questions they may have. The outpatient nurse
practitioner calls and sometimes meets with the patients at least once again
prior to surgery to review the patients’ pre-operative studies, update their
pre-operative paperwork, and to answer any questions or concerns about
their upcoming surgery. The patients are asked if they have read through the
material and watched the video. During this encounter, updates on smoking
cessation and exercise are documented and discussed. Following surgery,
additional teaching is done by the nursing staff and the teaching video and
discharge instructions are again reviewed. Furthermore, the patient is phoned
for a “day after discharge” call by a thoracic team member to check on the
patient’s progress and answer any questions the patient or family may have.
The patients and their families are seen in the office for a post-operative
visit usually 2-3 weeks after discharge. A 10 question “Thoracic Video Patient
Satisfaction Survey” is completed during this initial post-op visit. This survey
asks the patients to rate the educational video on content and how helpful
they felt the video was in preparing them for surgery and for what to expect
after surgery. Results: A “Thoracic Video Satisfaction Survey” has been given
to all patients undergoing thoracic surgery at Penn Presbyterian Medical
Center; Philadelphia, Pennsylvania over the past several months. Preliminary
results have shown that since the implementation of the thoracic teaching
video in conjunction with the written material there has been an increase
in patient’s satisfaction and a decrease in anxiety associated with thoracic
surgery Conclusion: Providing patients with multi-format education materials
and the ability to review them on their own time has proven successful at
achieving the stated goals. Moving forward we intend to build upon this
resource to improve the patient education program at our institution.
Additionally, we hope to conduct a formal research project in conjunction with
other institutions such as the University of Maryland to continue to develop
thoracic patient education and to help identify which programs work best in
promoting patient education and changing behaviors in the thoracic surgery
population.
Keywords: Patient Education Thoracic Surgery
NU02: PREPARING PATIENTS FOR TREATMENT
MONDAY, DECEMBER 5, 2016 - 16:00-17:30
NU02.03 ETHICAL DECISION MAKING
Sabine Ruppert
Department of Medicine Ii and Department of Medicine III, Division of Nephrology
and Dialysis, Vienna General Hospital, Vienna/Austria
Ethical decision making is very important in the context of treatment of
cancer patients. These decisions can lead to withdrawal or withholding of
life-sustaining therapy, or change the goal of the therapy from curative to
palliative. “Do-not-reanimate” or “allow-natural-death” orders are also part
of ethical decision making. Sometimes pain treatment is adapted or palliative
sedation is started. It is necessary to make these decisions to ensure dignity
at the end-of-life, which is a human right. Ethical decision making is usually
done state-of-the-art in the context of Palliative Care, which means dialogue
with the patient, the next of kin and other health-care-professionals involved
in the treatment. The decision making process is structured, documented
and can be replicated for everyone. Most of the time, these decisions are
made by physicians only, without a dialogue, especially in Austria in hospitals
or nursing homes. Sometimes patients are involved, but more often only
their relatives. Physicians rarely ask other health-care-professionals for
their opinion. End-of-life-decision-making seldom occurs as a structured
well documented process. But the fact, that by law physicians have to take
the final decision, does not prevent them from listening to and involving
the perspective of the different persons concerned. If the discussion stops
with the question “Who is allowed to decide?” then decisions would only be
S102 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017