Nurse-Led Model of Assessment and Care for Older People with Cancer

Wednesday, 1 August 2012: 10:30 AM

Alexandra L. McCarthy, RN, MN, PhD1
Patsy Yates, PhD, MSocSci, BA, DipAppSc, RN, FRCNA2
Gayle Salkield, RN, BBus3
Euan Walpole, MBBS, FRACP4
Damien Thomson, MBBS, FRACP4
Helen Skerman, PhD5
Susan Hausmann, RN, BN4
(1)Queensland University of Technology, School of Nursing, Kelvin Grove, Australia
(2)School of Nursing, Queensland University of Technology, Kelvin Grove Qld, Australia
(3)Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
(4)Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Australia
(5)Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia

Learning Objective 1: The learner will be able to understand the role of rigorous mixed-method research in determining appropriate models of cancer management

Learning Objective 2: The learner will be able to understand how nursing researchers can lead multidisciplinary teams to influence patient outcomes

Purpose: To present the results of a mixed-method study comparing the level of agreement of a two-phased, nurse-administered Comprehensive Geriatric Assessment (CGA) with current methods that assess the fitness for chemotherapy of older cancer patients.  A nurse-led model of multidisciplinary cancer care based on the results is also described.

Methods: The two phases comprised initial screening by a nurse with the Vulnerable Elders Survey-13 [VES-13], followed by nurse administration of a detailed CGA. Both phases were linked to a computerised algorithm categorising the patient as ‘fit’, ‘vulnerable’ or ‘frail’. The study determined the level of agreement between VES-13- and CGA-determined categories; and between the CGA and the physicians’ assessments. It also compared the CGA’s predictive abilities in terms of subsequent treatment toxicity; while interviews determined the acceptability of the nurse-led procedure from key stakeholders' perspectives.

Results: Data collection was completed in December 2011. The results will be presented at the conference. A consecutive-series n=170 will be enrolled, 33% of whom are ‘fit’; 33% ‘vulnerable’; and 33% ‘too frail’ for treatment. This sample can detect, with 90% power, kappa coefficients of agreement of ≥ 0.70 or higher (“substantial agreement”). Fitness sub-group comparisons of agreement between the medical oncologist and the nurse assessments can detect kappa estimates of Κ ≥ 0.80 with the same power.

Conclusion: The results have informed a nurse-led model of cancer care. It meets a clear need to develop, implement and test a nurse-led, robust, evidence-based, clinically-justifiable and economically-feasible CGA process that has relevance in national and international contexts.