PPCIP Collaborative Care Plans and Guidelines

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PPCIP Collaborative Care Plans and Guidelines

• A nursing intervention to assist in the
  management of breathlessness Meeting with
  Community Partners, Cathy Kiteley
• Sharilee Cox-Arseneault
• Jennifer Parkins

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Overview

• Welcome and introductions
• Identification of the project
• Community engagement
• Review of dyspnea
• The nuts and bolts of the intervention
• Role play
• Moving the intervention into practice
• evaluation

3
Welcome and warm up
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Identification of the project

• Community nurse led breathlessness intervention
• In collaboration with the dyspnea management
  collaborative care plan as part of the Provincial
  Palliative Care Integration Project (PPCIP)
• Endorsed by LHIN 56 PPCIP Steering Committee

5
The Nuts and Bolts of the Project

• Best evidence
• Conceptual approach
• Proposed intervention
• Planned education
• Evaluation

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Context

• Lung cancer is the most frequent diagnosed cancer
  overall in Ontario (Canadian Cancer Society,
  2007)
• Dyspnea common symptom for individuals with
  metastatic disease (breast, colon, prostate)
• Cancer Care Ontario and PPCIP have identified
  dyspnea as a priority symptom

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Context

• Nurses have good knowledge skill and judgment in
  symptom management. This project will articulate
  many of the interventions nurses are already
  using in their clinical practice and will
  incorporate best evidence.

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Best Evidence

• Findings from chart review on 183 cancer
  patients first visit attending Credit Valley
  Hospital Palliative Care Clinic (C Kiteley, A
  Kurtz-Melo, 2006)

9

• One years worth of data from the palliative care
  clinic analyzed.
• Here is what we found!!

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PPS Comparison on First Visit
LUNG
NON-LUNG
Average PPS Score 61
Average PPS Score 57
Total with PPS 60 and below Lung 81
Non-Lung 65
Statistically significant difference using
chi-square analysis
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Symptom Profile (ESAS) Comparison on First Visit
LUNG
Avg. Symptoms 6.4
77 had 6 or more symptoms rated 3 or greater
NON-LUNG
Avg. Symptoms 5.6
59 had 6 or more symptoms rated 3 or greater
Statistically significant difference using
chi-square analysis
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Comparison of Average Severity of ESAS Symptoms
on First Visit
Statistically significant difference using t
test Marginal significance
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Best Evidence

• Two Randomized controlled studies are the
  foundation of the proposed nursing intervention
• Studies by Corner et al 1996 and Bredin et al
  1999
• Improved dyspnea rating
• Improved function
• Improved QOL

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Best Evidence

• Another study by Hately et al (2003) replicated
  the nurse interventions in previous studies in a
  physio led clinic for breathlessness and found
  similar results

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Conceptualization

• Conceptualization A Parallel Model of Care

Bio-medical model Pathophysiology Isolate
cause Intervene Cure/remove sensation Therapeutic
Relationship Active vs passive Controlling
exclusive
A Parallel model Mind body Meaning Symptom
redefined as problem Therapeutic
relationship Partnership, reciprocity, mutual
inquiry
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Proposed Intervention

• For adult patients with lung cancer experiencing
  breathlessness receiving community home nursing
• Detailed assessment of breathlessness
• Advice/support on ways to manage
• Therapeutic relationship exploring meaning
• Training on breathing exercises and relaxation
• Goal setting
• Early recognition of problems warranting
  pharmacological or medical intervention

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Evaluation

• Focus group to evaluate nurses experience with
  the intervention
• Aims of evaluation will be
• Overall satisfaction and confidence in using
  intervention
• Evaluation of barriers or weaknesses with the
  program
• Perceived commitment by nurses
• Documentation challenges/issues

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References

• Bredin, M., Corner, J., Krishnasamy, M., Plant,
  H., Bailey, C., AHern, R.
• (1999). Multicentre randomised controlled trial
  of nursing intervention for breathlessness in
  patients with lung cancer. BMJ, 318, 901-903.
• Corner, J., Plant, H., A Hern, R., Bailey, C.
  (1996). Non-pharmacological intervention for
  breathlessness in lung cancer. Palliative
  Medicine, 10, 299-305.
• Hately, J., Laurence, V., Scott, A., Baker, R.,
  Thomas, P. (2003). Breathlessness clinics within
  specialist palliative care settings can improve
  the quality of life and functional capacity of
  patients with lung cancer. Palliative Medicine,
  17, 410-417.
• Kitson, A., Harvey, G., McCormack, B. (1998).
  Enabling the implementation of evidence based
  practice a conceptual framework. Quality in
  Health Care, 7, 149-158.

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References

• Logan, J., Graham, I. (1998). Toward a
  comprehensive
• Interdisciplinary model of health care research
  use. Science
• Communication, 20(2), 227-246.
• Registered Nurses Association of Ontario.
  (2002). Toolkit Implementation of clinical
  practice guidelines. Toronto, Canada
• Registered Nurses Association of Ontario.