Stewart Iain, Leary Alison, Tod Angela, Borthwick Diana, Khakwani Aamir, Hubbard Richard, Beckett Paul, Tata Laila J
Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB, UK.
School of Primary & Social Care, London South Bank University, SE1 0AA, UK.
Eur J Oncol Nurs. 2018 Oct;36:103-111. doi: 10.1016/j.ejon.2018.07.006. Epub 2018 Sep 6.
Health services across the world utilise advanced practice in cancer care. In the UK, lung cancer nurse specialists (LCNS) are recognised as key components of quality care in national guidelines, yet access to LCNS contact is unequal and some responsibilities are reportedly left undone. We assess whether any variation in working practices of LCNS is attributable to factors of the lung cancer service at the hospital trust.
Nationwide workload analysis of LCNS working practices in England, linked at trust level to patient data from the National Lung Cancer Audit. Chi-squared tests were performed to assess whether patient contact, workload, involvement in multidisciplinary teams (MDT), and provision of key interventions were related to 1) the trust's lung cancer service size, 2) LCNS caseload, 3) anti-cancer treatment facilities and 4) lung cancer patient survival.
Unpaid overtime was substantial for over 60% of nurses and not associated with particular service factors assessed; lack of administrative support was associated with large caseloads and chemotherapy facilities. LCNS at trusts with no specialty were more likely to challenge all MDT members (80%) compared with those at surgical (53%) or chemotherapy (58%) trusts. The most frequent specialist nursing intervention to not be routinely offered was proactive case management.
Working practices of LCNS vary according to service factors, most frequently associated with trust anti-cancer treatment facilities. High workload pressures and limited ability to provide key interventions should be addressed across all services to ensure patients have access to recommended standards of care.
世界各地的医疗服务机构都在癌症护理中采用先进的实践方法。在英国，肺癌专科护士（LCNS）在国家指南中被视为优质护理的关键组成部分，但获得LCNS服务的机会并不均等，而且据报道一些职责未得到履行。我们评估LCNS工作实践中的任何差异是否可归因于医院信托机构肺癌服务的因素。
对英格兰LCNS工作实践进行全国范围的工作量分析，并在信托层面与国家肺癌审计的患者数据相关联。进行卡方检验以评估患者接触、工作量、参与多学科团队（MDT）以及提供关键干预措施是否与以下因素相关：1）信托机构的肺癌服务规模；2）LCNS的病例量；3）抗癌治疗设施；4）肺癌患者的生存率。
超过60%的护士存在大量无薪加班情况，且与所评估的特定服务因素无关；缺乏行政支持与大量病例量和化疗设施相关。与外科（53%）或化疗（58%）信托机构的LCNS相比，没有专科服务的信托机构的LCNS更有可能挑战所有MDT成员（80%）。最常未常规提供的专科护理干预措施是主动病例管理。
LCNS的工作实践因服务因素而异，最常与信托机构的抗癌治疗设施相关。应在所有服务中解决高工作量压力和提供关键干预措施能力有限的问题，以确保患者能够获得推荐的护理标准。
