The role of advanced nursing in lung cancer: A framework based development

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Highlights

  • Definition of the role of Advanced Practice Lung Cancer Nurses (APLCN).

  • Highlighting the principal interrelated components of the APLCN role.

  • Evaluation of the applicability of the PEPPA framework in Europe.

  • Presentation of the development process of new Advanced Practice Nurse roles in cancer.

Abstract

Purpose

Advanced Practice Lung Cancer Nurses (APLCN) are well-established in several countries but their role has yet to be established in Switzerland. Developing an innovative nursing role requires a structured approach to guide successful implementation and to meet the overarching goal of improved nursing sensitive patient outcomes. The “Participatory, Evidence-based, Patient-focused process, for guiding the development, implementation, and evaluation of advanced practice nursing” (PEPPA framework) is one approach that was developed in the context of the Canadian health system. The purpose of this article is to describe the development of an APLCN model at a Swiss Academic Medical Center as part of a specialized Thoracic Cancer Center and to evaluate the applicability of PEPPA framework in this process.

Method

In order to develop and implement the APLCN role, we applied the first seven phases of the PEPPA framework.

Results

This article spreads the applicability of the PEPPA framework for an APLCN development. This framework allowed us to i) identify key components of an APLCN model responsive to lung cancer patients' health needs, ii) identify role facilitators and barriers, iii) implement the APLCN role and iv) design a feasibility study of this new role.

Conclusions

The PEPPA framework provides a structured process for implementing novel Advanced Practice Nursing roles in a local context, particularly where such roles are in their infancy. Two key points in the process include assessing patients' health needs and involving key stakeholders.

Introduction

In order to meet complex lung cancer patients' health needs, the role of the Advanced Practice Lung Cancer Nurse (APLCN) is well-established in North America, Australia and several North European countries. Yet to date, no such role has been developed in Switzerland. Indeed, the Master of Science in Nursing has been introduced relatively recently in Switzerland (since 2000 in the German-speaking part and since 2009 in the French-speaking part of Switzerland). Considering epidemiologic trends in lung cancer and the psychosocial and physical burden of these patients, it is imperative to develop the APLCN role in the Swiss context.

Globally lung cancer is the most common cancer, both in terms of new cases and deaths (Ferlay et al., 2014). Common physical complaints reported by lung cancer patients include dyspnea, fatigue, pain, anorexia, cough, and insomnia (Cooley, 2000, Iyer et al., 2013). Importantly, the physical symptoms resulting from the disease and its treatment can cause significant psychological distress, including depression and anxiety (Brintzenhofe-Szoc et al., 2009, Carlsen et al., 2005, Cooley et al., 2003). In addition, lung cancer carries a high disease burden and patients report high levels of unmet supportive care needs related to psychological and physical aspects of daily life (Li and Girgis, 2006, Sanders et al., 2010).

In recognition of the needs of cancer patients, the European Partnership for Action Against Cancer (EPAAC) recommends a specialized Multidisciplinary Team (MDT) that includes an expert nurse to provide expert clinical advice to patients, exchange key patient information and care recommendations with the MDT (Borras et al., 2014). The APLCN supports and counsels patients and families during all stages of the disease providing emotional, informational and behavioral support. These activities focus on: i) developing patient self-management of symptoms, ii) improving communication within the care team and iii) ensuring continuity of care (Moore, 2002). To date, there are limited data on the effectiveness of such specialized nursing roles for improving outcomes or continuity of care (Aubin et al., 2012). Two initial studies on the clinical effect of specialist nurses (Bredin et al., 1999) and the role of APLCNs (Moore et al., 2002) point to positive outcomes on lung cancer patients, with decreased self-reported breathlessness, enhanced performance status, as well as improved emotional state and patient satisfaction.

In line with the EPAAC recommendations, the University Hospital of Lausanne (CHUV) has launched a Thoracic Cancer Center and we undertook a structured process to develop, implement and evaluate a novel APLCN role as key component of a MDT within this Thoracic Cancer Center. The APLCN focuses on delivering and coordinating care for patients complex care needs and thus the role includes expanded autonomy beyond the traditional scope of nursing practice. Accordingly, this role can be considered within the domain of Advanced Practice Nursing (APN) (Bryant-Lukosius et al., 2004).

Introducing a new APN role is a complex and dynamic process that must overcome a number of barriers including: i) lack of clearly defined role and goals/expectations, ii) stakeholders' confusion related to describing the APN role, iii) difficulty in identifying and addressing obstacles to role implementation and iv) lack of evidence-based strategies guiding role development, implementation and evaluation (Bryant-Lukosius et al., 2004). Some have posited that using a systematic approach is an effective means to overcome these barriers. One such approach is the “Participatory, Evidence-based, Patient-focused process, for guiding the development, implementation, and evaluation of advanced practice nursing” (PEPPA framework) (Bryant-Lukosius and DiCenso, 2004). The PEPPA framework was developed in the context of the Canadian health system for APN role development. However, to our knowledge, this framework has not been tested outside of North American context (McNamara et al., 2009). Therefore, we aim to describe the development of an APLCN model at a Swiss Academic Medical Center as part of a specialized Thoracic Cancer Center and to evaluate the applicability of the PEPPA framework in this process.

Section snippets

Method

The PEPPA framework was developed to address implementation challenges for APN roles (Bryant-Lukosius and DiCenso, 2004) and is designed to: i) use the best available evidence and relevant sources of data to identify needs and establish goals and clearly define the role, ii) support the development of patient-centered nursing practice, iii) use APN skills/knowledge in all role dimensions, iv) engage key stakeholders in the development and implementation process, and v) define outcomes and

Results

The process of developing and implementing an APLCN role in a multidisciplinary team began in January 2012. The proximal goal was to delineate and implement the APLCN role into a health care setting in Switzerland that has yet to define APN roles. The ultimate goal being to enhance the effectiveness of multidisciplinary care with the inclusion of nursing interventions targeting the unmet self-management needs of lung cancer patients. The results of each phase of the PEPPA framework process is

Discussion

Herein we described the development process of the new APLCN role within a Swiss Thoracic Cancer Center enter. We employed the PEPPA framework to define the APLCN role (Fig. 1), and the APLCN-led intervention plan (Fig. 3). This framework was developed and implemented in the context of the Canadian health system (Bryant-Lukosius and DiCenso, 2004). In the present project, we introduced an APN role (APLCN) in a Swiss Thoracic Cancer Center. As the initial empirical demonstration of the

Acknowledgements

This work was supported by key professionals of Thoracic Cancer Canter of the University Hospital of Lausanne: Prof. Dr. Hans-Beat Ris, Dr. Alban Lovis, Prof. Dr. Laurent Nicod, Dr. Hasna Bouchaab, Dr. Mahmut Ozsahin, Dr. Nicolas Peguret, Dr. Igor Letovanec, Dr. Catherine Beigelman-Aubry, Claire Zurkinden, Jacqueline Bulliard and Marie-Rosalie Mélanjoie-Petite. Scientific consultation was provided by Prof. Kate White, Prof. Diane Morin and Prof. Serge Leyvraz. Dr. Andrew Dwyer and Dr. François

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