Class Preps Patients With AML for Successful At-Home Symptom Management and Self-Care

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The class focused on symptoms commonly experienced by hematology-oncology patients and symptom management strategies.
The class focused on symptoms commonly experienced by hematology-oncology patients and symptom management strategies.
The following article features coverage from the 2018 Oncology Nursing Society's Annual Conference in Washington, DC. Click here to read more of Oncology Nurse Advisor's conference coverage. 

WASHINGTON, DC — A patient-education class focused on symptom identification and management for patients with newly diagnosed acute myeloid leukemia (AML) and their family/caregivers was found to improve symptom identification and management after discharge, reduce unplanned readmissions, and increase patient satisfaction, according to a presentation at the 2018 Oncology Nursing Society (ONS) Annual Congress.

At this 31-bed inpatient hematology-oncology unit, the unplanned readmission rate among patients with AML was 30%. Although patients received a routine discharge call within 72 hours, concerns regarding symptoms and provider/appointment were high. To address these issues, a nurse team at Duke Cancer Institute, in Durham, North Carolina, developed a chemotherapy/biotherapy class as a response to the Patient-Family Education Committee's concerns regarding patient information on self-care. The goal was to ensure that all patients with newly diagnosed AML receiving induction chemotherapy and their families would have the knowledge they needed for this new journey.

The primary focus of the class was symptoms commonly experienced by hematology-oncology patients, symptom management strategies, and available resources (eg, spiritual, social work/case management, group and individual counseling, dietician). 

Attendees and their families received a packet that included the presentation slides, symptom management tip sheets, information on safety at home and when to call, reputable website to increase patients knowledge about their cancer, and the number for a 24-hour call hotline to a hematology-oncology nurse. The packet also included a survey to help ensure the class content was relevant to patients' and families' needs. Unit nurses strongly encouraged patients and their family/caregivers to attend before discharge.

Due to the success of the pilot class, the class was expanded in Fall 2016 to include all patients newly receiving chemotherapy/biotherapy, and the content was updated to include information on basic hematology and cancer physiology, potential symptoms and side effects, central lines, the care team, and Duke resources. 

Since the update to the program, 30 patients have participated in the class in less than 1 year. Class surveys indicate attendees are highly satisfied with the group classes and found the materials and discussions useful.

Prior to the chemotherapy/biotherapy classes, unplanned readmissions were at 30%; this was reduced to 16.6% after the pilot program (post 1 year) and was maintained after the curriculum update (post 2 years). Trends in length of stay and symptom severity was reduced in class attendees. 

Routine follow-up calls at 72 hours postdischarge also demonstrated continuing improved outcomes for patients. Post 1 year, 61% of patients reported 30 symptom and 14 provider/appointment concerns during discharge calls; post 2 year reports showed 41% of patients reported 16 symptom and 9 provider/appointment concerns during discharge calls.

Additional steps are underway to address the lessons learned and improve the program. A unit welcome letter for new patients and families was developed to let them know about the chemotherapy/biotherapy class. A back-up system was developed for data and patient attendance documentation that was challenged by program advances. Nurse/teacher documentation was also improved. 

“Offering a class focused on symptom management to inpatients receiving chemotherapy is feasible, increases patient and families' understanding of treatment side effects and proper management, and [is] easily implemented and sustainable,” said Preston Andrew, RN, CN III, OCN.

Increased patient and family knowledge and understanding returns a sense of control that was diminished with the cancer diagnosis. But, the class also provided benefits to nurses. It solidified the nurse's knowledge of signs and symptoms of adverse effects, and makes the nurse a better educator and caregiver, noted Preston Andrew, RN, CNIII, OCN, of Duke University Hospital/Duke Cancer Institute.

Reference

Andrew P, Smith S, Allen D. Group inpatient chemotherapy/biotherapy classes: reducing unplanned readmissions while improving symptom identification/management. Oral presentation at: ONS 43rd Annual Congress; May 17-20, 2018; Washington, DC.

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