Nurse Navigators telephone and web application follow-up intervention for patients treated with oral anticancer medication: an optimization of oncologists' medical time.

Abstract

6544 Background: Many interventions to improve safety and quality of oral anti-cancer medication have occurred the past few years. Frequently, these systems involve Nurse Navigators (NN) but rather limited data is actually available describing their activities and quantifying which intervention could have been performed without an oncologist's expertise. This is a major issue in optimizing the workload of oncologists statewide. Methods: The study was conducted at Gustave Roussy (Villejuif, France) as part of an assessment program of an intervention combining NN and mobile app dedicated to patients receiving oral cancer medication (cytotoxic, targeted therapies). A coding grid was developed to classify the NNs' activities from the intervention reports. NN interventions consist in regular follow-up calls and requests from patients and their relatives (via phone calls or mobile app). NN interventions recorded over a 24-month period were all encoded by two researchers. Results: 2395 interventions were analyzed concerning 236 patients, 1880 of which were regular follow-ups, and 515 patient requests. The majority of contacts were carried by phone conversation (94%). 52% of the interventions were followed-up upon by at least one additional action by the NN (n = 1250). In 25% (n = 318) of the interventions, the oncologist's expertise was required mainly because of the presence or aggravation of symptoms and/or toxicities or concerning oncological treatment (therapeutic protocol, biological assessment). 75% (n = 932) of the interventions have been processed successfully by NN by themselves. The principal actions carried out by the NN were: A. Contact or provide referral to a health professional or institution 24%, B. Advice to the patient 43%, C. Management of medical documents and appointments 6%; D. Administrative management 2%. Conclusions: Patients' needs for oral cancer drugs are mainly related to advice, information and coordination of the care pathway. In the majority of interventions, the NNs were able to manage these situations by themselves, which could optimize the workload of oncologists.