Shared care follow-up of patients with B-cell neoplasms based on nurse-led telephone consultations and PRO-data: a feasibility study from the North Denmark Region

Mia Sommer,Rasmus Froberg Brøndum,Tarec Christoffer El-Galaly,Mette Grønkjær,Marianne Tang Severinsen,Lone Frandsen,Jakob Madsen,Paw Jensen,Martin Bøgsted,Lars Børty Nielsen,Erik Elgaard Sørensen,Søren Ramme Nielsen

doi:10.1186/s12913-020-05899-8

Mia Sommer, Rasmus Froberg Brøndum + Show 10 more

Open Access

https://doi.org/10.1186/s12913-020-05899-8

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Abstract

BackgroundPatients with B-cell neoplasms in remission are monitored with regular physician visits at the hospital. The current standard follow-up procedure is not evidence-based or individualized to patient needs. To improve and individualize the follow-up, we investigated the feasibility of a shared care follow-up initiative, with alternating physician visits and nurse-led telephone consultations and assessments based on patient-reported outcome (PRO) data.MethodsPatients ≥18 years diagnosed with B-cell neoplasms were eligible for the study when they were in remission and stable without treatment for at least 6 months. Patients were assigned to alternating visits with physicians and nurse-led telephone consultations. The nurse-led telephone consultations were based on PROs, which were collected with the European Organization for Research and Treatment of Cancer questionnaire (EORTC-QLQ-C30), the Myeloproliferative Neoplasm – Symptom Assessment Form, and the Hospital Anxiety and Depression Scale. Patients completed questionnaires before every nurse-led consultation. We also applied the Patient Feedback Form to survey patient acceptance of the requirement of questionnaire completion. We applied descriptive statistics, in terms of counts (n) and proportions (%), to describe the study population and all endpoints.ResultsBetween February 2017 and December 2018, 80 patients were enrolled. Adherence, measured as the recruitment rate, was 96% (80/83), and the drop-out rate was 6% (5/80). During the study period, 3/80 (4%) patients relapsed, and 5/80 (6%) patients returned to the standard follow-up, because they required closer medical observation. Relapses were diagnosed based on unscheduled visits requested by patients (n = 2) and patient-reported symptoms reviewed by the nurse (n = 1). The response rate to questionnaires was 98% (335/341). A total of 58/79 (74%) patients completed the Patient Feedback Form; 51/57 (89%) patients reported improved communication with health care professionals; and 50/57 (88%) patients reported improved recollection of symptoms as a result of completing questionnaires.ConclusionBased on patient adherence, a low relapse rate, and positive patient attitudes towards completing questionnaires, we concluded that a shared care follow-up, supported by PROs, was a feasible alternative to the standard follow-up for patients with B-cell disease in remission.

Highlights

Patients with B-cell neoplasms in remission are monitored with regular physician visits at the hospital
Based on patient adherence, a low relapse rate, and positive patient attitudes towards completing questionnaires, we concluded that a shared care follow-up, supported by patient-reported outcome (PRO), was a feasible alternative to the standard follow-up for patients with B-cell disease in remission
This study investigated the feasibility of a shared care follow-up initiative, featuring alternating nurse-led telephone consultations, supported by PROs, and regular physician visits, as an alternative to the standard followup for patients treated for B-cell neoplasms

Summary

Introduction

Patients with B-cell neoplasms in remission are monitored with regular physician visits at the hospital. To improve and individualize the follow-up, we investigated the feasibility of a shared care follow-up initiative, with alternating physician visits and nurse-led telephone consultations and assessments based on patient-reported outcome (PRO) data. Patients with incurable B-cell neoplasms that do not require immediate, active treatment are sometimes managed with watch and wait (WAW) follow-ups These patients, and patients in remission after treatment are routinely followed by the attending physician. Nurse-led interventions have proven successful, in terms of meeting patient needs and addressing psychosocial issues These interventions have demonstrated high patient acceptance and offered advantages, including convenience and individualized care [20,21,22]. We investigated the feasibility of a shared care follow-up initiative, with alternating standard physician visits and nurse-led telephone consultations, based on the PROs of patients with B-cell neoplasms

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Discussion

Conclusion