First of it’s kind, nurse led oral anti-cancer medication trial is delivering care in the community in Donegal

An oncology research project led by Advanced Nurse Practitioner (ANP) Dr Janice Richmond at Letterkenny University Hospital is providing practical benefits to patients receiving oral anti-cancer medication in Donegal.

ANPs are the highest level of clinical experts in the nursing profession in Ireland today. Dr Richmond qualified as the first accredited Advanced Nurse Practitioner in Oncology in Ireland in 2006 and was recently awarded Senior Researcher of the Year by the Irish Cancer Society for her work on this project.

The primary goal of the research project was to develop and investigate the potential transition of care from the hospital to community settings for patients receiving oral anti-cancer medications. The possibility of this had long been discussed by the Oncology Day Ward staff, who believed that there was a better way to care for these patients.

A part of this work, in its initial stages, was to obtain and analyse stakeholder’s (patients, clinicians and policy experts) perceptions of a possible transition. In line with the Sláintecare model of “right care, right time, right place” the ANP integrated care model successfully trialled by Dr Richmond and the wider team was about improving the patients’ experience of receiving treatment with the oral anti-cancer medications to make the process as efficient and convenient as possible. Another benefit of this, is that it frees up hospital capacity in the Oncology Day Ward for patients who need to attend to receive acute therapies. Overall, the model has huge potential for national implementation.

The pilot of reviewing patients receiving oral anti-cancer medications in a community setting commenced in January 2022. The team analysed the safety and efficacy of this new model of care and also investigated it’s acceptability to staff and patients. 37 patients were enrolled on the trial and they had their assessments for oral anti-cancer therapy in a community setting either in person or virtually.

Throughout the 4-month pilot, 152 patient assessments were carried out by the ANP Oncology ( Janice Richmond), usually in Scally Place, which was set up to mirror a primary health care setting. The benefit to patients is shorter waiting times, ease of access and continuity of care while the hospital benefits from additional capacity added back to the Oncology Day Unit.

The acceptability of this new model was investigated by asking 31 health care staff (nurses, doctors, pharmacists, and managers) three anonymous questions, and a high level of satisfaction was noted.

Speaking about the potential of the trial Dr Richmond said, “Transitioning to a community-based oral anti-cancer medication (OAM) model would be a radical change for oncology in the Irish healthcare system; however, the COVID-19 pandemic forced swift changes in the management of OAM, and stakeholders believed these changes were positive and could be cultivated further.

“The feedback we received from patients throughout this study was very clear; patients expressed overwhelmingly positive experience of the new model of care. It was viewed as being holistic, comprehensive, organised and uninterrupted. With an integrated approach and with support and access to the wider hospital-based Multi-Disciplinary Team there is huge scope for this model to be implemented in other regions providing a similar positive experience for patients.”

Olive Gallagher, Director of Nursing for the Saolta Group Cancer Managed Clinical and Academic Network (MCAN) praised the work adding: “Janice’s work is a key enabler of the NCCP Systemic Anti-Cancer Therapy (SACT) Model of Care and plays a critical role in creating additional capacity in the oncology/ haematology day ward, it demonstrates the real value of nurse led research in shaping future healthcare delivery for our patients.”

Sean Murphy, Hospital Manager said, “I am delighted to see this initiative deliver such positive results for cancer patients in our region and I would like to congratulate Dr Richmond and her colleagues for their work in developing this new model of care.”

Terry Hanan, National Clinical Lead for Cancer Nursing with the National Cancer Control Programme added, “The NCCP commends Dr Janice Richmond on this valuable patient focused initiative. Janice’s research has highlighted that ANPs are well positioned to deliver an integrated safe service to patients in a community setting. This fulfils the Sláintecare ethos while alleviating the pressure points in the oncology day unit. Proof of concept is clearly evident from her work and this has the potential to positively impact on patient care delivered nationally.”

The project was supported by the Irish Cancer Society, the Health Research board, National Cancer Control Programme, HSE Office of Nursing and Midwifery Services Director.

Photo caption
Mary Grace Kelly, Janice Richmond, Alison Johnstone: Oncology Research Team in Letterkenny University Hospital