Feasibility study of an oncology nurse practitioner model of care in a rural cancer setting (#217)
Aims: To assess the feasibility of a shared care model involving an Oncology Nurse Practitioner (ONP) in the care provided to medical oncology patients at a rural cancer service in NSW.
Methods: A newly appointed Transitional ONP (TONP) commenced seeing patients at the Intervention site in August 2011, in conjunction with Visiting Medical Oncologists and registrars. Data was obtained from patient surveys, staff interviews, ARIA. Outcomes were acceptability of the model; impact on patient outcomes; and costs. A standardised quality of care (QoC) score (0-100) was derived from patient surveys distributed at the Intervention and a Control hospitals at baseline and post-intervention. Differences in the QoC scores pre and post-introduction of the TONP model were assessed via a multiple ANOVA, with an interaction between time and hospital to determine between-hospital differences. Analyses were adjusted for multiple comparisons. Qualitative data from staff interviews was analysed in NVivo-10 using Interpretative Phenomenological Analysis.
Results: At baseline, 63 patient surveys (63%) were completed at the Intervention hospital and 45 (45%) at the Control hospital, with a similar post-intervention response. The TONP saw 8 patients per month at commencement, increasing to 89 per month at intervention conclusion, for assessment, 3, 6 and 12-month reviews and counselling. A small but increasing pre/post-intervention trend (after Bonferroni adjustment) in QoC scores was detected at the Intervention [estimate=3.6, CI=(-0.36, 7.56), p=0.0418] but not at the Control site [estimate=1.93, CI=(-3.13, 6.98), p=0.3924]. Data saturation was reached at 13 staff interviews, with major themes emerging around how to introduce an ONP model of care in a rural setting and perceived benefits and challenges.
Conclusion: ONPs have the potential to reduce inequalities in access to cancer services for the 30% of the Australian population living in rural/remote areas. Assessment of the full impact of this model was limited; challenges will be discussed.