Patients’ learning and participation in their breast
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CN43 Patients’ learning and participation in their breast cancer care
L.E. Boman
1
, K. Sandelin
2
, Y. Wengstro¨m
3
, C. Sile´n
1
1
Department of Learning, Informatics, Management and Ethics, Karolinska Institute,
Stockholm, Sweden,
2
Molecular Medicine and Surgery, Department of Oncology-
Pathology, Karolinska Institutet, Stockholm, Sweden,
3
Department of Neurobiology,
Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
Background: Patients’ participation in treatment and care is considered to increase
their safety and well-being. There is a lack of knowledge about what participation
means for the patients and how it can be supported in breast cancer care. A prerequisite
for patients’ participation is their knowledge. Changing perspective, from patients’
information needs to their learning, can increase our understanding about how partici-
pation can be facilitated. The purpose of this study was to explore patients’ experiences
of learning, understanding and participation in their breast cancer care.
Methods: Sixteen patients with breast cancer were interviewed. The interviews were
analyzed according to abductive content analysis taking the perspective from learning
theories.
Results: The first part of the study explored patients’ learning. The patients are forced
to interact with a vast amount of information. Bodily sensations and experiences from
being part of events are important sources. The information is interpreted to an under-
standing which is concealed or expressed which affect patient participation. The strug-
gle to understand and manage the new life situation is an ongoing process for a long
time. The preunderstanding and driving forces of the patients, time for contemplation
and dialogue with staff, were essential features in this struggle
(1)
. The second part
explores patient participation. The concept of patient participation was defined differ-
ently by different patients and there was uncertainty about its meaning. The patients’
understanding of their disease, treatment and care affected their participation. A pre-
requisite for participation was the respectful treatment from health care staff contribu-
ting to a feeling of being “seen” as a human being. The patients’ wishe s varied as did
their needs to participate in treatment decisions. Participation also meant a continuous
struggle to manage self-care during a long period of time and access to health care is
needed to support patients.
(1)
Engqvist Boman et al. Patients’ learning and understand-
ing during their breast cancer trajectory. Patient Education and Counseling 100 (2017)
795–804.
Conclusions: New kinds of training programs for staff and patients are suggested,
focusing on patients’ learning and the new roles of partnership.
Legal entity responsible for the study: Karolinska Institutet, Department of Learning,
Informatics, Management and Ethics.
Funding: Karolinska Institutet in collaboration with the Regional Cancer Centre
Stockholm-Gotland, Stockholm County Council.
Disclosure: All authors have declared no conflicts of interest.
CN44 Incidence and risk factors of phlebitis in patients with peripheral
parenteral nutrition administration
S.Y. Oh
1
, J.M. Lee
1
, J.W. Kim
1
, S.H. Kim
1
, J.M. Park
1
, G.Y. Yeo
1
, J.E. Hyun
1
, J-H. Park
2
1
Nursing, Asan Medical Center, Seoul, Republic of Korea,
2
College of Nursing, Ajou
University, Suwon, Republic of Korea
Background: Peripheral parenteral nutrition is one of the easiest ways to provide nutri-
tion for patients who have difficulty with enteral nutrition. But, on the other hand it is
attended with danger such as, phlebitis. The purpose of this study was to investigate
incidence of phlebitis and its risk factors in patients with peripheral parenteral nutrition
administration.
Methods: Prospective observational study was performed with 289 hospitalized adult
patients with gastrointestinal diseases. The researchers evaluated peripheral venous
catheter that administered peripheral parenteral nutrition until their remov al and
investigated the incidence of phlebitis using phlebitis scale of Infusion Nurses Society
(2016). Logistic regression model was used to identify risk factors involved with occur-
rence of phlebitis. The statistical significance limits were set at p < 0.05.
Results: The incidence of phlebitis was 37.0% (107 cases). Among them, Grade I was
24.6% (71 cases), Grade II was 12.4% (36 cases) and Grade III and IV did not occur.
Platelet count (OR 2.13, CI 1.07-4.26, p¼.032), nutrition infusion rate (OR 0.36, CI
0.16-0.79, p¼.012) and infusion period (OR 1.02, CI 1.00-1.03, p¼.033) had statisti-
cally significance with phlebitis occurrence.
Conclusions: Using peripheral parenteral nutrition must be carefully reconsidered for
patients with risk factors of phlebitis. In using peripheral parenteral nutrition, adjusting
infusion rate deserves to be considered with care. Moreover, in case of extension of
peripheral parenteral nutrition therapy, medical team must regards using another way
such as middle line or central line for nutrition therapy in a serious light.
Legal entity responsible for the study: Asan Medical Center.
Funding: Has not received any funding.
Disclosure: All authors have declared no conflicts of interest.
CN45 Specialized nursing interventions in optimizing patient
communication undergoing total laryngectomy
A.A. Frade, S.S.A. Miguel
Service of Head and Neck Surgery, Otorhinolaryngology and Endocrinology, Instituto
Portugu
^
es de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
Background: Permanent and immediate laryngeal voice loss, resulting from total lar-
yngectomy can be psychologically devastating to the patient and family, generating feel-
ings of stress, fear, and frustration (Brunner et al, 2016). In the immediate
postoperative period, writing and lip read are the most commonly methods of commu-
nication used by patients. However, this surgery is often accompanied by neck dissec-
tion, resulting in neck swelling, which difficult the movement of the lips and limits limb
mobility required for readable writing (Matos et al, 2009). In conclusion, these
approaches may not be effective, leaving patients frustrated and unable to express their
care needs (Brunner et al, 2017). Thus, communication between patients and health
professionals becomes difficult, generates anxiety and anguish in the person and family
and has implication in the process care. Specialized care is therefore required for this
type of patients, especially those provided by nursing, highlighting the use of augmen-
tative and/or alternative communicatio n strategies (AAC).
Methods: A critical reflection based on the results of a previous review, were performed
to identify which AAC strategies promoting effective communication in the laryngec-
tomized patient.
Results: Strategies identified as promoting effective communication include the use of
low-technology and high-technology devices.
Conclusions: The use of AAC strategies improves the quality of care provided and
allows a better understanding of the needs of the laryngectomized patient, which conse-
quently will give them greater autonomy, control over their life and facilitating their
adaptation. Beyond these implications for nursing, effective communication is a right
of the individual and an essential component of the quality of care and patient safety.
Legal entity responsible for the study: Ana Frade, Susana Miguel.
Funding: Has not received any funding.
Disclosure: All authors have declared no conflicts of interest.
CN46 Safe navigation of CARs in a changing landscape
M. Davies
1
, E. Dolan
2
, S. Neeson
2
, E. Blowers
3
, K. Linton
4
, F. Thistlethwaite
5
1
The National Institute for Health Research (NIHR) Manchester Clinical Research
Facility, The Christie NHS Foundation Trust, Manchester, UK,
2
Clinical Research Facility,
The Christie NHS Foundation Trust, Manchester, UK,
3
Patient Recruitment, The Christie
NHS Foundation Trust, Manchester, UK,
4
Medical Oncology, Manchester Cancer
Research Centre, Manchester, UK,
5
Medical Oncology, The Christie NHS Foundation
Trust, Manchester, UK
Background: Advanced Therapy Medicinal Products (ATMPs) such as CD 19 chimeric
antigen receptor (CAR) therapies offer unprecedented promise for long term remission
and even cure in pre-treated and refractory B cell malignancies. Extensive interest in
new T cell engineered treatments for other malignancies has developed as a result.
These complex treatments are associated with acute and potentially fatal toxicities,
making patient safety paramount. CARs are often delivered on haematopoietic stem
cell transplant (HSCT) units with JACIE accreditation, an internationally recognised
quality system. To enhance capacity for growing numbers of ATMP trials The Christie
has utilised the NIHR clinical research facility (CRF).
Methods: Process mapping of the patient pathway alongside a gap analysis using JACIE
standards has provided a framework to underpin the development of the CRF includ-
ing: Advanced therapies team Increase in establishment Practice educator Education
programme & HSCT placements JACIE quality manager to align SOPs and policies
Changes to medical cover.
Results: Engagement across the organisation is a priority, with a focus on safety and
mitigating risk. Recruitment to key posts is underway, along with specialised staff train-
ing. Relationships are being forged and strengthened with essential specialties such as
critical care and neurology. The first clinical trials are open but recruitment and use of
V
C
European Society for Medical Oncology 2018. Published by Oxford University Press on behalf of the European Society for Medical Oncology.
All rights reserved. For permissions, please email: journals.permissions@oup.com.
Annals of Oncology 29 (Supplement 8): viii695–697, 2018
doi:10.1093/annonc/mdy277
CANCER NURSING: PATIENT SAFETY
Downloaded from https://academic.oup.com/annonc/article-abstract/29/suppl_8/mdy277/5140453 by guest on 28 November 2018
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