The UK Oncology Nursing Society (UKONS) annual conference, held on 11-12 November 2022 in Belfast, was the society's biggest conference to date. The main theme was ‘Cancer Care in the Digital Age’ plus some of the challenges facing oncology nursing.
Friday 11 November
The conference opened with a thought-provoking talk from Heather Monteverde, Head of Services for Macmillan Cancer Support in Northern Ireland and Professional Adviser in the Department of Health for Northern Ireland. She discussed the vision for cancer nursing in Northern Ireland (NI) and pointed out how unique NI is as its cancer services are led by nurses. She highlighted the future challenges for nursing and questioned what oncology nursing will look like in 10 years.
Oncology in prisons
Jo Armes, Professor of Cancer Care and Digital Health at the University of Surrey, gave a captivating talk on the care of people in prison with cancer. Professor Armes discussed her research into the burden of cancer in prisons. It is well known that infectious and viral diseases are more prevalent in prison populations, but there is little research about the prevalence and treatment of cancer. Professor Armes explained how cancer patients in prison have poorer survival rates and receive fewer treatments. She highlighted that the cost of diagnosing and treating cancer is substantially higher when escorts and bed watches are included. Therefore, patients have worse experiences of getting a diagnosis, gaining access to cancer information and managing side effects.
Her research found that communication between professional groups is poor and exacerbated by limited understanding of the ‘other’ system. Differences between organisational structures and cultures inhibit integrated cancer care.
Artificial intelligence
The first morning concluded with an industry-sponsored session from Roche Products Ltd entitled, ‘From Code to Clinic: Using Artificial Intelligence to Improve Cancer Care’. This session was chaired by Dr Majid Kazmi, Consultant Haematologist and Deputy Medical Director, and Director of Innovation, Research, Digital and Commercial for Cancer & Surgery at Guy's and St Thomas' NHS Foundation Trust, London.
Rebecca Pope, UK Digital and Data Science Innovation Lead for Roche UK gave an engaging presentation on the use of artificial intelligence in health care and a ‘deep fake’ communication project to tackle issues with the lack of translators to provide personalised care to breast cancer patients in Hull.
Breakout sessions
Three breakout sessions formed the basis of Friday afternoon. Each focused on oral presentations from selected poster submissions.
Breakout 1
This session discussed supportive cancer care in the digital age. The four presentations in the session were:
- Implementation of electronic patient reported outcome measures (ePROMs) for remote monitoring of symptoms and quality of life in lung cancer
- Perceptions of the Electronic Holistic Needs Assessment (eHNA) for people with breast cancer: the potential for value or paradox
- Clinical effectiveness of the Respiratory-Distress Symptom Intervention (RDSI) in lung cancer: results of a randomised controlled trial
- Development and user-testing of RITA: An artificial intelligence-enabled virtual assistant to support patients on their first visit to one cancer centre in Wales.
ePROMS: Janelle Yorke, Chief Nurse at The Christie NHS Foundation Trust and Chair in Cancer Nursing at the University of Manchester, started the session with her presentation on ePROMS, where she summarised the use of PROMs in health care and discussed the difference between a PROM and clinical data. She went on to highlight the benefits of using PROMs in clinical practice and gave an interesting overview of the ‘Christie Approach’ for its ePROM programme, using the example of patients with lung cancer.
eHNA: next up was Dr Lydia Briggs, Honorary Associate Chief Nurse for Research (Nursing and AHP), The Christie NHS Foundation Trust, NIHR Clinical Lecturer at the University of Manchester, and Clinical Lead for Personalised Care and Cancer Academy Education Development Lead, Greater Manchester Cancer Alliance.
Dr Briggs discussed her study on the use of the eHNA and its contribution to meaningful support for women with breast cancer. The study found that implementation of the eHNA appeared superficial, creating cultures of evidencing actions and achieving targets rather than meaningful conversations. The study also found patients' views of the eHNA appeared paradoxical, as most perceived it to be meaningful ‘in principle’ but reported minimal benefits or negative results in reality. She concluded that practice improvements should consider the impact of patient, staff and organisational factors in the context of the delivery process (introductions, practicalities, support and care planning in the eHNA process).
RDSI: Professor Janelle Yorke returned to present her work on an intervention for RDSI in lung cancer. Her talk outlined the experience of symptoms in lung cancer, discussed new insights for symptom cluster management and outlined the development of a novel complex intervention for symptom self-management.
RITA: The final talk in this breakout session was presented by Jodie Sherburn, Innovation and Research Nurse, and Ross McLeish, Head of Innovation at Velindre University NHS Trust, Cardiff. Their talk discussed an artificial intelligence-enabled virtual assistant called RITA. During COVID-19, RITA was refocused to provide tailored information to patients, carers and families at their first cancer centre visit. They found that RITA provided accurate information, which may potentially minimise searches for online information that may be less precise. It may also help reduce the burden of phone calls and help free clinicians' time for patient care.
Breakout 2
The second breakout session was titled ‘Communicating with patients in modern cancer care’. The four sessions were:
- Evaluating the pilot training course ‘No conversation too tough’, to help health professionals support parents with dependent children when a parent is dying
- Bereaved parents' experiences of adapting to life after the death of a co-parent with cancer who has dependent children
- Communicating with adolescents/young adults with cancer as an early career nurse
- Planning and developing an intervention to promote social eating for patients living with and beyond head and neck cancer.
Death of a parent: Johanna Groothuizen, Research Fellow at the University of Surrey, presented the first talk about a 1-day training course for nurses to help prepare families for parental death. The course was co-designed with cancer and palliative care professionals, children's bereavement specialists, those with lived experience, communication skills experts, healthcare educators and academics. The course was evaluated very highly by 35 delegates. The confidence of the delegates increased significantly regarding initiating and closing a conversation; the timing of conversations; the needs of children; and managing one's own emotions. The next steps are to deliver the course to other specialisms, and to school teachers.
Co-parent death: The second talk in this session was delivered by Dr Jeff Hanna, Postdoctoral Researcher at Ulster University. He discussed his research on bereaved parents' experience of managing family life when a co-parent of dependent children has died with cancer. The research highlighted two main themes: adapting to life without the parent and keeping the dead parent's memory alive. There were some poignant take-home messages that could benefit nurses working with terminal patients who have children.
Communication: Dr Maria Cable, an Independent Nurse Educator and Researcher, presented her poster on communicating with adolescents and young adults with cancer (AYAC) as an early career nurse. The research found that AYAC nursing is uniquely challenging, demanding and complex work. Coupled with this, early career nurses operate both within and across many boundaries – occupational, departmental, organisational and age-related. The stories told in this study contributed to a new understanding and cultural narrative about the nature of AYAC nursing. Dr Cable concluded by highlighting how important it is to look after our young, both nurses and patients.
Head and neck cancer: The final talk in this breakout session was from Mark Dornan, PhD Researcher from Ulster University. The presentation focused on an intervention to promote social eating for patients living with and beyond head and neck cancer. This is so important because 90% of patients have eating and drinking challenges after treatment. A guide was developed for people living with head and neck cancer entitled ‘Eating with others’, containing tips for patients who were ready to move towards eating meals with others. These tips included: being open and honest with others, planning ahead, minimising attention on food and focusing on another activity around eating, such as hosting or cooking.
Breakout 3
The final breakout on Friday, ‘The Future of Acute Cancer Care’, had four sessions:
- Patients' experiences of cancer immunotherapy with immune checkpoint inhibitors (ICIs): a systematic review and qualitative evidence synthesis
- Addressing unmet patient needs through an immunotherapy late effects clinic
- Successful implementation of electronic patient reported outcome measures (ePROM) in a breast cancer adjuvant human epidermal growth factor receptor 2 (HER2) therapy telephone clinic
- Transforming and supporting breast cancer care in the digital age: patient acceptance and experiences of using a web-based intervention to enhance self-management following breast cancer surgery.
ICIs: Dr Tessa Watts, Reader in Supportive Care, Cardiff University, started her presentation by highlighting that ICIs are one of the most successful developments in treatment for certain cancers, transforming the outcomes for many patients with advanced disease. Understanding the impact treatment with ICIs has on patients is crucial to identify their support needs. The aim was to explore patients' experience of ICIs through qualitative evidence synthesis. The methodology of the systematic review was described, commencing with a review of the literature, which demonstrated that there were no qualitative studies. It is hoped that by understanding patients' experiences of treatment with ICIs, future treatments and sources of support could be developed. Most study participants were people with melanoma. All patients received ICIs, either as first- or second-line treatment, alone or in combination. Five key themes emerged:
- Variability in immune-related adverse effects (IRAEs)
- Uncertainty and psychological impact of ICIs
- Hope for ICIs as a medical innovation
- Barriers to reporting and managing IRAEs
- Knowledge and information issues.
The conclusions were that ICIs are perceived positively by some. Available qualitative evidence would suggest patients have numerous unmet needs, particularly regarding information and psychological support. There is a need to ensure information about IRAEs is clearly communicated in a timely manner and to co-develop support to enable patients to manage fear and uncertainty.
Immunotherapy late effects: Dr Joanne Bird, Clinical Nurse Specialist in Immunotherapy Late Effects & Melanoma, Sheffield Teaching Hospitals NHS Trust and Honorary Research Fellow, University of Sheffield, followed next to discuss her poster on addressing unmet patient needs through an immunotherapy late effects clinic. Many patients reported late effects of immunotherapy, which impacted on their quality of life. However, there is insufficient time to incorporate late effects monitoring into cancer follow-up.
Dr Bird described how she has set up a nurse-led immunotherapy late effects screening service, with the aim of detecting complications earlier to reduce mortality and optimise quality of life. It was designed to mirror the existing late effects service for chemotherapy and stem cell transplants while taking the known effects of immunotherapy into account. This was supported by the late effects multidisciplinary team, which included endocrinology representation and links to multiple specialties.
Patients are referred to the service and receive a 40-minute screening in-depth consultation with a clinical nurse specialist, including onward referrals to specialist services, information and support, and lifestyle advice tailored to their needs. In the first 12 months of this service, 44 patients (81%) reported ongoing side effects or symptoms. The three main safety concerns were fatigue, arthralgia and skin rash/pruritus. Feedback from patients was very positive.
Dr Bird's conclusions were that toxicities are not always recognised post treatment and screening for ongoing and new toxicities can improve the patient experience. Research is needed to demonstrate whether this early identification translates into improved quality of life and a reduction in mortality.
HER2 therapy: The penultimate presentation in this session was by Kerry Chidlow, Advanced Practitioner, The Christie NHS Foundation Trust, on behalf of the adjuvant HER2 therapy team. Breast cancer is the most common of all cancers, and 20% are HER2-positive. HER2 treatments such as Herceptin (trastuzumab) significantly improve patient outcomes. This treatment is well tolerated but, due to the cardiac toxicities, requires regular echocardiography monitoring. The specialist HER2 therapy team provide 114 hours/week support to an increasing number of new patients. In 2022, 265 new patients were referred. The HER2 therapy team was formed in December 2006 and, since then, treatment pathways have become more complex with increased toxicities. Patients require longer follow-up and more complex discussions regarding treatment options/changes to treatment and potential trial involvement. The team introduced an ePROM (My Christie My Health). Patients were sent a text reminder to complete 12 symptom and 6 quality-of-life questions, 7 days before a planned telephone call. If there were no red flags and the cardiac scan was satisfactory, a text message was sent to report that all results were okay. Telephone follow-up was provided if requested by the patient. The team concluded that the ePROM has resulted in significant efficiencies in the HER2 treatment pathway. Patients are supportive of the service. The team hope to role out this initiative to other disease groups.
Digital age care: The final presentation in this session was from Sue Hartup, Nurse Research Fellow in Breast Oncology, Leeds Teaching Hospitals NHS Trust. She discussed transforming and supporting breast cancer care in the digital age, particularly patient acceptance and experiences of using a web-based intervention to enhance self-management following breast cancer surgery. Surgery for breast cancer confers comorbidities including high rates of persistent post-surgical pain. Rising survivorship has resulted in a significant increase in health burden, requiring a need to consider alternative methods to support self-management. Web-based interventions have been shown to improve self-management in chronic conditions and improve communication in cancer care.
Following a local audit of 119 patients, it was concluded that surgical pathways do not support patient self-management of symptoms. A web-based initiative (WBI) was identified as a method to improve self-management. Sue described the stages of intervention development. The ePainQ symptom questionnaire was developed and is a multi-component symptom management system built into the electronic patient record with both patient- and clinician-facing components.
A feasibility study aimed to evaluate the acceptability, usability and perceived usefulness of the WBI in newly diagnosed breast cancer patients. Patients were involved at all stages. They co-produced the content of the WBI, reviewed patient and study documents, tested the WBI and took part in interviews following use. The feasibility study found that the ePainQ was acceptable, usable and perceived to be useful for newly diagnosed breast cancer patients. Additional research and evaluation is required to gain a greater understanding of the successes and challenges of using WBIs to promote and improve patient self-management. The study findings provide evidence and support for a phase III randomised controlled trial of ePainQ. There is the potential to roll out WBIs such as ePainQ into standard NHS surgical practice.
Industry-sponsored session
Friday afternoon wound up with an industry sponsored session by Daiichi Sankyo and AstraZeneca. Entitled ‘Practical Considerations to Support HER2+ mBC Patient Management in the Digital Era’. It was chaired by Dr Catherine Oakley, Chemotherapy Nurse Consultant, Guy's and St Thomas' NHS Foundation Trust.
The UKONS AGM began soon after, followed by a debate about in-person versus virtual consultations.
Saturday 12 November
The second day began with Dr Catherine Oakley, who returned to present her work on innovative approaches to pre-systemic anti-cancer therapy (SACT) preparation for patients. Next, Professor Tanya McCance, Mona Grey Professor of Nursing Research & Development at Ulster University, gave an engaging and thought-provoking summary of her career's work, examining person-centredness in nursing care, looking at how the principles could be applied and measured.
Industry-sponsored session
The morning finished with another industry-sponsored session by Gilead Sciences Ltd. This time, Dr Georgette Oni, Consultant Plastic Reconstructive and Oncoplastic Breast Surgeon, Nottingham University Hospitals NHS Trust; Dr Majid Kazmi from Guy's and St Thomas' NHS Foundation Trust and Toral Shah, Nutritional Scientist and Integrative Medicine Practitioner and Founder of The Urban Kitchen, gave a sensitive and engaging talk on tackling racial inequalities in cancer care.
Breakout sessions
The breakout sessions that followed were interactive sessions on:
- Coaching and self-care: this session concentrated on attendees building the skills to look after themselves while progressing in their careers
- The Aspirant Cancer Career and Education Development (ACCEND) programme, a large, collaborative, and exciting project to restructure cancer careers
- SACT safety, covering evidence-based management of extravasation, new UKONS–sponsored research into the perception of risk from nurses administering SACT and the development of the UKONS digital SACT passport.
Breakout 1
Coaching: This interactive, engaging and inspiring session was divided into two presentations. The first was, ‘The power of coaching conversations’ presented by Duncan Enright, Managing Director of EBN Health. He described how coaching conversations are key to leadership and interactions of all kinds. Nurses are naturally good coaches as this requires empathy. He then described the six leadership styles: visionary, coaching, affiliative, democratic, pace setting and commanding.
The coaching style of leadership is valuable in most work-based settings. The benefits being that it motivates, supports and draws out the best contribution from individuals in a team. It also leads to a positive impact on the culture of an organisation as it builds long-term capabilities and trust. Next the ‘Grow model’ was discussed – a memory tool to encourage and guide a coaching conversation. This tool has four steps: the topic, the goal, the reality, and the options and what's next. The audience had the opportunity to practise using this tool in groups. The presenter encouraged everyone using the tool to pick up on non-verbal cues and to use open questions. All participants agreed that the tool was useful.
Self-care: The second presenter in this session was Jayne Ellis, Managing Director, EF Training. She discussed recognising compassion fatigue and caring for yourself. Jayne described her experience working and training as a nurse in a large organisation. As individuals, we are offered a wide range of training courses that assist us in our daily jobs. However, health professionals are not trained to ‘self care’ and protect themselves – this therefore can lead to compassion fatigue. The model of compassion fatigue, first described by Charles Figley (a traumatologist) was shared.
This can manifest through the physical and emotional effects of stress responses directly as a result of our work. This is called vicarious trauma. It particularly impacts nurses due to the empathetic connection we have with patients, their families and colleagues. Over time, the effects of the emotional impact of our jobs cannot be escaped. How we recognise and respond in a proactive manner can enable us to develop strategies to build and sustain our emotional resilience. Jayne provided the audience with a few mindfulness and relaxation exercises to use, including breathing techniques. It is important for healthcare staff to make time for relaxation, to have a hobby, and to ensure they have enough sleep.
Breakout 2
Ruth Hammond, UKONS Education Lead, welcomed all to the interactive session.
ACCEND programme: June Davis, Director, Allied Health and Professional Advisor, Macmillan Cancer Support, described the importance of the ACCEND programme. She explored the key issues, including navigating some of the current readily available and established frameworks. June shared the aim of end-to-end career pathway mapping and the key focus of each of the workstreams.
Oncology careers: Professor Vanessa Taylor, Deputy Head of Nursing, Midwifery and Professional Programmes/Chair in Teaching and Learning, University of York, delved deeper into workstream 5 of ACCEND, looking at the cancer career and education framework. ACCEND aims to provide the infrastructure to support whatever aspirations oncology health professionals may have, whether that is to develop through the levels of practice or delve deeper within one specific level. It also aims to set a standard for supporting the educational framework. This will allow health professionals to evidence their practice through the framework, putting the emphasis on the value of work-based learning.
Small group work: Small groups were formed to discuss the framework. Some thoughts from the groups included:
- The need for guidance on implementation of the framework, highlighting ACCEND Champions across the nation
- Financial aspects of developing through the levels of practice: what incentive is there to do the work?
- Links to performance review/appraisals
- Pathways to feed into job plans
- Supporting junior staff
- Preceptorship benefits and development
- Getting multi-source feedback
- Portability: knowing the standard is the same everywhere you go – fluidity
- Tying in the framework with revalidation
- Education and staff development to retain staff
- Sign off for the document – how is this supported?
- Mapping all education programmes to the framework.
All comments and feedback were highly appreciated by the ACCEND team and taken on board to be fed back into the workstreams.
Breakout 3
The final breakout of the conference discussed safe practice in SACT. It was chaired by Kay Bell, UKONS Champions Lead and Lisa Barrott, UKONS Partnership Lead. It comprised three sessions.
Safety: ‘Anthracycline chemotherapy – is it safe to administer peripherally?’ was presented by Dr Rosie Roberts, Specialist Nurse, SACT, Velindre Cancer Centre.
SACT passport: The second session provided an update on the electronic SACT passport and was again presented by Dr Rosie Roberts.
Cytotoxic drug exposure: Finally, there was a session on UKONS' perception and experience of potential occupational exposure to cytotoxic drugs: an update and future research priorities. This was delivered by Dr Karen Campbell, Macmillan Associate Professor in Cancer Nursing and Dr Margaret Dunham, Associate Professor in Nursing, both at Edinburgh Napier University and Dr Janyne Afseth, Senior Lecturer, School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen.
Industry-sponsored session
Bristol Myers Squibb hosted a session on working collaboratively to evolve cancer services that are fit for the future.
Closing session
The academic programme closed with the presentation of prizes and votes of thanks for Sam Wigfall (who is retiring from the UKONS Board) and the hard work put in by Kirsten Wicke and her team from Media 1 Productions, who organised the event.
SAVE THE DATE
UKONS Annual Conference 2023
Let's Integrate Cancer Care
17-18 November, ICC Wales
For more information go to: www.ukons.org