Nurse-Led Symptom Management Clinic

A nurse-led interdisciplinary symptom management team has been implemented at the Billings Clinic Cancer Center in Montana, part of a top 100 hospital, according to Truven Health Analytics. The team was put together in response to the Commission on Cancer’s mandate for making palliative care services available and suggesting that interdisciplinary symptom management teams be developed.

These teams would include a provider and a nurse trained in palliative care and hospice, a pharmacist, a social worker, a mental health clinician, and a chaplain.

“Palliative care is often thought of as end-of-life care, but it really relates to quality of life from the time of diagnosis,” said Alison Weber, RN, BSN, who presented this poster. “Palliative care encompasses psychosocial, spiritual, physical, and advanced care planning.”

Patients undergoing cancer treatment at the center were screened for distress, and the sources of distress were identified. The top 6 sources of distress were (in descending order) fatigue, pain, sleep, peripheral neuropathy, skin problems, and difficulty concentrating.

Assessment, triage, and protocols were developed for various symptoms. The team held weekly meetings. After the program was put in place, patients attended a weekly symptom management clinic. Weber’s impression is that patients love the attention and care they get, and that their quality of life is improved.

When symptoms arise, the nurses identify which team members are needed for help in symptom management. For example, if the patient has taste changes, a dietitian might be called in; if the patient is in pain, a pain management staff member will be consulted. If symptoms do not resolve, then a provider is consulted; urgent care and even emergency care are provided if needed.

“This program has been ongoing for the past 4 years. Patients who engage with the nurse-led team seem to love it. They feel their complaints are heard and that they are given attention. The main challenge in implementing this type of interdisciplinary team is to get providers’ buy-ins. We need to convince providers that this effort provides added value,” said Weber.

She said that the information in her poster provides a model for cancer center personnel who want to implement a symptom management team, and she sees this approach gaining favor in the future. “This care is reimbursable for NPs and PAs, and it is billed as a clinic visit,” she said.

Reference
1. Weber A, Waitman K, Blaseg K, et al. A nurse-led symptom management clinic: serving cancer patients across the continuum. Presented at: 38th Annual Congress of the Oncology Nursing Society; April 25-28, 2013; Washington, DC. Poster 172.

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