Clinical Support for Oncology Nurse Case Writers in Asynchronous Consultation Service

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Oncology nurse case writers (ONCWs) are integral to the asynchronous consultation service for cancer patients. Their role is to review patients’ medical records and compile oncological history into a patient clinical narrative (PCN), which is sent to a physician for a written second opinion. A case audit at a designated cancer center in California identified a need for improvement in the quality of PCNs. In addition, ONCWs also voiced a need for clinical support and resources to fulfill their roles with competency, confidence, and efficiency. This quality improvement (QI) project focused on providing lung cancer education; utilizing PCN-writing algorithms; and initiating nurse clinical support (NCS) meetings to evaluate changes in the ONCWs’ self-perceived level of clinical competency, confidence, and efficiency in composing lung cancer PCNs, along with improvements in the quality of lung cancer PCNs. A total of nine ONCWs volunteered to participate in the project. Participants attended two 1-hour lung cancer education modules, used lung cancer PCN-writing algorithms, and attended NCS meetings every other week. Of the 12 lung cancer PCN-writing competency criteria, which were developed by the QI leader tailored toward an ONCW’s role on the basis of the National Comprehensive Cancer Network Guidelines® and the Oncology Nursing Society’s Oncology Nurse Generalist Competencies (ONGCs), one criterion had already achieved the target rating of ≥4.5 on a 5-point Likert scale before project implementation. Of the remaining 11 criteria, seven criteria achieved the target rating, and four criteria did not but achieved a rating close to the target. However, all criteria demonstrated positive changes. The self-perceived confidence and efficiency levels in composing a lung cancer PCN improved and achieved the target ratings. The goal of achieving quality level 5 (highest) on 90% of 20 random lung cancer PCNs was not met, but 85% (17/20) of the cases reached quality level 5. This finding is noteworthy, as none of the 20 PCNs were at quality level 5 before project implementation. The lung cancer PCN-writing algorithms and NCS meetings provided the ONCWs with the needed assistance in writing lung cancer PCNs. The project outcomes suggest that clinical support for ONCWs improved self-perceived competency, confidence, and efficiency in composing lung cancer PCNs and enhanced the quality of lung cancer PCNs. Ongoing clinical support may increase the level of satisfaction regarding the extent of clinical support and the retention rate of ONCWs. Additionally, clinical support may potentially increase revenue by increasing ONCWs’ productivity. Moreover, the positive impact on the quality of written second opinions is likely to lead to positive patient outcomes. The recommendations for the organization to maximize the benefit of implementing clinical support for ONCWs include having a dedicated ONCW educator, developing education modules on other cancer diagnoses, uploading voice-recorded learning modules that are easily accessible, and offering continuous learning opportunities.
Submitted in partial fulfillment of the requirements for the degree Doctor of Nursing Practice
Nursing, Health Education