CN1 - Remote monitoring by Nurses Navigators (NNs): From experimentation to optimisation of routine practices

Background

CAPRI is a randomised phase III trial comparing digital and NNs intervention versus usual care in patients (pt) treated with oral anticancer agents (OAA) at Gustave Roussy cancer Center. Results showed that CAPRI intervention improved Relative Dose Intensity, patient experience, grade 3 toxicities and optimised hospitalisation . The aim of this longitudinal analysis is to describe NNs activity data in order to understand how NNs monitoring could be optimised for implementation and sustainability.

Methods

NNs conduct regular phone monitoring, evaluate alert’s level based on algorithms (designed according to NCI-CTCAE) and determine actions to implement mainly: providing advice to patients, referral to the General Practitionner or oncologist, organise an hospitalisation. A coding grid was developed to analyse the interventions of the NNs in order to identify the actions performed and to assess their autonomy in the encountered situations. All interventions (regular follow-ups and patient requests) were included in the evaluation. Two distinct periods (P1 : 11/2016 – 04/2018 and P2 : 05/2018 – 10/2019) were defined to study the evolution of the 6 NNs activities.

Results

A total of 3942 interventions were extracted concerning 272 patients (pt) and 3445 could be analysed. One action was decided by NNs at least in 2062 (59.9%) of these interventions (1345 of which were regular follow-ups, and 717 upon pt requests). 77.4% (n=1595) of the interventions have been processed by the NNs without referral to the oncologist (77.4% for P1 and 79.4% P2). The reasons to refer to the oncologist were: presence of new symptoms/toxicity (82%), follow-up of OAA cessation/resumption of treatment for surgery or treatment, biological tests for resumption of treatment (12,5%), other reasons (5.5%).

Conclusions

NN’s autonomy increases over time, which suggests a learning curve. However, several NNs have practiced and improved a rigorous procedure leading to these results. All of this algorithms make the practices more secured and maximize the NNs decision- making autonomy. The implementation of a new protocol allowing a wider perimeter of action of NNs would allow to limit the solicitations of oncologists.

Clinical trial identification

NCT02828462.

Editorial acknowledgement

Legal entity responsible for the study

Gustave Roussy.

Funding

Astrazeneca, Novartis, Fondation Philanthropia, ARS Ile de France, Agence Nationale de la Recherche.

Disclosure

F. Scotté: Financial Interests, Personal and Institutional, Invited Speaker: MSD; Financial Interests, Personal and Institutional, Invited Speaker: Roche; Financial Interests, Personal and Institutional, Invited Speaker: Pfizer; Financial Interests, Personal and Institutional, Invited Speaker: BMS; Financial Interests, Personal and Institutional, Invited Speaker: Pierre Fabre Oncology ; Financial Interests, Personal and Institutional, Invited Speaker: Biogaran Mylan; Financial Interests, Personal and Institutional, Invited Speaker: Mundi Pharma; Financial Interests, Personal and Institutional, Invited Speaker: Amgen; Financial Interests, Personal and Institutional, Invited Speaker: Leo Pharma. O. Mir: Financial Interests, Personal, Advisory Board: Bayer; Financial Interests, Personal, Advisory Board: Blueprint Medicines; Financial Interests, Personal, Invited Speaker: BMS; Financial Interests, Personal, Invited Speaker: Eli-Lily; Financial Interests, Personal, Invited Speaker: Ipsen; Financial Interests, Personal, Advisory Board: MSD; Financial Interests, Personal, Advisory Board: Pfizer; Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Invited Speaker: Servier; Financial Interests, Institutional, Principal Investigator: Bayer; Financial Interests, Institutional, Principal Investigator: Blueprint Medicines; Financial Interests, Institutional, Principal Investigator: Eli Lily; Financial Interests, Institutional, Principal Investigator: Epizyme. All other authors have declared no conflicts of interest.