Patient’s perception of Robotic Surgery for malignant ...

14/06/2012 Katrin Evans

Patient’s perception of Robotic Surgery

for malignant gynaelogical desease

Role of Advanced Practice Nurse

Plan

1. Generality about Robotic Surgery

2. Perception of patient about RS

3. Means provided to improve the support

4. Perspectives

5. Conclusion



Introduction

The technique of Robot Assisted Laparoscopy is a

technical-onset

Its impact seems to be positive

on the hospital

on patient stress

improve the quality of surgical procedures

In our Institution (IPC)

we support and we treat patients with malignant disease

we have the chance to make such new generation equipment available to patients


Robotic Surgery :some figures

France : 48 Robots

Marseille’s Region: 3 Robots

Since 2007 : in our Institution

2011 : 200 Procedures (104 for urologic malignancies 96 for gynaecologic malignancies)


Gynaecological malignancies in our Institution (IPC)

Gynaecological oncology (figures 2011)

Cervical cancer 65 %

Endometrial cancer 25%

Ovarian cancer 10 %

endometrial

25%

ovarian

10%

cervical

65%

cervical

endometrial

ovarian

RS procedures (IPC) for the five past years

Main indications and evolution

36

179

96

12 10

Indications bénignes

Cols

Endomètres

Ovaires

CIN


Gynaelogical oncology:

Surgical procedures

Hysterectomy

Oophorectomie

Omentectomy

Lymphadenectomy (pelvic and aortic)

Complexe procedures (in case of recurrence)


Gynaelogical oncology (IPC)

Simple therapeutic course : one treatment

Complex therapeutic course :several therapeutic areas

Surgery-radiotherapy

Concomittant chemoradiotherapy – following by adjuvant surgery

Improve the management of multiple complex conditions and thus increase satisfaction and efficiency


The need for Patient’s Centered Care

(delivery of health care service which makes the most sense for patients)

Plan cancer 1(France 2003)

Plan Cancer 2(France 2009)

Integrating the patient in an active relationship

Patient at the center of a human practice care

The patients can contribute positively to his own care

Nurse consultation,nurse care coordination(graduate APN)


Care coordinators (APN) : missions and roles

Infirmier Coordinateur de Parcours en cancérologie (APN)

Coordination Nursing Research

Support Improvement

Announcement Follow up

Education Counselling


A different perception


What’s change in patient’s mind undergoing RS ?

• The usual perception of the surgical procedure is modified They are used to imagine their surgery as the direct work of the surgeon they choose on their body

• Technical-onset

• Need to have more informations to visualize what’s going to happen to her

• Need to be informed more clearly to maintain trust


Patient knowledge of her desease and the treatment

Does the patient believe

• That her life is at risk?

• That her diagnosis is correct ?

• That the recommanded treatment plan will make the difference?

• That she must accept this clinical trial?


Surgeon visit

validation

RS programmed

APN

Consultation

Pre operative

Imaging lab

YES

J0

j15

Anesthesist

visit


Pre-operativ sequency for RS

Coordination and monitoring (anesthesit pre operative imaging (PET scanner MRI) laboratory) multidisciplinary appointment

Paths improvement

Recomended timeliness

good organization and good coordination are reassuring

Annoucement of the surgical procedure

by the physician

APN intervention


patient

surgeon

anesthesist

nurse

oncologist

radiologist

psychologist

The patient is supported within a multidisciplinary team


Identification of a nurse coordinator APN

May help promote trust with patients

Provide the patient with a single point of contact with the hospital

Centralize informations inside and outside the institution (home nurse,general practitioner…)

Nurse announcement consultation

You just saw the surgeon ?

What did you understand ?

What did he say ?

Patients are counseled pre operatively

Usual questions asked by the patient and her family

Course of surgery

Hospital stay

Pain

Post operative complication

Asthenia

Duration of Occupational disability

Taking care of her family

Sexuality

Lost of body image


Pre operative consultation by APN

Bio psycho social analysis (holistic care)

Advocacy

Hospital stay organisation

Discharge organisation

Multidisciplinary team (psychologist social workers beautician home nurse nursing home )

Inter disciplinary pluri professionnal support



Practicals informations

Appointments planning

Course of hospitalization

Information on personnal medical insurance

Information on medical transportation

Information on bowel preparation and dieting

Information about prevention of post operative complication (LMWH,elastic stockings )


Benefits of RS : reformulation

Faster recovery

Shorter hospital stay

Peri operative complications reduced

Less Postoperative pain

Less bleeding (less transfusion)

Less risk of infection (obese patients)

Cosmetic impact


Information on the risks of RS

Risks for any anesthesia Reactions to drugs,respiratory Respiratory problems

Risks for any surgery

Bleeding Infection

Specific Risks

lymphoecel

Conversion

Post operative Risks

Venous thromboembolism

What to do at home Numbers to call if problems Continuity of care


The stress of the patients facing a diagnosis of malignant desease

It has been demonstrated that providing accurate information to patients with cancer reduces their emotional distress and enhances their ability to care for themselves and to carry on with daily activities

Indeed ,detailed information on the desease is important for the patient to make informed decisions regarding treatment option


Improving access to information and advices

Written information about the treatment and the surgical procedure

Written care plan

Explanatory diagrams provided by the physicians

List of organizations and support groups

Information devices


http://www.chirurgie-

robotique.com/

http://www.institutpaolicalmettes

.fr/

E.R.I

Inter active

terminals


Nursing Perspectives for 2012

Objectives

Improve of RS support –reducing wainting time

Determine specific needs of patient undergoing RS

Improve satisfaction

Evaluate the effectiveness of the intervention of nursing coordinators on the management of patients with RS

Investigation

Patients seen in pre-op have all been revised post op and asked by the Nurse Coordinator about

their global satisfaction if they felt safe

utility of the care coordination

how long they have to recover after their surgery …

Prelimininary DATA

The first feed back of patients were positive

In all cases patients did not regret their support and would recommend the same procedure

Most found positive the counsistency of dialogue with the Nurse Coordinator

The most part say they were well informed about the surgery

Few patients called us to inform us of specific adverse events

Positive effects of

Nurse coordination for RS ?

These intervention increased knowledge about RS for this population.

Being around the patient from the time of diagnosis through the end of the treatment

Inspiring and stentghening trust and hope

Collaborative relationships between nurse and physicians can free physicians to handle more complex care


patient

surgeon

anesthesist

nurse

oncologist

radiologist

psychologist

Nurse coordination For RS


Conclusion

These interventions can determine specific needs for this population

Patient information and advocacy is an essential nursing function

These primary results are encouraging but further research is necessary to understand how nurses can best help women alleviate anxiety before RS.

Further research is required before the impact of APN on aspect of quality of life for women with GC can be shown.

This intervention can be replicated by nurses in other settings.

Good Morning, I'm not going to talk about technical aspects of surgery Other interventions will address these aspects my point is the perception of patients regarding the care ways to improve this one

Im coordinator nurse such an APN i m working in IPC Cancer Center in Marseilles

We receive and we treat

patients with cancer

Patient’s perception of Robotic Surgery for malignant ...

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