Unplanned readmission in elderly patients and the state of nursing engagement

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Published: 22 Nov 2018
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Prof Cindy Kenis - University Hospital Leuven, Leuven, Belgium

Cindy Kenis speaks to ecancer at the International Society of Geriatric Oncology 2018 conference in Amsterdam about the rates of unplanned readmissions in elderly patients.

She explains how those patients who had received a 'high risk' status during their geriatric assessment also had a higher rate of unplanned readmission.

Kenis also goes into depth about the state of nursing for elderly patients and the challenges in improving nursing engagement particularly in terms of attending important conferences like SIOG.

This service has been kindly supported by an unrestricted grant from Janssen Oncology.

Related to unplanned readmissions we performed a large multicentric prospective study, observational, in Belgium in 22 different hospitals. In that study we included about 8,451 people and there we performed geriatric screening and assessment. We know that unplanned readmissions after cancer treatment decisions is one of the special outcomes of interest to take into account.

So what we have done is we performed a geriatric screening and a geriatric assessment and about two to three months after the treatment decision we went to take a look at that outcome to see how many people were unplanned readmissions between the baseline screening and the baseline assessment and the time point of the follow-up. We did that in two different groups so we have taken a look in the group of patients that had a good geriatric screening, so patients where we think they are fit enough for their therapy, and we have done that also in the group of patients who had a screening at risk and we compared both groups in that study.

How did the data fare between the two groups?

Yes, there we have seen that the people or the patients that had a geriatric screening at risk had a higher rate of unplanned readmissions, about 22%, in comparison to 12% in the patients that were not at risk at this geriatric screening. So there we see that it’s important to take a look at that outcome and also to see how many times, for example, people were unplanned readmitted and definitely also to take a look at the reason for unplanned readmissions.
Tell us about the nursing discussions at SIOG.

Related to yesterday we had in SIOG an important nursing day. Within SIOG we have the nursing and allied health interest group particularly working on special topics of research and educational related issues. We know in current clinical practice that it’s very important for oncology nurses, that they are aware of the fact that older patients need special attention. They are all over the world questioning how we are going to improve our care for older patients with cancer and that’s where SIOG has an important role because we have the experience and we know that we can have the knowledge to integrate geriatric screening, geriatric assessment. But we also know which other points are important to take into account – functionality, cognition, nutrition – and it’s really important that oncology nurses all over the world taking care of older patients with cancer are aware of these issues. That’s why we are focussing on the nurses here, that are present here, but we are also trying to reach out to the nurses that can’t be here to teach them how they can be aware of these issues and how they can handle them in clinical practice.

Is the overall growth in SIOG attendance also reflected in the nursing areas?

We are trying to reflect membership and we are trying to reach out to a lot of nurses and definitely in the countries where the conference is taking place but it’s very difficult to find possibilities and ways to reach out to the nurses because of specific characteristics like language barriers and something like that. So we have to find a way that we have things available, educational tools that we can translate or provide to nurses in other countries but in the way that they can use them and integrate them in their clinical practice.

What important updates would you like to highlight from SIOG this year?

We had yesterday a very important topic focussing on all implementation aspects related to geriatric screening and assessment. There we see if we take a look at different countries in the world that we all struggle with the same barriers and challenges. So we know which geriatric screening tools are available, we know that we can perform an integrated geriatric assessment in clinical practice but it’s never easy to, first of all, find the patients that you need and that you can reach out to them. Secondly it’s difficult in all the countries to find a way to implement the geriatric screening, to teach nurses how to do it. It’s also a second or an additional challenge to find ways to proceed with the geriatric assessment and to find geriatric expertise in the hospitals that are where the oncology nurses are working.

What would your take home message be?

The biggest important message is that nurses have a key role in the care of older patients with cancer and the key role is a role that is so important that they need to be aware of the meaning that they can have for older patients with cancer. And also that they need to be aware of the age-related aspects that are so important for that patient population.