Management of Malignant Bowel Obstruction: An Innovative Proactive Outpatient Nurse-Led Model of Care for Patients With Advanced Gynecologic Cancer

Nazlin Jivraj; Yeh Chen Lee; Lisa Tinker; Valerie Bowering; Sarah E Ferguson; Jennifer Croke; Katherine Karakasis; Tanya Chawla; Jenny Lau; Pamela Ng; Preeti Dhar; Eran Shlomovitz; Sarah Buchanan; Neesha Dhani; Amit M Oza; Terri Stuart-McEwan; Stephanie Lheureux

doi:10.1097/NCQ.0000000000000661

Management of Malignant Bowel Obstruction: An Innovative Proactive Outpatient Nurse-Led Model of Care for Patients With Advanced Gynecologic Cancer

J Nurs Care Qual. 2023 Jan-Mar;38(1):69-75. doi: 10.1097/NCQ.0000000000000661. Epub 2022 Oct 10.

Authors

Nazlin Jivraj¹, Yeh Chen Lee, Lisa Tinker, Valerie Bowering, Sarah E Ferguson, Jennifer Croke, Katherine Karakasis, Tanya Chawla, Jenny Lau, Pamela Ng, Preeti Dhar, Eran Shlomovitz, Sarah Buchanan, Neesha Dhani, Amit M Oza, Terri Stuart-McEwan, Stephanie Lheureux

Affiliation

¹ Division of Medical Oncology and Hematology (Drs Dhani, Lheureux, and Oza), Princess Margaret Cancer Centre (Mss Jivraj, Tinker, Bowering, Ng, and Buchanan and Dr Lau), Toronto, Ontario, Canada; Royal Hospital for Women and University of South Wales, Randwick, New South Wales, Australia (Dr Lee); Divisions of Gynecologic Oncology (Dr Ferguson), General Surgery (Drs Dhar and Shlomovitz), and Radiology (Dr Shlomovitz), University Health Network (Dr Croke and Mss Karakasis and Stuart-McEwan), Toronto, Ontario, Canada; Departments of Obstetrics and Gynecology (Dr Ferguson), Radiation Oncology (Dr Croke), and Surgery (Drs Dhar and Shlomovitz), and Lawrence S. Bloomberg Faculty of Nursing (Ms Stuart-McEwan), University of Toronto (Dr Oza), Toronto, Ontario, Canada; Mount Sinai Hospital, Toronto, Ontario, Canada (Dr Chawla); and Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (Dr Chawla).

PMID: 36214674
DOI: 10.1097/NCQ.0000000000000661

Abstract

Background: Malignant bowel obstruction (MBO) in patients with advanced gynecologic cancer (GyCa) can negatively impact clinical outcomes and quality of life. Oncology nurses can support these patients with adequate tools/processes.

Problem: Patients with GyCa with/at risk of MBO endure frequent emergency or hospital admissions, impacting patient care.

Approach: Optimizing oncology nurses' role to improve care for patients with GyCa with/at risk of MBO, the gynecology oncology interprofessional team collaborated to develop a proactive outpatient nurse-led MBO model of care (MOC).

Outcomes: The MBO MOC involves a risk-based algorithm engaging interdisciplinary care, utilizing standardized tools, risk-based assessment, management, and education for patients and nurses. The MOC has improved patient-reported confidence level of bowel self-management and decreased hospitalization. Following education, nurses demonstrated increased knowledge in MBO management.

Conclusions: An outpatient nurse-led MBO MOC can improve patient care and may be extended to other cancer centers, fostering collaboration and best practice.

MeSH terms

Female
Humans
Intestinal Obstruction* / etiology
Intestinal Obstruction* / pathology
Intestinal Obstruction* / therapy
Neoplasms*
Nurse's Role
Outpatients
Palliative Care
Quality of Life