Integrated Oncology Nursing Service (IONS)
Authors: Whelan Dawn , Parthiban Ciara 
Published: January 2024

In recent years, the clinical context for cancer has changed and it is now characterized by extended survival rates and complex cancer trajectories and symptomatology.The changes in landscape of cancer care have included a shift towards the home setting or the outpatient setting with an increase in the amount of care being delivered at home or transferred to the patient/family themselves.

According to the literature, societies are confronted with an increasing burden of health care as a result of an ageing population, the growing number of chronic diseases and coronavirus have forced governments and health care to seek new models in order to organize health care cost-effectively, without losing the current quality of care.Multi-professional and multi-agency interventions are now needed compared to when single specialities used to suffice.We need holistic care delivered in partnership to individuals, by flexible person-centred approaches.

The Acute Oncology and Community Services have come together to collaborate to provide supportive care to vulnerable cancer patients in the community. The objective of this Integrated Oncology Nursing Service (IONS) role is to refer cancer patients to Community Intervention Team (CIT), post a specialised oncology telephone triage by the Acute Oncology Clinical Nurse Specialist (AO CNSp), to further assess/treat patients in the community. The CIT will provide services such as clinical vitals, phlebotomy, medication administration and psychological support to patients in their home. The AO CNSp. will then link in with the patient at home the next day and continue to consult with the oncology/haematology team to discuss the best way to manage the patient at home. We aim to bring together these separate organisations and place an emphasis on the shared values of timely, efficient and person-centered care.

The benefit of this innovation is hoped to

•Reduce unscheduled presentations and result in admission avoidance for patients accessing the Tallaght Hospital Oncology Services.

•Improve the quality of patients treatment

•Bring specialist knowledge to patients

•Provides support to patients in their own home

•Provide outreach to unwell patients at home

 

The network governance model including nursing and clinical governance is shared by the Director of Public Health Nursing, the Director of Nursing of Tallaght University Hospital and the Oncology and Haemtology Consultants in Tallaght University Hospital.

We will roll out education and training with competencies before commencing the pilot.

There will be a dual approach to the evaluation of this initiative focusing on organisational impact and patient outcomes and experiences. A service evaluation has been completed already. A qualitative approach will be utilised to determine the patient’s experience and ethical considerations will be incorporated into the rolling out of the service.

In conclusion, modern cancer care is mainly delivered on an outpatient basis, meaning that there are many people in the community at risk of side effects of treatment or manifestations of progressive disease that can present as emergencies. This is where the Integrated Oncology Nursing Service is most valuable, providing outreach to acutely unwell patients at home and bringing specialist knowledge to their management.