3 April 2020
Macmillan have published some guidance for patients and carers who are approaching the end of life during the current pandemic. This is an excellent resource and is very clear. Available here: https://www.macmillan.org.uk/coronavirus/end-of-life-care-and-coronavirus.
In addition to this CRUSE have also published some very helpful material on bereavement and grief during the crisis which is aimed at those left behind when someone dies during this time. Accessible here: https://www.cruse.org.uk/get-help/coronavirus-dealing-bereavement-and-grief
Access this free, online learning resource, developed by Skills for Health to support those working in the public sector, particularly key workers, to learn about COVID-19. This regularly updated guidance will ensure the workforce is well prepared to recognise and prevent the spread of the virus over the coming weeks and months, allowing for continuity of your best possible service delivery during these unprecedented times. This includes Statutory/Mandatory e-learning training, aligned to the UK’s Core Skills Training Framework, including Infection Prevention and Control. The introductory course is available here. https://www.skillsforhealth.org.uk/covid-19-course
In order to support nurses returning to SACT practice during COVID-19 the Guy’s’ Cancer Academy are providing free access to the video lectures from their online SACT course. If you would like to gain access, please ask your manager to email Julie.Bishop@gstt.nhs.uk . Your manager needs to provide your name, email address and place of work. They need to confirm that you are someone who has previously been SACT competent and are required to update your knowledge and skills to be able to return to SACT practice.
It is important that we continue to support and educate patients starting treatment to manage their side effects and to report symptoms appropriately to acute oncology services. Pre-treatment consultations can be conducted by telephone or via video link. UKONS have produced a film to support patients and explain the contents of the CRUK ‘Your Cancer Treatment Record to accompany these consultations. This film can be accessed here https://www.youtube.com/watch?v=16ZIZ3Il6UI&feature=youtu.be
Daubman, B. R., Cranmer, H., Black, L., & Goodman, A. (2019). How to talk with dying patients and their families after disasters and humanitarian crises: a review of available tools and guides for disaster responders. Journal of International Humanitarian Action, 4(1), 10 https://doi.org/10.1186/s41018-019-0059-6
Duan, L., & Zhu, G. (2020). Psychological interventions for people affected by the COVID-19 epidemic. The Lancet Psychiatry.https://doi.org/10.1016/S2215-0366(20)30073-0
Hollander, J. E., & Carr, B. G. (2020). Virtually perfect? Telemedicine for covid-19. New England Journal of Medicine.https://www.nejm.org/doi/full/10.1056/NEJMp2003539
NHS Education for Scotland (2020) COVID-19: Difficult conversations – why we need to talk about dying.https://learn.nes.nhs.scot/28261/quality-improvement-zone/learning-programmes/scottish-quality-and-safety-sqs-fellowship-programme/difficult-conversations-why-we-need-to-talk-about-dying
WHO (2020) Mental health and psychosocial considerations during the COVID-19 outbreak. [includes tips on communication]https://apps.who.int/iris/bitstream/handle/10665/331490/WHO-2019-nCoV-MentalHealth-2020.1-eng.pdf
Zhou, X., Snoswell, C. L., Harding, L. E., Bambling, M., Edirippulige, S., Bai, X., & Smith, A. C. (2020). The Role of Telehealth in Reducing the Mental Health Burden from COVID-19. Telemedicine and e-Health. https://www.liebertpub.com/doi/full/10.1089/tmj.2020.0068
British Association of Critical Care Nurses has produced a range of Covid-19 Nurse Educational Resource materials here https://www.baccn.org/about/covid-19-nurse-educational-resource-centre/resources-1/
Health Education England, has produced some guidance and education tools for health professionals via e-learning, accessible here https://www.e-lfh.org.uk/programmes/coronavirus/
World Health Organisation, real-time training for the coronavirus outbreak ,with a range of different courses https://openwho.org/
BMJ Best Practice Guidelines include a section on COVID-19 accessible here- https://bestpractice.bmj.com/topics/en-gb/3000168#important-update
UpToDate are providing a good summary of the latest evidence relating to COVID-19, which are continuously updated and these are accessible here https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19
As Oncology Nurses across the UK continue to respond to the COVID-19 pandemic and the accompanying massive changes to the way in which oncology services are delivered. UKONS and Macmillan Cancer Support are moving to weekly Breaking News updates on resources which might help our membership (in fact all cancer nurses) to cope with these huge pressures.
1. Rapid NICE Guidance
The NHS Guidance on Oncology patients and COVID-19 which was produced last week https://www.england.nhs.uk/coronavirus/publication/specialty-guides-cancer/ has now ben supplemented by the ‘COVID-19 rapid guideline: delivery of systemic anticancer treatments’. This is an important document which re-iterates the previous document but outlines the procedure for prioritisation of SACT and defines the national prioritisation categories for SACT. The document also outlines other good practice, defines the role of MDT working in SACT prioritisation and stresses the importance of communication with patients with regard to this. UKONS was consulted and contributed to this advice and it is available here: https://www.nice.org.uk/guidance/ng161
2. Palliative Care and COVID
The APC have collated useful online resources to support your palliative care response to COVID-19. This is not an exhaustive list but is selected for important and reliable sources. The UK resources are placed first, and the NICE guidance (see above) is particularly important. International resources are also useful but may be less directly relevant to the UK situation and any medication references will differ of course. https://docs.google.com/document/d/1HR1ulUBbCjlITkuB-sUQJZ90yx9l2v3N_JUqPMm7qpw/mobilebasic
3. Managing Clinical Trials During Coronavirus Pandemic
The Medicines and Healthcare Products Regulatory Agency (MHRA) are adopting a flexible and pragmatic approach, with regard to regulatory requirements for clinical trials during this time. They have recognised that clinical trial resource may be absent or redeployed from research activities and regulatory affairs towards front-line care. Their first priority is the safety of trial participants. This guidance will be updated as the situation changes over time and contains information on pausing clinical trials..https://www.gov.uk/guidance/managing-clinical-trials-during-coronavirus-covid-19
4. Pre-chemotherapy Clinics
Omitting all non-essential hospital visits is a sound principle which has resulted in many hospitals utilising telephone or video-conferenced clinics instead. Specialist cancer nurses are already involved in these clinics and the discussion and outcomes need to be captured and documented accurately.
5. Pre-treatment Consultations
It is important that we continue to support and educate patients starting treatment, to manage their side effects and to report symptoms appropriately to acute oncology services. Pre-treatment consultations can be conducted by telephone or via video link. UKONS have produced a film to support patients and explain the contents of the CRUK ‘Your Cancer Treatment Record' to accompany these consultations. This film can be accessed here https://www.youtube.com/watch?v=16ZIZ3Il6UI&feature=youtu.be
6. Managing Your Mental Health During the Pandemic
The Mental Health Foundation have produced some excellent guidance on how to safeguard your mental health in these trying circumstances. There are some great tips here. https://www.mentalhealth.org.uk/publications/looking-after-your-mental-health-during-coronavirus-outbreak
Macmillan Cancer Support have also produced a list of resources
The NHS are recommending Every Mind Matters https://www.nhs.uk/oneyou/every-mind-matters/.
7. COVID-19 and Pregnancy
Royal College of Obstetricians and Gynaecologists (RCOG) have released advice. This resource provides guidance for healthcare professionals working with pregnant women, but also gives Occupational health advice for employers and pregnant women during the COVID-19 pandemic. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/
8. Advice for Patients on a ‘Grab Bag’ if hospitalised during current crisis.
Following a very recent admission to hospital, one of our board members has produced the following list for our patients who might find themselves admitted during the current situation. Prepare a ‘Grab Bag’ of essential items in case you need to go into hospital. Make sure you take disposal items with you if you have them. Take
Don’t bother taking a towel and best to take disposable slippers that you can discard at the end of the stay.
It is likely, and desirable that you should try and leave hospital as soon as it is safe to get home. Staff will give you advice on this.
9. The Macmillan ‘Cancer and Coronavirus’ page has lots of links and is continuously updated. Macmillan have reconfigured a new page and they will begin to add more tools and resources that professionals can signpost people to. There are also some physical activity videos that are also in place. Available here https://www.macmillan.org.uk/coronavirus
10. Royal College of Radiologists have published advice on radiotherapy and have now supplemented this by giving advice on imaging in the current pandemic. This is available here https://www.rcr.ac.uk/college/coronavirus-covid-19-what-rcr-doing/coronavirus-covid-19-resources/coronavirus-covid-19
All UK Oncology Nurses are currently involved with trying to keep patients safe as they can be from the COVID-19 illness caused by the novel coronavirus. Oncology patients have been recognised for some time as being an ‘at risk’ group and now we are in the position of trying to take steps to protect them. This ‘Top Story’ will take the form of a number of links and resources to try and help us do that. We have worked with Macmillan Cancer Support to collate these resources but there is new material appearing all the time. The most important of these will be circulated by email to try and ensure we keep you as informed as possible
All that remains is for UKONS and Macmillan to thank Oncology Nurses for continuing to work selflessly to protect our patients during this demanding time. We will try and circulate any information we can to help you in your work.