No abstract

Nursing literature regarding cholangiocarcinoma is scarce. Studies that focus on nursing care, symptom management, and nursing management of patients with biliary obstruction are needed. Nutrition and palliative care management of patients with cholangiocarcinoma are key areas of nursing management.

Background: Patients with cholangiocarcinoma often have indwelling biliary stents or catheters which are prone to obstructions and/or infections; studies show that 20–40% present with fever and/or jaundice requiring urgent treatment in the outpatient setting for which there are no uniform guidelines. The goal was to develop an expert panel consensus on this topic using the modified RAND/UCLA Delphi process to rate treatment appropriateness. Methods: Thirteen expert physicians from relevant specialties, geography, and practice settings were recruited for the panel. Patient scenarios were developed and panelists rated the therapies before and after a face-to-face discussion. The appropriateness of various therapies was rated on a scale from 1–9 and classified as appropriate, inappropriate, or uncertain. Scenarios with greater than 2 (>2) ratings of 1–3 (inappropriate) and greater than 2 (>2) ratings of 7–9 (appropriate) were considered to have disagreement and were not assigned an appropriateness rating. Results: Panelists were from all US regions and the UK (8%) and had practiced for a mean 16.5 years (4–33 years). Panelists rated 480 scenarios before the meeting and re-rated 288 of the clinical scenarios after the meeting. The panelists agreed that ongoing treatment with chemotherapy did not influence decision-making and, therefore, 192 scenarios were excluded from the final list. Disagreement decreased from 37.5% before to 10.4% after the meeting. Consensus on stent/tube manipulation and inpatient antibiotic therapy was obtained and summarized in patients as “appropriate” or “maybe appropriate” based on a patient’s bilirubin level at presentation. Conclusions: The Delphi process produced consensus guidelines to fill an unmet need in the urgent management of ascending cholangitis in patients with cholangiocarcinoma.

Background: Biliary obstruction often occurs with hepatobiliary cancers. Treatment consists of internal biliary stents or external biliary drains. Patient education regarding signs and symptoms of cholangitis, change of stents, or care of biliary drains is both critical and challenging. The Nursing Advisory Board of the Cholangiocarcinoma Foundation (CCF) found patient questions regarding stents and drains posted on the CCF website. Quality of life is impacted by treatment complications as well as lack of knowledge regarding living with stents or drains. Aim: To compare stent and biliary drain patient education practices of NCCN Member Institutions across the United States. Methods: A 40 item information survey was sent to the NCCN Member Institutions by email. Intended respondents were nursing or health professionals who provided patient instruction regarding biliary stents drains. The survey was sent to interventional radiology and endoscopy departments. It included questions regarding demographics of respondents, patient education and instructions, supplies provided, signs and symptoms to be reported, and follow-up appointments. Results: There were 26 survey responses. Of the 26 responses, 23 responses were complete. Patient education regarding stents or drains was predominantly completed by registered nurses (74%), or nurse practitioners (26%). The largest number of respondents practiced in interventional radiology (52%), endoscopy (13%), and other (30%), which included gastroenterology, or surgery. Verbal and written instructions were provided by 87% of NCCN centers. There was variation in survey responses regarding biliary drains. Survey responses regarding biliary stents were more cohesive. A schedule for stent change was provided by 75% of NCCN Member Institutions, although there was variation on length of time between stent exchanges. The majority of patients at these institutions receive education regarding signs and symptoms to report (95%). Conclusion: Discharge instructions to patients with external drains are inconsistent. Although there is some agreement among NCCN Member Institutions, the schedules for stent change vary. Patient education and instruction is predominantly provided by nurses and NPs. The importance of teaching signs and symptoms to report is evident in this sample. Standardized patient instructions post stents or external biliary drains may enable patients to care for drains and will help nurses and NPs reinforce consistent education.

e15641 Background: CC pts with biliary stents or catheters are prone to have obstruction/infection and studies show 20-40% present with fever/or jaundice requiring urgent treatment for which there is no uniform guideline. We aimed to develop an expert panel consensus on this topic using the modified RAND/UCLA Delphi process to rate treatment appropriateness. Methods: We recruited 13 physician experts from relevant specialty, geography, and practice settings. Patient scenarios were developed and panelists rated the therapies before and after a face-to-face discussion. The appropriateness of various therapies was rated on a 1-9 scale and classified as appropriate, inappropriate, or uncertain. Scenarios with > 2 ratings of 1-3 (inappropriate) and > 2 ratings of 7-9 (appropriate) were considered to have disagreement and were not assigned an appropriateness rating. Results: Panelists were from all US regions (92%) and the UK (8%); had practiced for a mean 16.5 years (4-33 years). Panelists rated 480 scenarios before the meeting, but re-rated only 288 clinical scenarios as they felt that ongoing treatment with chemotherapy did not influence decision-making. Disagreement decreased from 37.5% before the meeting to 10.4% after. Consensus statements are summarized in the table below. Conclusions: The Delphi process produced consensus guidelines to fill an unmet need in urgent management of ascending cholangitis in pts with CC. (Support: The Cholangiocarcinoma Foundation). [Table: see text]