Nurse led telephone contact facilitating “virtual” lung cancer clinics reduces outpatient attendances and maintains patient satisfaction

UK lung cancer targets mandate that initial treatment is given within 62 days of referral. In 2020 the target will be tightened with diagnosis, staging and a treatment decision for 95% patients expected within 28 days. Investigations post- CT are traditionally arranged after patients attend a specialist clinic. Local audit of pathway delays showed this can prolong the investigation pathway. Following audit, we implemented a new diagnostic pathway for lung cancer. This introduced daily virtual clinics to review CT scans and clinical details and to arrange appropriate investigations including PET CT, full lung function tests and the most appropriate invasive biopsy. Patients are contacted by specialist nurses via telephone prior to their OPD appointment to schedule and explain these investigations. Audit showed implementation led to a reduction in mean OPD attendances from 2.4 to 1.75 and improvement in compliance with national targets. Given the sensitive potential diagnosis, we wanted to assess patient satisfaction with primary telephone contact. We undertook a postal survey of patients diagnosed post-implementation. 38 questionnaires were sent with 18 responses. 100% of responding patients were happy to have been investigated in this way. 77.7% were already aware of the possibility of a cancer diagnosis from primary care. Specific feedback showed no concerns and expressed reassurance with communication and speed of investigations. Conclusion: Patients report positive experience when first specialist contact is via telephone to facilitate early diagnosis in the setting of lung cancer and virtual clinics reduce total outpatient clinic attendances.