MLTI-04. The Role of the Outpatient Registered Nurse in the care of Brain Metastases

INTRODUCTION: Brain metastases is a complex disease, requiring a skilled clinical team to deliver medical and surgical care. The nurse is an integral member of the interdisciplinary team. Despite this, the role of the nurse in brain metastasis care has been neglected in the literature. Moreover, while education for neurology nursing exists, there is a paucity of literature defining the nursing care specific to brain metastases. The aim of this study was to describe the essential nursing functions in brain metastases within medical and surgical clinics. METHODS: A working-group comprised of 2 registered nurses and a clinical nurse specialist in specialty brain metastases at Memorial Sloan-Kettering Cancer Center was formed. A KSA framework was used to develop a survey to assess nurses’ knowledge, skills, and attitudes regarding care of patients with brain metastases. 2 nurses were surveyed. Oncology nursing competencies were scored by medicine and surgical nurses for importance. Mean scores were calculated and ranked. RESULTS: Nurses consistently reported care coordination; symptom management and monitoring parameters; knowledge of treatment modalities; and referrals as key competencies. More variably endorsed competencies included access devices (implanted port and Omaya); managing immunocompromised patients; and legal issues (consent). The nurses reported important knowledge includes screening and treatment guidelines; epidemiology; disease states including brain metastases and leptomeningeal disease; and tumor histology. Important skills include neurological exam; triage; critical thinking; and patient education. Important attitudes include being empathetic, communicative, positive, truthful, and realistic. CONCLUSION: As the care of the patient with brain metastases evolves, interdisciplinary clinical practice models with advanced nursing training must occur. As the repertoire of clinical trials for patients with brain metastases continues to expand, future studies should assess the effects of specialized nursing training on clinical outcomes in patients with brain metastases.