Posted 31 October 2019 - 11:00
Posted 31 October 2019 - 11:00
Features
A day in the life of a clinical research nurse
By sharing their work diaries, three cancer clinical research nurses offer an insight into the challenges and rewards of the role
By sharing their work diaries, three cancer clinical research nurses offer an insight into the challenges and rewards of the role
- Clinical research helps find new treatments and improve outcomes
- Cancer clinical research nurses are at the forefront of the delivery of clinical trials
- They also play a vital role in supporting patients and being their advocate
Clinical research plays a crucial role in finding new treatments and improving patient outcomes and standards of care.
At the forefront of this process are clinical research nurses, who undertake research through the delivery of clinical trials.
They are directly involved in the patient care pathway, playing an important role as the patients advocate, ensuring their safety and supporting them throughout their time on the clinical trial.
By sharing their work diaries, three cancer clinical research nurses offer an insight into the challenges and rewards of the role
- Clinical research helps find new treatments and improve outcomes
- Cancer clinical research nurses are at the forefront of the delivery of clinical trials
- They also play a vital role in supporting patients and being their advocate
Clinical research plays a crucial role in finding new treatments and improving patient outcomes and standards of care.
At the forefront of this process are clinical research nurses, who undertake research through the delivery of clinical trials.
They are directly involved in the patient care pathway, playing an important role as the patient’s advocate, ensuring their safety and supporting them throughout their time on the clinical trial.
Here, three such nurses offer an insight into their careers – the high points, the challenges and the importance of a role that plays an integral part in finding new treatments.
Diary One:
Suriya Kirkpatrick is a senior cancer research nurse and genomics practitioner based at Southmead Hospital, North Bristol NHS Trust, Bristol
Picture: Jon Rowley
7.45am My day begins early in the office before the rest of the team arrive. I use the time to try and catch up on some management and administrative tasks.
8.30am Greet the team and make sure everyone is happy with their allocation and clinical commitments for the rest of the week. Any concerns are addressed.
9.30am Carry out an appraisal for our trial administrator and agree a development plan.
11.45am Return missed call from a patient with bowel cancer who recently consented to a bowel sparing study looking at surgery versus radiotherapy or a combination of radiotherapy and chemotherapy (STAR TREC trial). She pulled the chemo radiation arm and is due to start treatment in a couple of days. She is anxious and is having second thoughts. I reassure her that participation in a clinical trial is voluntary, reminding her that she can withdraw at any time and choose to have the surgery. We end the call with her acknowledging her anxious feelings but feeling reassured. I also remind her she can come back to me with any further questions or call her cancer nurse specialist (CNS) if she needs further support.
12.30pm I go to the haematology clinic to meet a research participant and his daughter.
‘She is anxious and is having second thoughts, and I reassure her that participation in a clinical trial is voluntary’
I begin by thanking the patient for consenting to take part in a study, however explain that he is no longer eligible to continue on the study and explain why that is.
1.10pm I meet briefly with the pharmacist to discuss prescriptions for new studies opening in haematology. We discuss how and when these will be built into chemocare, our electronic prescribing system, and agree a date for review.
1.30-2pm Lunch and catch up with the rest of the team.
2-4pm Attend nurse-led trials clinic. See patients at different stages of their myeloma for follow up on a variety of trials. Work closely with the consultants, CNSs and chemo nurses to ensure adherence to trial protocol and to identify potential new patients who are eligible. One of the patients is recruited onto an observational commercial trial – I celebrate them being the first UK patient recruited to it.
Diary Two:
Amy Kirkby is a cancer research nurse at the Lincolnshire Clinical Research Facility at the Pilgrim Hospital in Boston, Lincolnshire
8.45am Urgent emails are attended to and requests that can be delegated are forwarded to the research assistants.
10am Telephone follow-ups completed for three patients taking part in a commercial breast cancer trial. Patients are assessed for signs and symptoms of breast cancer recurrence, such as any breast changes or changes to appetite, weight loss or new pains.
Information gathered on any adverse events experienced since their last assessment, any changes to their medication and compliance with endocrine therapy assessed.
One patient doesn't seem like her usual self. When I gently mention this to her, she breaks down. She says she has been under a lot of stress, is struggling to cope and feels the enormity of her diagnosis and treatment journey are now affecting her too.
I offer reassurance, empathy and guidance. She had previously seen the hospital counsellor so I encourage her to make another appointment. At the end of the call she says she feels relief that her feelings have been validated – this may not be part of the trial protocol requirements, but it is part of being a cancer research nurse.
11am A much-needed cup of tea after the telephone follow-ups. Then on with the documentation: all trial follow-up information must be appropriately recorded in the medical notes, as it constitutes source data. Then I update our trial database and log the visit in our local portfolio management system and tool for tracking visits to ensure appropriate financial management.
12pm Preparation for trial monitoring visit. A clinical research associate from the breast cancer study sponsor is coming later in the week for a monitoring visit, to check that the relevant regulatory and ethical approvals and associated documentation are present and correct. He will then compare the source data, such as medical notes, with the information recorded on the study database to quality check the data submitted.
‘One patient doesn't seem like her usual self, and when I gently mention this to her she breaks down’
1pm I attend the breast multidisiplinary team (MDT) meeting. Breast surgeons, radiologists, CNSs and the MDT coordinator discuss results of all recent breast imaging and biopsy results to plan the interventions needed. I also highlight patients who are potentially eligible for any clinical trials we have open to recruitment, and we discuss when best to introduce the clinical trial to the patient.
It is imperative to introduce the concept of a clinical trial as early as possible so the patient can make a fully informed decision. However, the immediate appointment where they receive their postoperative histology results and adjuvant treatment plan is a time when they receive a huge amount of information, so it is important to be mindful of information overload.
If a patient is eligible for a trial that would begin after completion of chemotherapy, then it is preferable to introduce the study during the chemotherapy treatment period.
2pm New ovarian cancer clinical trial introduced and discussed with a medical oncologist.
2-4.15pm Research nurse-led clinic conducted in the consultation room within our department for the Add Aspirin clinical trial, which is assessing the effects of aspirin on disease recurrence and survival in common solid tumours.
Four patients are seen, weight and blood pressure recorded, recent blood results reviewed, compliance with trial medication assessed, concomitant medication reviewed along with the need for any of the medications restricted during the trial protocol. Aspirin-related toxicities recorded and graded. Next supply of trial medication issued if appropriate, along with blood request form for next visit. Next consultant appointment confirmed.
Diary Three:
Laura Kusyk is a senior paediatric oncology research nurse at the Royal Manchester Children’s Hospital
8am I start by checking emails. Each morning we receive a list of patients on oncology and outlying wards. I check the list for patients on trial and for any serious adverse events that may need to be completed and sent to the study sponsor. As a team we discuss the diary for today and highlight any potential challenges.
8.30am Today we are recruiting a new patient to a phase 1 study. I sit in on a consultation with the principle investigator to support the patient. The family has previously been given study information, so they are invited to ask questions and then sign informed consent.
Screening bloods and assessments are completed, with the patient sent to relevant departments for more tests, such as an echocardiogram. I then take the bloods to the laboratory, processing the samples to obtain plasma and store in our study freezer. The patient has been having issues with feeding and appetite, so I complete a referral and contact the dietitian for input.
11am A patient with a brain tumour on a phase 3 study has a central line insertion and lumbar puncture in theatre. I am called to theatre, as cerebrospinal fluid is needed for diagnostic and trial purposes. I assist with the lumbar puncture and retrieve the specimen to the histopathology department.
‘No two days are the same, which is one of the reasons I love my job’
I also take some of the trial specimen to our lab to store in the freezer, ready to be requested for the sponsor. I then give the sample forms from these samples to the phase 3 clinical trials coordinator.
12pm A courier collects blood plasma samples from a pharmacokinetic study. These need to go to Newcastle to test drug concentrations in blood samples taken over time. Results will be sent back to us in a few weeks, which the team will use to dictate new doses of chemotherapy. I have lunch.
1pm A patient on a phase 1 study arrives for their weekly dosing of the novel drug on our day-case unit. I perform assessments and take bloods, then sit in while the patient is reviewed by the principal investigator to assesses any adverse events and perform a physical exam. Once ready from pharmacy, the treatment is given over one hour under the care of the research team.
2pm Time for the MDT weekly meeting, which reviews the ward and any outlying patients. We review patients both on and off study, which is an important opportunity for us to highlight any potential issues, flag any opportunities and ask questions.
3pm Back at my desk I listen to a voice message from a parent of a patient on a study. I call them back to discuss an end of cycle scan that had been booked for early in the morning. This is inconvenient as the family live far away, so I liaise with radiology and the booking team to see about changing the slot.
3.10pm In my final hour of the day I enter visit data on electronic case report forms. I action urgent queries and make a plan to revisit other queries during the week ahead. Finally, as a team, we manage to fit in a quick handover to reflect on the day and identify important points for the next working day.
4.10pm I leave the hospital to walk to the car park. Driving home, I am able to reflect on the successes and challenges of my day. No two days are the same, which is one of the reasons I love my job.
Are you a clinical research nurse? Enter the RCNi Nurse Awards today
Cancer Research UK is supporting the Excellence in Cancer Research Nursing category at this year’s RCNi Nurse Awards. This award recognises and celebrates the amazing contribution of clinical research nurses who deliver cancer research through patient-facing cancer clinical trials. It is open to all clinical research nurses who work on clinical trials in cancer and have demonstrated excellence through their delivery of high-quality cancer research to patients on clinical trials, improving their outcomes and experience.
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