Evaluation of a nurse-led telephone clinic in the follow-up of patients with malignant glioma

The aim of this study was to evaluate nurse-led telephone follow-up (NTF) f or patients with high-grade glioma as an alternative to conventional clinic follow-up (CCF) and to assess patient satisfaction with this approach. Patients who were completing primary therapy for high-grade glioma and were suitable for CCF were offered the alternative of nurse-led telephone follo w-up. NTF was arranged by the nurse at mutually agreed times. Assessment wa s by open discussion and a semistructured questionnaire, together with the Barthel Activities of Daily Living Index. Formal medical assessment in the clinic was arranged at LC-month intervals or earlier if indicated. Twenty-t wo patients were asked to complete a satisfaction questionnaire. Between February 1996 and October 1997, 43 patients with high-grade glioma, one with primitive neuroectodermal tumour and one with oligoastrocytoma ag reed to be monitored by NTF. Their median survival from diagnosis was 16 mo nths (95% confidence interval 13-23 months). At the time of analysis, the m edian time of follow-up by the telephone clinic was 6 months (range 2-21), with symptomatic progressive disease the reason for discontinuation of NTF in all patients. Two-hundred and fifty-four telephone calls were made, of w hich 234 were routine and 20 non-routine, being initiated by the patients o r their carers. NTF was considered as a sufficient replacement for CCF duri ng the stable phase of the disease. There were 41 unscheduled clinic visits , of which 31 were at the time of progression and usually initiated at NTF. The majority of unplanned visits were due to a change in symptoms and woul d not have been avoided with CCF carried out at the same time intervals. Pa tient satisfaction was high, with a median satisfaction score of 9, (range 3.6-10) on a scale of 0-10. NTF provides an alternative approach to conventional hospital attendance an d moves the emphasis away from cancer surveillance to a more patient centre d supportive model. It can be carried out without apparent detriment to the patient and is associated with high satisfaction rating.