NSP-10: Addressing the complex care needs of the individual with Multiple Myeloma (MM) and their family: contribution of advanced practice myeloma nurses

Introduction: Australia has the highest incidence of multiple myeloma (MM) internationally, with a projected increase of 42% by the year 2040. This projected increase combined with changes to approaches to treatment, management of associated toxicities, in a predominantly older patient cohort has highlighted a need to examine new approaches to the delivery of care for this incurable disease. To inform the development of new models of care delivery, a MM Specialist Group commissioned the development of a White Paper.

Methods: A systematic review of advance nurse practice roles in cancer and haematology was undertaken. Indepth interviews with haematology health care professionals (HCP) explored their perspective of gaps in current delivery of care models, potential approaches to address these, and current challenges in delivery clinical MM care. Fifteen haematology medical and nursing specialists participated in the telephone interviews. These were thematically analysed.

Results: Systematic review of studies of advanced practice nurse (APN) roles consistently report positive findings. Studies focused on three areas: comparison of medical versus nurse delivery of care (replacing component of a medical role); development of new nursing role to improve patient outcomes; and nurse led models of care. While the quality of the research was variable, studies consistently report positive findings in support of APN roles benefiting patient outcomes and improved service delivery. Improvements were reported in patient symptom management, emotional wellbeing, being informed, earlier referral to palliative care, increased communication with primary care. The review highlighted the need to establish consistent nomenclature and scope of nursing practice in line with APN roles. Interviews with stakeholders highlighted the perception addressing the increasingly complex nature of MM patients, treatment optimization needed to be a priority, and that currents service delivery approaches were not designed or resourced to meet the increasingly complexity associated with the care of those impacted by MM. HCP identified the heterogeneous and unpredictable nature of the disease establishing MM as a complex disease to treat with transition to lifelong active treatments, a compounding toxicity profile, and comorbidities associated with an older population.

Conclusions: Drawing on these findings the patient centred Model for Complex Myeloma Care incorporates components to optimize care; MM supportive care, tailored education, advocacy, coaching, access, assessment, and monitoring been developed. The MM White Paper recommends establishment of MM specific APN roles to provide tailored specialist care and need for service planning to address the growing incidence in MM. Further exploration of older MM specific needs as recommended, and this work is currently underway.