Conscious that patients on oral anti-cancer medicines can spend many hours on crowded day wards over the course of a year as they come in every month to renew prescriptions and for assessments, they set about devising a trial that could make their treatment less hospital-based.

The idea they struck upon was to take a trial group of patients off the day ward from their second or third cycle of treatment onwards, and follow them outside of that setting as they continue to self-administer their medicines at home.

Patients would be supported through telephone consultations following an initial face-to-face  appointment at her office in Letterkenny University Hospital, and would periodically attend for physical examinations and assessments throughout their treatment.

Working in partnership with Prof Andrew Murphy, Director of the Health Research Board (HRB) Primary Care Clinical Trials Network Ireland, and Dr Patrick Murphy the team successfully applied for the Cancer Nursing Research Award 2021 - an initiative aimed at stimulating nurse-led research and promoting partnerships between clinicians and academics which is funded by the Irish Cancer Society in collaboration with the HRB, the National Cancer Control Programme and the Office of the Nursing and Midwifery Serviced Director.

Urgent solution

With the project commencement date looming and all the planning in place, the trial would in fact go on to become an urgent service solution with the onset of the pandemic.

“I had planned to only take a small cohort of patients on oral anti-cancer medications out of the oncology day ward for the research, but when Covid-19 hit I was asked to take them all out and that’s what we did,” she recalls.

'Stepping outside the box'

Richmond says initial feedback from patients involved in the model has been positive and that the support of the Society, made possible through funds raised from events including by Donegal Relay for Life, was invaluable even as the official project start date moved from April to September in the circumstances.

“I often think about stepping outside the box - not everything has to be done the way it always has been. Particularly with regard to oral medications, they can revolutionise our approach to cancer care yet day units are often still at capacity, patients still wait for a long time and in fairness this isn’t unique to Ireland, so the challenge is trying to think if there’s a better way of doing this.

“Research helps us step back and ask the big questions: what are we doing and for what benefit? Having the research award gives you time to stand back, analyse and think about how we can make services better.

“The Irish Cancer Society were very supportive and have worked with us on the unprecedented delays, so our funding is secure and there were no negatives from the situation.

“With my clinical nurse manager colleagues Mary Grace Kelly and Alison Johnston along with all the rest of the team members we’re now moving on at pace with the research and we’re still hopeful that we’ll come in around the timeline initially laid out for it.”