{"paper_id":"ce51f39e-4fd6-43b0-81ed-125f59951c2b","body_text":"Obstet Gynecol Res 2018; 1 (2): 028-032                                   DOI: 10.26502/ogr005  \nObstetrics and Gynecology Research - Vol. 1 No. 2 - Jun 2018.  28  \nResearch Article \nNurse Led Follow Up:  Is It The Best Way Forward for Post-\nOperative Endometriosis Patients? \n \nR Mallick*, Z Magama, C Neophytou, R Oliver, F Odejinmi \n \nBarts Health NHS Trust, Whipps Cross University Hospital, London, UK \n \n*Corresponding Author: R Mallick, Barts Health NHS Trust, Whipps  Cross University Hospital, London, UK; \nE-mail: rmallick@doctors.org.uk  \n \nReceived: 03 April 2018; Accepted: 09 April 2018; Published: 12 April 2018 \n \n \nAbstract \nThe benefits of nurse led follow-up are well documented in the wider literature and include higher patient \nsatisfaction rates, improved information delivery and quicker discharge rates. Unfortunately there is a paucity of \ndata when it comes to benign gynaecology and the aim of  this study was to establish the efficacy of outpatient \nservices offered by an endometriosis specialist nurse compared to standard medical follow up in women undergoing \noperative laparoscopy for severe endometriosis. Outcome measures included both patient satisfaction and the \nduration of follow-up until discharge. Our findings highlight that a nurse led service is highly acceptable to patients \nand leads not only to higher satisfaction rates, but also a reduced duration of follow-up resulting in a significantly \nmore cost effective service without any detriment to the patient. \n \nKeywords: Endometriosis; Nurse \n \n1. Introduction \nEndometriosis remains a challenging condition to manage and ideally patients with severe endometriosis should be \nmanaged in a tertiary referral BSGE (British Society for Gynaecological Endoscopy) centre where they will have \naccess to a more holistic and multi-disc iplinary approach to th eir care including contact with an endometriosis \nclinical specialist nurse (CNS).  \n \nThe benefits of a nurse led service are numerous and widely documented in the literature, particularly in the medical \nsetting [1-3]. However when it comes to  benign gynaecological conditions and specifically endometriosis, there is a \n\nObstet Gynecol Res 2018; 1 (2): 028-032                                   DOI: 10.26502/ogr005  \nObstetrics and Gynecology Research - Vol. 1 No. 2 - Jun 2018.  29  \npaucity of data. The role of the endometriosis nurse is not only invaluable in the early stages of diagnosis and \nmanagement, particularly with regards to patient support and counselling [4, 5], but they also play a fundamental \nrole in the post-operative period supporting the patient, offering them a readily available port of call and taking them \nthrough the treatment pathway to a successful discharge. In this day in age of non-team based medical training, it is \nvery rare for the patient to be seen by the same junior medical member of staff and t hus the continuity of care a \nendometriosis nurse offers is invaluable.  \n \nThe aim of this study was to establish the efficacy of outpatient services offered by an endometriosis CNS, \ncompared to standard medical follow up, in women undergoing operative laparoscopy for severe endometriosis \nassessing both patient satisfaction and the duration of follow-up until discharge. \n  \n2. Materials and methods \nA prospective cohort study was undertaken on women undergoing operative laparoscopy for severe endometriosis \nand receiving outpatient follow-up led by  either a CNS or a gynaecology specia list registrar. The primary outcome \nwas patient satisfaction levels, with the secondary outc ome being the duration of follow-up until discharge from \noutpatient endometriosis services. The inclusion criteria were duration of symptoms for over 6 months prior to \nsurgery and the presence of severe endometriosis (stage 3 or 4) diagnosed during laparoscopy. \n \nPatients were asked to complete a Likert satisfaction scale 3 months post-operatively, after having received regular \noutpatient clinic follow-up. The BSGE pelvic pain questionnaire was used to collect information on the severity of \nsymptoms, previous treatment and quality of life before ope rative laparoscopy, as well as 6 months and 1 year post-\noperatively. The duration of outpatient clinic follow-up, from the time of operation until complete discharge from \nclinic, was also recorded.  \n \n Data is presented as the mean+/-s tandard error of the mean (SEM). All data was normally distributed and \ncomparison between the 2 groups was undertaken using the unpaired t-test. The threshold for statistical significance \nwas set at p<0.05. The data was analysed using Prism software (version 7).  Ethical approval was sought but not \nrequired, as this was a review of clinical services. \n \n3. Results \nA total of 74 women were included in this cohort study. 50 women received outpatient clinic follow-up by the CNS \nand twenty-four by the gynaecology registrar. Baseline characteristics were comparable between the two groups. No \nstatistical difference was detected be tween the two groups in the reporting of  symptoms, severity of disease or \nquality of life before operative laparoscopy or at 6 months and 1 year post-operatively. More than 95% of patients in \neach group underwent a one-stage procedure with recto-vaginal resection. The rates of post-operative complications \nwere comparable between the two groups.  \n \n\nObstet Gynecol Res 2018; 1 (2): 028-032                                   DOI: 10.26502/ogr005  \nObstetrics and Gynecology Research - Vol. 1 No. 2 - Jun 2018.  30  \nThe mean overall satisfaction rate as reported by patients on a Likert satisfaction scal e was 8.0±0.2 and 5.3±0.5 out \nof a maximum of 10 for the CNS and registrar groups respectively (p <0.05) (Figure 1). The average duration of \nfollow-up from the time of operation to complete discharge from outpatient endometriosis services was 29.0±3.3 \nand 44.8±7.8 weeks for the CNS and registrar groups respectively (p<0.05), accounting for a 1.5 times earlier \ndischarge for patients followed-up by the CNS (Figure 2).  \n \n \n  \nFigure 1: Overall satisfaction scores \n \n \n  \nFigure 2: Duration of follow-up from operation to discharge \n \n4. Discussion \nOur findings highlights that follow up of patients with severe endometriosis by a CNS is not only acceptable to \npatients, but patients tend to prefer this with higher satisfaction rates recorded when compared to standard follow up. \n\n\nObstet Gynecol Res 2018; 1 (2): 028-032                                   DOI: 10.26502/ogr005  \nObstetrics and Gynecology Research - Vol. 1 No. 2 - Jun 2018.  31  \nAlthough data in an endometriosis setting is limited, thes e high satisfaction rates are well documented in the wider \nliterature from a multitude of medical settings [2, 4, 6]. Furthermore a randomized controlled trial by Dawes et al. \nwhich compared specialist nurse support ed discharge with routine hospital care in a benign gynaecological setting \nfound a significantly reduced post-operative length of hospital stay, improved information delivery and patient \nsatisfaction in the specialist nurse group [7]. \n \nThe patients undergoing nurse led follow-up were also discharged quicker, making the service more cost effective. \nAlthough carried out in a different setting this compares fa vourably with the findings of Graham et al, who found \nthat following day case laparoscopic surgery patients in the nurse led discharge group were much likely to be \ndischarged quicker than in the doctor led group [8].  \n \n5. Conclusion \nEndometriosis is a challenging condition to manage and patients benefit significantly from a holistic \nmultidisciplinary approach with early input and support from an endometriosis CNS. Post-operatively developing a \nservice allowing these patients to be followed up by the CNS facilitates an extension of the continuity of care and \nresults in higher satisfaction rates and reduced duration of follow-up resulting in a significantly more cost effective \nservice without any detriment to the patient.  \n \n6. Declaration of interest \nThe authors declare that there is no conflict of interest regarding the publication of this article. \n \nReferences \n1. Moore S, Corner J, Haviland J, Wells M, Salm on E, Normand C, et al. Nurse led follow up and \nconventional medical follow up in management of patients with lung cancer: randomised trial. BMJ 325 \n(2002): 1145. \n2. Lewis R, Neal RD, Williams NH, Fr ance B, Wilkinson C, Hendry M, et al. Nurse-led vs. conventional \nphysician-led follow-up for patients with cancer: systematic review. J Adv Nurs 65 (2009): 706-723. \n3. Laurant M, Reeves D, Hermens R, Braspenning J, Grol R, Sibbald B. Substitution of doctors by nurses in \nprimary care. Cochrane Database Syst Rev 2005 (2): Cd001271. \n4. Courtenay M, Carey N. The impact and effectiveness of nurse-led care in the management of acute and \nchronic pain: a review of the literature. J Clin Nurs 17 (2018): 2001-2013. \n5. Cambitzi J, Nagaratnam M. Endometriosis-associat ed pain syndrome: a nurse-led approach. British \nJournal of Pain 7 (2013): 31-38. \n6. Hill J. Patient satisfaction in a nu rse-led rheumatology clinic. Journal of Advanced Nursing 25 (1997): \n347–354. \n7. Dawes HA, Docherty T, Traynor I, Gilmore DH, Ja rdine AG, Knill-Jones R. Specialist nurse supported \ndischarge in gynaecology: A randomised comparison and economic evaluation. European Journal of \n\nObstet Gynecol Res 2018; 1 (2): 028-032                                   DOI: 10.26502/ogr005  \nObstetrics and Gynecology Research - Vol. 1 No. 2 - Jun 2018.  32  \nObstetrics & Gynecology and Reproductive Biology 130 (2007): 262-270. \n8. Graham L, Neal CP, Garcea G, Lloyd DM, Robertson GS, Sutton CD. Evaluation of nurse-led discharge \nfollowing laparoscopic surgery. Journal of Evaluation in Clinical Practice 8 (2012): 19-24. \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nThis article is an open access article distributed under the terms and conditions of the\n  Creative Commons Attribution (CC-BY) license 4.0 \nCitation: R Mallick, Z Magama, C Neophytou, R Oliver, F Odejinmi. Nurse Led Follow Up:  Is It The Best Way \nForward for Post-Operative Endometriosis Patients?. Obstetrics and Gynecology Research 1 (2018): 028-032.","source_license":"CC0","license_restricted":false}