(PA-129) Co-designing an Implementation Strategy for a Nurse and Pharmacist-led Intervention Addressing the Long-term Needs of Patients Living with Multiple Myeloma (MM)

People living long-term with myeloma are at an increased risk of cardiovascular disease, secondary primary malignancies, infections, and age-related health issues. The aim of this study is to apply implementation science methods to co-design and develop a strategy for embedding a nurse and pharmacist-led intervention into routine follow-up care for people living with MM in preparation for a pilot feasibility study.

Methods:

A qualitative study was conducted to inform the development of an implementation strategy for a nurse and pharmacist-led intervention addressing the long-term needs of people living with MM. The first phase involved co-designing the intervention with key stakeholders. Three focus groups were conducted with 14 multidisciplinary participants, including clinicians and service administrators from the multiple myeloma (MM) service. Data were analysed using a deductive approach, guided by the Action, Actor, Context, Target, and Time (AACTT) framework. This framework was used to map existing care pathways and specify preferred implementation strategies, including ‘who’ should perform specific actions, ‘what’ they should do, ‘when’ and ‘where’ it should occur, and ‘to whom’ it should be directed.

Results: Participants identified changes required to embed the intervention into routine follow-up care.  The haematologist was identified as a key stakeholder of the MM team to introduce the intervention to the patient. Patients who were greater than 3 months into maintenance treatment and with stable disease were identified as eligible for the intervention. A referral was generated by the haematologist to the MM specialist nurse who triaged the referral and requested the administration team to book consecutive pharmacist and nurse clinic appointments.  Patient reported outcome measurements (PROMs) including MYPOS, Brief Fatigue Inventory and COST FACIT 2, were sent to the patient by the MM specialist nurse 1 – 2 weeks prior to the clinic appointment. The pharmacist-led review involved a comprehensive medication review including assessing supportive care prescribing, drug interactions, patient adherence and symptom management, as well as supporting medication management and education. The nurse-led review undertook a comprehensive health assessment informed by the PROMs and with a distinct survivorship focus including adherence to vaccination, recommended cancer prevention screening, modifiable cardiovascular risk factors and promoting healthy lifestyle behaviours.  A care plan was developed with a set of recommendations which was sent to the patient, their GP, the haematologist and other health care providers involved in patient’s care.

Conclusions: This implementation strategy provides a systematically structured approach to delivering an intervention that is aligned with what is acceptable and feasible for clinicians in the MM team; and offers an assessment of the long-term needs of patients living with MM