Metastatic breast cancer nurse training program

Gillian Kruss is a metastatic breast cancer nurse practitioner at Monash Health and the Chief Clinical Lead for Education at McGrath Foundation.

‘Rosie’ is a telepresence robot that assists with delivering a metastatic breast cancer nurse training program (MBCNTP) onsite at health services during COVID. The MBCNTP is an idea that I've had in mind for years. It was only when I collaborated with organisations that we were able to assemble a dynamic team to develop he MBCNTP and associated research. We didn’t initially envisage that we would be including telepresence robots into the design.

The project is a collaboration between Monash Health, McGrath Foundation (MF), Southern Melbourne Integrated Cancer Service (SMICS) and Monash University. I originally thought of the idea of a MBCNTP in 2016, after a SMICS consumer recognised as far back as 2012 there was a gap. They observed patients with early breast cancer were getting a lot more support from the breast care nurses (BCNs) than those with metastatic disease. It has since been identified globally that many of those with metastatic breast cancer (MBC) have unmet complex supportive care needs and a high level of distress associated with having an incurable illness.

So, we knew this group of consumers needed better supportive care. The MF and Breast Cancer Network Australia subsequently lobbied the federal government to receive funding for 30 MBC nurses in 2019. We now have 170 MF-funded BCNs in Australia. Twenty-two of these are dedicated MBC nurse positions. We recognised that there was a need to train these nurses as it requires specialised knowledge, skills and confidence to work with those with MBC.

As Monash Health has been identified as an organisation that has an ideal model for MBC nurses, we thought this was the best venue to facilitate upskilling nurses who work with MBC patients. We assembled a working party between the four organisations and thought about how we could design this MBCNTP. We developed 20 modules, or elements of practice, identified as critical for MBC nursing for nurses to access on the McGrath Foundation portal.

The design of the MBCNTP follows a prepare, explore and apply model whereby nurses prepare by completing specific modules. Then, in pre-COVID times they would have had three days of practical experience onsite at Monash Health. They then return to their workplaces to apply what they have learnt while being supported with bimonthly clinical supervision (CS) for a year. During CS, they can discuss any barriers to integrating what they've learned, or any tricky cases they may have encountered.

Then, COVID happened. Initially we thought, ‘We can't get these nurses across the borders during lockdowns, let alone through the front door of the hospital.’ We had to think of an innovative way to safely run this training program as we originally designed. We tossed around ideas such as using a GoPro, or virtual reality glasses to enable nurses to view the clinical areas remotely, but quickly realised that the nurses needed to be able to interact with clinicians and patients. So, we thought, ‘How about a robot that can follow us around in the hospital?’

Rosie the Robot is named after the robot in The Jetsons and looks like an iPad on a Segway. The iPad provides the nurse with a 180-degree view of the clinical areas. Feedback so far from participating nurses is that they felt like they were present in the room. The nurse’s face is displayed on the iPad [like a Zoom meeting] so patients and clinicians can interact with them and the nurses can talk and hear. Originally, we were going to control the robot’s movement from our end but we found the Wi-Fi wasn’t strong enough to have another person connected. Interestingly, what we thought would be a problem has increased the nurses’ sense of being present and in control. The nurses have found the app or keyboard control system very intuitive to use to drive the robot.

The robot so far has enabled the trainee nurses to remotely listen in on the palliative care handover and then participate in the oncology ward round. Nurses have been given a tour of the onsite cancer services such as the radiotherapy and chemotherapy centres, the pharmacy and so on. The nurses have been able to remotely participate in the MBC multidisciplinary team meeting and then visit the MBC clinic to sit in on telehealth or face-to-face consultations with the clinician and the patients. The robot can just sit beside the clinician and allow the nurse (who may be located in regional Victoria or interstate) to safely observe and interact during the consultation from the comfort of their home or workplace.

Everyone's quite excited. Both clinicians and patients find a degree of novelty in it. It's becoming a common sight around Moorabbin Hospital where I work. People are used to seeing the robot following me around and visitors often stop and talk to the nurse inside the robot. I think this initiative has opened up many possibilities. A clinician could do a ward round remotely via the robot if there is good Wi-Fi, or patients and visitors could come and tour the hospital remotely via the robot. We're researching the effectiveness of using the robot to find out if it is an equivalent method of delivering this MBCNTP compared to having the nurse participate in-person.