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Hart NH, Crawford-Williams F, Crichton M, Yee J, Smith TJ, Koczwara B, Fitch MI, Crawford GB, Mukhopadhyay S, Mahony J, Cheah C, Townsend J, Cook O, Agar MR, Chan RJ. Unmet supportive care needs of people with advanced cancer and their caregivers: a systematic scoping review. Crit Rev Oncol Hematol 2022; 176:103728. [PMID: 35662585 DOI: 10.1016/j.critrevonc.2022.103728] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 01/11/2023] Open
Abstract
Examining and addressing unmet care needs is integral to improving the provision and quality of cancer services. This review explored the prevalence of unmet supportive care needs, and factors associated with unmet need, in adults with advanced cancers (solid and hematological malignancies) and their caregivers. Electronic databases (PubMed, CINAHL, EMBASE) were searched, producing 85 papers representing 81 included studies. People with advanced cancer reported the highest unmet needs in financial, health system and information, psychological, and physical and daily living domains, whereas caregivers reported the highest unmet needs in psychological, and patient care and support domains. Distress, depression, and anxiety were associated with higher unmet needs across all unmet need domains for people with advanced cancer and their caregivers. Substantial heterogeneity in study populations and methods was observed. Findings from this review can inform targeted strategies and interventions to address these unmet needs in people with advanced cancer.
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Affiliation(s)
- Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, WA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia; Institute for Health Research, University of Notre Dame Australia, WA, Australia.
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia
| | - Megan Crichton
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia; Nutrition and Dietetics Research Group, Bond University, QLD, Australia
| | - Jasmine Yee
- Centre for Medical Psychology and Evidence-Based Decision-Making, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Thomas J Smith
- Division of General Internal Medicine, John Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bogda Koczwara
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, SA, Australia; Flinders Cancer and Innovation Centre, Flinders Medical Centre, SA, Australia
| | - Margaret I Fitch
- School of Graduate Studies, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gregory B Crawford
- Discipline of Medicine, University of Adelaide, SA, Australia; Northern Adelaide Local Health Network, SA, Australia
| | - Sandip Mukhopadhyay
- Burdwan Medical College, West Bengal, Kolkata, India; Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Chan Cheah
- Internal Medicine, UWA Medical School, University of Western Australia, WA, Australia; Department of Haematology, Sir Charles Gairdner Hospital, WA, Australia; Department of Haematology, Hollywood Private Hospital, WA, Australia
| | | | - Olivia Cook
- McGrath Foundation, NSW, Australia; School of Nursing and Midwifery, Monash University, VIC, Australia
| | - Meera R Agar
- IMPACCT Centre, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia
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2
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Loizidou M, Sefcikova V, Ekert JO, Bone M, Samandouras G. Reforming support systems of newly diagnosed brain cancer patients: a systematic review. J Neurooncol 2022; 156:61-71. [PMID: 34826034 PMCID: PMC8714629 DOI: 10.1007/s11060-021-03895-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/05/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE Despite the increasing incidence of currently incurable brain cancer, limited resources are placed in patients' support systems, with reactive utilisation late in the disease course, when physical and psychological symptoms have peaked. Based on patient-derived data and emphasis on service improvement, this review investigated the structure and efficacy of the support methods of newly diagnosed brain cancer patients in healthcare systems. METHODS This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Articles from PubMed, Embase, and CENTRAL databases were screened with six pre-established eligibility criteria, including assessment within 6 months from diagnosis of a primary malignant brain tumour. Risk of bias was evaluated using the Newcastle-Ottawa Scale and Critical Appraisal Skills Program (CASP) Qualitative Studies Checklist. RESULTS Of 5057 original articles, 14 were eligible for qualitative synthesis. Four studies were cross-sectional and ten were descriptive. Information given to patients was evaluated in seven studies, communication with patients in nine, and patient participation in treatment decisions in eight. Risk of bias was low in ten studies, moderate in two, and high in two. CONCLUSIONS Techniques promoting individualised care increased perceived support, despite poor patient-physician communication and complexity of the healthcare system. Extracted data across 14 included studies informed a set of guidelines and a four-step framework. These can help evaluate and reform healthcare services to better accommodate the supportive needs of this patient group.
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Affiliation(s)
- Maria Loizidou
- UCL Queen Square Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK.
| | - Viktoria Sefcikova
- UCL Queen Square Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK
| | - Justyna O Ekert
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Matan Bone
- Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, UK
| | - George Samandouras
- UCL Queen Square Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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3
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van Roij J, de Zeeuw B, Zijlstra M, Claessens N, Raijmakers N, de Poll-Franse LV, Brom L. Shared Perspectives of Patients With Advanced Cancer and Their Informal Caregivers on Essential Aspects of Health Care: A Qualitative Study. J Palliat Care 2021; 37:372-380. [PMID: 33541221 DOI: 10.1177/0825859721989524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study is to explore the essential aspects of health care according to patients with advanced cancer and their informal caregivers by using a dyadic approach. METHODS Seven focus groups and 7 in-depth semi-structured interviews were conducted. Patients with advanced cancer and informal caregivers were recruited between January 2017 and June 2017 in 6 Dutch hospitals. All interviews were audiotaped, transcribed verbatim, and open coded using a thematic analysis approach. For this analysis Atlas.ti was used. RESULTS There was congruence between the aspects mentioned by patients and their informal caregiver. Two essential aspects of quality of care arose: "relation" and "organization of care." Regarding relation, patients and informal caregivers found it essential that health care professionals were personally engaged and provided support and compassion. Regarding organization of care, patients and informal caregivers expressed the importance of supportive care being offered multiple times during the disease trajectory, continuity of care, and well-organized logistics tailored to their needs. CONCLUSION This study generates awareness among health care professionals that patients with advanced cancer and their relatives have similar perspectives on essential aspects of care and may increase anticipation to meet health care preferences to optimize care.
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Affiliation(s)
- Janneke van Roij
- The Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.,Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands.,Association for Palliative Care in the Netherlands, Utrecht, the Netherlands
| | - Bibi de Zeeuw
- The Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Myrte Zijlstra
- The Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.,Association for Palliative Care in the Netherlands, Utrecht, the Netherlands.,Department of Internal Medicine, St. Jans Gasthuis, Weert, the Netherlands
| | - Niels Claessens
- Department of Pulmonology, Rijnstate, Arnhem, the Netherlands
| | - Natasja Raijmakers
- The Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.,Association for Palliative Care in the Netherlands, Utrecht, the Netherlands
| | - Lonneke van de Poll-Franse
- The Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.,Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Linda Brom
- The Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.,Association for Palliative Care in the Netherlands, Utrecht, the Netherlands
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Schmidt G, Mathes S, Klein E, Kiechle M, Paepke D. Evaluation of an Expert Guided Integrative Therapy Concept in Patients With Breast or Gynecological Cancer During Systemic Therapy. J Evid Based Integr Med 2020; 25:2515690X20949444. [PMID: 32808558 PMCID: PMC7436788 DOI: 10.1177/2515690x20949444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose. Breast and gynecological cancer patients undergoing systemic therapy frequently request integrative therapy concepts. The potential of integrative therapy (IM) lies in minimizing side effects of conventional cancer treatments and therefore decreasing treatment delays. IM can help to improve patients’ physical and emotional well-being, optimizing health and quality of life as IM involves patients in their own treatment. A counseling service for integrative medicine concepts as an outpatient program was implemented in our cancer center in 2013. Methods. In 2016 and 2017 144 breast and gynecological cancer patients were included into our specific IM program. The program comprises biological based complementary and alternative medicines (BB-CAM), a structured exercise therapy, manipulative and body-based practices, nutritional counseling, psycho-oncological and relaxing therapies. Therapists with additional specialization for IM, guide the treatment units. The program was evaluated via self-administered questionnaire. Results. 78% of the participating patients noticed an improvement by using BB-CAMs. 86% stated to feel better through participation in the structured exercise program. 74% profited from nutritional counseling and 91% from manual therapy. 93% of the patients treated with body compresses considered the application as soothing. The Bio-Frequency Sound Color Bed led to a relaxation in 96%. Psychological therapy improved coping with the disease in 70% of the patients. Conclusion. Integrative oncology combines the best practices of conventional and complementary therapy, uniting them in a holistic concept. Data show that our integrative therapy concept is well accepted by the patients and that therapy- and disease-related side effects can be reduced.
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Affiliation(s)
- Georg Schmidt
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Sofia Mathes
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Evelyn Klein
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Daniela Paepke
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
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Chae BJ, Lee J, Lee SK, Shin HJ, Jung SY, Lee JW, Kim Z, Lee MH, Lee J, Youn HJ. Unmet needs and related factors of Korean breast cancer survivors: a multicenter, cross-sectional study. BMC Cancer 2019; 19:839. [PMID: 31455311 PMCID: PMC6712787 DOI: 10.1186/s12885-019-6064-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Identification of specific needs in patients with cancer is very important for the provision of patient-centered medical service. The aim of this study was to investigate the unmet needs and related factors of Korean breast cancer survivors. METHODS A multicenter, cross-sectional, interview survey was performed among 332 Korean breast cancer survivors. The Comprehensive Needs Assessment Tool for cancer patients was administered to survivors who gave written informed consent to participate. Data were analyzed using t-test, ANOVA and multiple regression analysis. RESULTS The level of unmet needs was highest in the domain 'Information and education' (mean ± SD; 1.70 ± 1.14) and the item with the highest level of unmet needs was 'Needed help in coping with fear of recurrence' (2.04 ± 1.09). Unmet needs were correlated with age, stage, multiplicity, HER2, treatment state, marital status, employment, psychosocial status, and problems in EQ-5D dimensions. In multiple regression analysis, the 50-59 age group showed a higher level of recognition for physical symptom needs and the unemployed group expressed greater needs for information and education. Survivors with multiplicity had greater needs in the domains of healthcare staff and physical symptom. The stress group showed high levels of needs in all domains except religious support. The group with thoughts of suicide showed higher levels of unmet needs for physical symptom. CONCLUSION Most prevalent unmet needs in Korean breast cancer survivors were found in the 'information and education' domain. The 50-59 age group, unemployment, multiplicity, stress and suicidal thoughts were associated with higher levels of unmet needs among Korean breast cancer survivors. Our findings revealed more vulnerable breast cancer survivors with unmet needs and physicians should take a precision approach to satisfy unmet needs of these survivors.
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Affiliation(s)
- Byung Joo Chae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University school of Medicine, Seoul, Korea
| | - Jihyoun Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University school of Medicine, Seoul, Korea
| | - Hyuk-Jae Shin
- Department of Surgery, Myongji Hospital, Goyang, Korea
| | - So-Youn Jung
- Breast Cancer Center, National Cancer Center, Goyang, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Juhyung Lee
- Department of Preventive Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Hyun Jo Youn
- Department of Surgery, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University and Biomedical Research Institute, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, Korea.
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6
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van Vliet LM, de Veer AJ, Raijmakers NJ, Francke A. Is Information Provision about Benefits and Risks of Treatment Options Associated with Receiving Person-Centered Care?: A Survey among Incurably Ill Cancer Patients. J Palliat Med 2019; 22:797-803. [DOI: 10.1089/jpm.2018.0591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Anke J.E. de Veer
- Nivel, Netherlands Institute of Health Services Research, Utrecht, the Netherlands
| | - Natasja J.H. Raijmakers
- Nivel, Netherlands Institute of Health Services Research, Utrecht, the Netherlands
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Anneke Francke
- Nivel, Netherlands Institute of Health Services Research, Utrecht, the Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Horneber M, van Ackeren G, Fischer F, Kappauf H, Birkmann J. Addressing Unmet Information Needs: Results of a Clinician-Led Consultation Service About Complementary and Alternative Medicine for Cancer Patients and Their Relatives. Integr Cancer Ther 2018; 17:1172-1182. [PMID: 30352519 PMCID: PMC6247549 DOI: 10.1177/1534735418808597] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose. To report on a telephone consultation service with
cancer patients and their relatives about complementary and alternative medicine
(CAM) between 1999 and 2011. Methods. We offered a
Germany-wide, free-of-charge telephone consultation service about CAM led by
oncology clinicians from a comprehensive cancer center. The consultations
followed a patient-centered approach with the aim to provide guidance and
evidence-based information. Sociodemographic, disease-related data as well as
information about the consultations’ content were collected in a standardized
manner, and feedback questionnaires were sent out immediately after the
consultations. Results. Overall, 5269 callers from all over
Germany used the service (57% patients, 43% relatives). The “big 4” cancer types
(breast, gastrointestinal, prostate, and lung) accounted for 55% of all calls.
In 67% of calls, patients had just received the diagnosis or commenced
anticancer therapy; 69% of patients had advanced or metastatic diseases. More
than half of the callers (55%) had vague concerns like “what else can I
do?” rather than specific questions related to CAM. The
consultations covered a broad spectrum of issues from CAM therapies to cancer
treatment and measures supportive of health, nutrition, and psychosocial
support. Callers highly valued the service. Conclusions.
Consulting about CAM addresses important unmet needs from cancer patients and
their relatives. It provides clinicians with the opportunity to engage in open
and supportive dialogues about evidence-based CAM to help with symptom
management, psychological support, and individual self-care. Consulting about
CAM cannot be separated from consulting about conventional care and should be
provided from the beginning of the cancer journey.
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Affiliation(s)
- Markus Horneber
- 1 Department of Internal Medicine, Division of Oncology and Hematology, Paracelsus Medical University, Klinikum Nuernberg, Nuernberg, Germany
| | - Gerd van Ackeren
- 2 Department of Internal Medicine, Hematology and Oncology, Vivantes Clinic Neukoelln, Berlin, Germany
| | - Felix Fischer
- 3 Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Berlin, Germany
| | - Herbert Kappauf
- 4 Hematology/Medical Oncology, Psychooncology and Palliative Medicine, Starnberg, Germany
| | - Josef Birkmann
- 1 Department of Internal Medicine, Division of Oncology and Hematology, Paracelsus Medical University, Klinikum Nuernberg, Nuernberg, Germany
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8
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Johnson CE, McVey P, Rhee JJO, Senior H, Monterosso L, Williams B, Fallon-Ferguson J, Grant M, Nwachukwu H, Aubin M, Yates P, Mitchell G. General practice palliative care: patient and carer expectations, advance care plans and place of death-a systematic review. BMJ Support Palliat Care 2018:bmjspcare-2018-001549. [PMID: 30045939 DOI: 10.1136/bmjspcare-2018-001549] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/20/2018] [Accepted: 07/04/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND With an increasing ageing population in most countries, the role of general practitioners (GPs) and general practice nurses (GPNs) in providing optimal end of life (EoL) care is increasingly important. OBJECTIVE To explore: (1) patient and carer expectations of the role of GPs and GPNs at EoL; (2) GPs' and GPNs' contribution to advance care planning (ACP) and (3) if primary care involvement allows people to die in the place of preference. METHOD Systematic literature review. DATA SOURCES Papers from 2000 to 2017 were sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. RESULTS From 6209 journal articles, 51 papers were relevant. Patients and carers expect their GPs to be competent in all aspects of palliative care. They valued easy access to their GP, a multidisciplinary approach to care and well-coordinated and informed care. They also wanted their care team to communicate openly, honestly and empathically, particularly as the patient deteriorated. ACP and the involvement of GPs were important factors which contributed to patients being cared for and dying in their preferred place. There was no reference to GPNs in any paper identified. CONCLUSIONS Patients and carers prefer a holistic approach to care. This review shows that GPs have an important role in ACP and that their involvement facilitates dying in the place of preference. Proactive identification of people approaching EoL is likely to improve all aspects of care, including planning and communicating about EoL. More work outlining the role of GPNs in end of life care is required.
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Affiliation(s)
- Claire E Johnson
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- School of Nursing & Midwifery, Monash University, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
| | - Peta McVey
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Joel Jin-On Rhee
- General Practice Academic Unit, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Hugh Senior
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- College of Health, Massey University, Auckland, New Zealand
| | - Leanne Monterosso
- School of Nursing & Midwifery, Notre Dame University, Fremantle, Western Australia, Australia
- Centre for Nursing and Midwifery Research, St John of God Murdoch Hospital, Murdoch, Western Australia, Australia
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Briony Williams
- School of General Practice and Rural Medicine, University of Western Australia, Perth, Western Australia, Australia
- Primary Care Collaborative Cancer Clinical Trials Group, University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Fallon-Ferguson
- School of General Practice and Rural Medicine, University of Western Australia, Perth, Western Australia, Australia
- Primary Care Collaborative Cancer Clinical Trials Group, University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Grant
- Victoria Comprehensive Cancer Centre Palliative Care Research Group, University of Melbourne, Melbourne, Victoria, Australia
| | - Harriet Nwachukwu
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michèle Aubin
- Département de médecine familiale et de médecined\'urgence, Universite Laval, Faculte de medecine, Québec City, Canada
| | - Patsy Yates
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Wang T, Molassiotis A, Chung BPM, Tan JY. Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care 2018; 17:96. [PMID: 30037346 PMCID: PMC6057056 DOI: 10.1186/s12904-018-0346-9] [Citation(s) in RCA: 352] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 06/25/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This systematic review aimed to identify the unmet care needs and their associated variables in patients with advanced cancer and informal caregivers, alongside summarizing the tools used for needs assessment. METHODS Ten electronic databases were searched systematically from inception of each database to December 2016 to determine eligible studies. Studies that considered the unmet care needs of either adult patients with advanced cancer or informal caregivers, regardless of the study design, were included. The Mixed Methods Appraisal Tool was utilized for quality appraisal of the included studies. Content analysis was used to identify unmet needs, and descriptive analysis was adopted to synthesize other outcomes. RESULTS Fifty studies were included, and their methodological quality was generally robust. The prevalence of unmet needs varied across studies. Twelve unmet need domains were identified in patients with advanced cancer, and seven among informal caregivers. The three most commonly reported domains for patients were psychological, physical, and healthcare service and information. The most prominent unmet items of these domains were emotional support (10.1-84.4%), fatigue (18-76.3%), and "being informed about benefits and side-effects of treatment" (4-66.7%). The most commonly identified unmet needs for informal caregivers were information needs, including illness and treatment information (26-100%) and care-related information (21-100%). Unmet needs of patients with advanced cancer were associated with their physical symptoms, anxiety, and quality of life. The most commonly used instruments for needs assessment among patients with advanced cancer were the Supportive Care Needs Survey (N = 8) and Problems and Needs in Palliative Care questionnaire (N = 5). The majority of the included studies investigated unmet needs from the perspectives of either patients or caregivers with a cross-sectional study design using single time-point assessments. Moreover, significant heterogeneity, including differences in study contexts, assessment methods, instruments for measurement, need classifications, and reporting methods, were identified across studies. CONCLUSION Both advanced cancer patients and informal caregivers reported a wide range of context-bound unmet needs. Examining their unmet needs on the basis of viewing patients and their informal caregivers as a whole unit will be highly optimal. Unmet care needs should be comprehensively evaluated from the perspectives of all stakeholders and interpreted by using rigorously designed mixed methods research and longitudinal studies within a given context.
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Affiliation(s)
- Tao Wang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Betty Pui Man Chung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jing-Yu Tan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
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Main B, McNair A, Haworth S, Rooshenas L, Hughes C, Tierney P, Donovan J, Thomas S, Blazeby J. Core information set for informed consent to surgery for oral or oropharyngeal cancer: A mixed-methods study. Clin Otolaryngol 2017; 43:624-631. [DOI: 10.1111/coa.13037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- B.G. Main
- School of Social and Community Medicine; University of Bristol; Bristol UK
- University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - A.G.K. McNair
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - S. Haworth
- School of Social and Community Medicine; University of Bristol; Bristol UK
- School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - L. Rooshenas
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - C.W. Hughes
- University Hospitals Bristol NHS Foundation Trust; Bristol UK
- School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - P. Tierney
- University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - J.L. Donovan
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - S.J. Thomas
- University Hospitals Bristol NHS Foundation Trust; Bristol UK
- School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - J.M. Blazeby
- School of Social and Community Medicine; University of Bristol; Bristol UK
- University Hospitals Bristol NHS Foundation Trust; Bristol UK
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11
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Vargas EA, Mahalingam R, Michaels B, Cabrera L, Campbell E, Liu R. Perceptions of Control in Women Undergoing Cancer-Related Surgery on Psychological Perceptions of Health. SEX ROLES 2017. [DOI: 10.1007/s11199-017-0865-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Gillespie J, Kacikanis A, Nyhof-Young J, Gallinger S, Ruthig E. Information Needs of Hepato-Pancreato-Biliary Surgical Oncology Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:589-595. [PMID: 27075195 DOI: 10.1007/s13187-016-1034-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A marked knowledge gap exists concerning the information needs of hepato-pancreato-biliary (HPB) surgical oncology patients. We investigated the comprehensive information needs of this patient population, including the type and amount of information desired, as well as the preferred method of receiving information. A questionnaire was administered to patients being treated surgically for cancers of the liver, pancreas, gallbladder, or bile ducts at Toronto General Hospital, part of the University Health Network, in Toronto, Canada. The questionnaire examined patients' information needs across six domains of information: medical, practical, physical, emotional, social, and spiritual. Among 36 respondents, the importance of information and amount of information desired differed significantly by domain (both p < 0.001). This group of patients rated information in the medical and physical domains as most important, though they also desired specific items of information from the emotional, practical, and social domains. Patients' overwhelming preference was to receive information via a one-on-one consultation with a healthcare provider. It is important for healthcare providers working with HPB surgical oncology patients to be comprehensive when providing information related to patients' cancer diagnosis, prognosis, associated symptoms, and side effects of treatment. Certain emotional, practical, and social issues (e.g., fears of cancer recurrence, drug coverage options, relationship changes) should be addressed as well. Face-to-face interactions should be the primary mode of delivering information to patients. Our findings are being used to guide the training of healthcare providers and the development of educational resources specific to HPB surgical oncology patients.
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Affiliation(s)
- Jacqueline Gillespie
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Anna Kacikanis
- Sprott Department of Surgery, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada
- Present Address: St. Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - Joyce Nyhof-Young
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Helliwell Medical Education Centre, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada
| | - Steven Gallinger
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Sprott Department of Surgery, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada
| | - Elke Ruthig
- Patient and Family Education Program, Toronto General Hospital, University Health Network, 200 Elizabeth St., 9NU-908, Toronto, ON, M5G 2C4, Canada.
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Fletcher C, Flight I, Chapman J, Fennell K, Wilson C. The information needs of adult cancer survivors across the cancer continuum: A scoping review. PATIENT EDUCATION AND COUNSELING 2017; 100:383-410. [PMID: 27765377 DOI: 10.1016/j.pec.2016.10.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/29/2016] [Accepted: 10/08/2016] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To provide an updated synthesis of the literature that investigates the self-reported information needs of people diagnosed with cancer across the cancer continuum. METHODS We conducted a scoping review of the literature published from August 2003 to June 2015 and expanded an existing typology summarizing the information needs of people diagnosed with cancer. RESULTS The majority of the included studies (n=104) focused on questions relevant to the diagnosis/active treatment phase of the cancer continuum (52.9%) and thus the most frequently identified information needs related to this phase (33.4%). Information needs varied across the continuum and the results highlight the importance of recognising this fact. CONCLUSION People diagnosed with cancer experience discrete information needs at different points from diagnosis to survival. Much of the research conducted in this area has focused on their information needs during the diagnosis and treatment of cancer, and literature relating to information needs following completion of treatment is sparse. PRACTICE IMPLICATIONS Further research is needed to discern the specific nature of the treatment concerns and identify the information needs that survivors experience during recurrence of cancer, metastasis or changes in diagnosis, and the end of life phase of the cancer continuum.
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Affiliation(s)
- Chloe Fletcher
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Adelaide, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Adelaide, Australia.
| | - Janine Chapman
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Adelaide, Australia
| | - Kate Fennell
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Adelaide, Australia; Cancer Council SA, Adelaide, Australia
| | - Carlene Wilson
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Adelaide, Australia; Cancer Council SA, Adelaide, Australia
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Moghaddam N, Coxon H, Nabarro S, Hardy B, Cox K. Unmet care needs in people living with advanced cancer: a systematic review. Support Care Cancer 2016; 24:3609-22. [PMID: 27137214 DOI: 10.1007/s00520-016-3221-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/17/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE The support needs of cancer patients vary according to the phase of their cancer journey. Recent developments in healthcare are such that the advanced cancer phase is increasingly experienced as a chronic illness phase, with consequent changes in patient support needs. Understanding these needs, and identifying areas of unmet need, can enable us to develop services that are more adequate to the task of supporting this population. METHODS We conducted a systematic search of four electronic databases to identify studies examining the unmet needs of people living with advanced cancer. Relevant data were extracted and synthesised; meta-analyses were conducted to obtain pooled estimates for prevalence of needs. RESULTS We identified 23 studies (4 qualitative) for inclusion. Unmet needs were identified across a broad range of domains, with greatest prevalence in informational (30-55 %), psychological (18-42 %), physical (17-48 %), and functional (17-37 %) domains. There was considerable heterogeneity amongst studies in terms of methods of assessment, coding and reporting of needs, respondent characteristics, and appraised study quality. CONCLUSIONS Heterogeneity made it difficult to compare across studies and inflated confidence intervals for pooled estimates of prevalence-we need standardised and comprehensive approaches to assessment and reporting of unmet needs to further our understanding. Nonetheless, the review identified prominent needs across a range of (interacting) experiential domains. Moreover, by focussing on unmet needs for support, we were able to extrapolate potential implications for service development.
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Affiliation(s)
- Nima Moghaddam
- College of Social Sciences, University of Lincoln, Brayford Pool, Lincoln, UK.
| | | | | | - Beth Hardy
- Department of Health Sciences, University of York, York, UK
| | - Karen Cox
- School of Health Sciences, University of Nottingham, Nottingham, UK
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15
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Taylor-Ford M. Clinical considerations for working with patients with advanced cancer. J Clin Psychol Med Settings 2015; 21:201-13. [PMID: 24916664 DOI: 10.1007/s10880-014-9398-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Advanced cancer is a life-limiting condition, but improvements in medical care are contributing to longer survival among some patients. As a result, it is likely that mental health professionals will be called upon to assist more patients with advanced cancer. The present paper reviews the psychological literature and from it draws clinical considerations for working with individuals affected by advanced cancer. It begins with a brief description of advanced cancer and the medical attributes of an advanced cancer diagnosis, and then catalogues salient medical, psychological, existential, and interpersonal challenges faced by this patient population. The review concludes with recommendations for treatment planning including an overview of some of the more recently tested and widely available interventions. It is hoped that this review will serve as a resource for professionals working with patients affected by advanced cancer.
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Affiliation(s)
- Megan Taylor-Ford
- Department of Psychology, University of Southern California, SGM 501, 3620 South McClintock Ave., Los Angeles, CA, 90089-1061, USA,
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16
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Bogaardt H, Veerbeek L, Kelly K, van der Heide A, van Zuylen L, Speyer R. Swallowing problems at the end of the palliative phase: incidence and severity in 164 unsedated patients. Dysphagia 2014; 30:145-51. [PMID: 25533181 DOI: 10.1007/s00455-014-9590-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 12/04/2014] [Indexed: 11/25/2022]
Abstract
Swallowing problems are reported to be a common finding in patients who receive palliative care. In existing literature, the incidence of swallowing problems is mostly described in small numbers of patients at the start of the palliative phase. As we hypothesized that the incidence of dysphagia might increase as the palliative phase progresses, this study describes the incidence of swallowing problems and related problems in 164 unsedated patients at the end of the palliative phase, defined by the last 72 h before their death. To determine the incidence of swallowing problems and related problems, questionnaires were completed bereaved by relatives and nursing staff. Our data shows that in the palliative phase the incidence of swallowing problems can be as high as 79 %. A significant correlation was found between swallowing problems and reduced psycho-social quality of life as assessed by nursing staff (ρ = -.284). Overall the nursing staff rated the incidence and severity of swallowing problems (and related problems like frequent coughing, loss of appetite, and problems with oral secretions) lower than the relatives. This study suggests that incidence of swallowing problems at the end of the palliative phase is high and that these difficulties may not only result in discomfort for patients, but also can raise concern for caregivers. More information and education on management of swallowing problems in palliative settings might be needed for both relatives and nursing staff. However, the data also suggest that any intervention should be proportional to the level of distress caused by the intervention.
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Affiliation(s)
- Hans Bogaardt
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 2141, Australia,
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18
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Cramer H, Cohen L, Dobos G, Witt CM. Integrative oncology: best of both worlds-theoretical, practical, and research issues. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:383142. [PMID: 24371456 PMCID: PMC3863498 DOI: 10.1155/2013/383142] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 11/08/2013] [Accepted: 11/08/2013] [Indexed: 12/15/2022]
Abstract
More and more cancer patients use complementary therapies. As the majority of patients do not disclose their use of complementary therapies to their oncologists, they expose themselves to possible detrimental effects from the therapies due to drug interactions. To meet the needs of patients and health care professionals on valid information on complementary therapies, the collaborative research project "Competence Network Complementary Medicine in Oncology-KOKON", an interdisciplinary network for complementary medicine research in oncology, was established. Moreover, Integrative Oncology, a combination of conventional and evidenced-based complementary therapies delivered using a comprehensive approach, is now increasingly used in the United States and Europe. A variety of different Integrative Oncology models have been established worldwide including an expert-based model at the Kliniken Essen-Mitte, Essen, Germany and a patient-centered, evidenced-based approach at The University of Texas MD Anderson Cancer Center. Both models are briefly reviewed. More research is needed and Comparative Effectiveness Research that places strong emphasis on the comparison of different treatment options in usual care settings by including more heterogeneous patients, using less standardized treatment protocols, and measuring patient-centered outcomes would provide useful information for decision-making. To improve the quality of care and research in Integrative Oncology, sustainable financial models for Integrative Oncology and more funding for research are needed.
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Affiliation(s)
- Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Lorenzo Cohen
- Department of General Oncology and the Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Claudia M. Witt
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, 10M7 Berlin, Germany
- University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, MD 21201, USA
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19
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Wiljer D, Walton T, Gilbert J, Boucher A, Ellis PM, Schiff S, Sellick SM, Simunovic M, Kennedy E, Urowitz S. Understanding the needs of colorectal cancer patients during the pre-diagnosis phase. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:402-407. [PMID: 23690171 DOI: 10.1007/s13187-013-0465-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Patients with colorectal cancer (CRC) face a number of challenges leading up to diagnosis; however, research is limited regarding their specific needs during the pre-diagnosis period. A multicenter cross-sectional survey was conducted to elicit information about the CRC experience during the pre-diagnosis phase. Across the three sites, 104 eligible patients were approached, and 82 patients completed the survey, for a total response rate of 78.9%. The needs most identified by participants during the pre-diagnosis period were informational (31.6%) and emotional (20.3%) needs; social needs were rated as the least important need for these patients (7%). The majority (84.0%) reported that these needs were met. Participants reported feeling shocked or overwhelmed on learning of their diagnosis (57.1%) and high levels of anxiety during this time (40.0%). The majority (77.9%) of participants reported that they were not directed to any resources to help address their anxiety. Informational and emotional needs are identified as the most important needs during the pre-diagnosis phase, and for most these needs are being met; however, some participants are experiencing high levels of anxiety without access to appropriate resources. Further work is required to understand the optimal mechanisms to address identified needs during this pre-diagnosis period and to assess the potential benefits and costs of addressing these needs.
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Affiliation(s)
- David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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20
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Huebner J, Senf B, Micke O, Muecke R, Stoll C, Prott FJ, Muenstedt K, Dennert G. Online information on complementary and alternative medicine for cancer patients: evidence-based recommendations. ACTA ACUST UNITED AC 2013; 36:273-8. [PMID: 23689222 DOI: 10.1159/000350307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many cancer patients use complementary and alternative medicine (CAM). Most websites offering online information on CAM are not helpful for them. METHODS We extracted decisive elements for online information on CAM by analyzing the literature on the information needs of cancer patients and on counseling cancer patients on CAM. RESULTS Key issues for online information on CAM are the qualification of the authors, transparency and accountability of the information, description of the aims, a scientific approach, description of treatment alternatives, support for the patient-physician relationship, individualized information, a summary of the information, disclosure of funding, and the privacy policy. CONCLUSIONS The communicative challenge will be to convey information without destroying hope and motivation. We suggest that CAM topics should be integrated into broader information provided on cancer (etiology, conventional treatment). By also providing information for physicians, such a website could promote shared decision-making. Online information will gain the status of independent expert knowledge if provided by a well-known scientific organization as, e.g., a national cancer society.
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Tomlinson K, Barker S, Soden K. What are cancer patients' experiences and preferences for the provision of written information in the palliative care setting? A focus group study. Palliat Med 2012; 26:760-5. [PMID: 21908521 DOI: 10.1177/0269216311419988] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Whilst there is a wide range of literature pertaining to the need for excellent verbal communication within the palliative care setting, there is a paucity of research designed to identify the written informational needs of such patients. AIM To identify the experiences and wishes of patients known to a specialist palliative care service in England with regards to written information. We considered both generalizable written information (such as leaflets, books and internet resources) as well as individualized information (for example, copies of letters given to patients). DESIGN Five focus group discussions were recorded and transcribed for analysis. SETTING/PARTICIPANTS The focus groups took place at one specialist palliative care unit in England. Twenty-two patients with cancer over the age of 18 years were recruited. RESULTS Inductive, realist thematic analysis of the data set was performed. Themes have been broadly categorized into three main areas: (i) patients' views on the role of written information, (ii) their experiences of written information in different formats, and (iii) their thoughts on what written information they would most value. CONCLUSIONS Written information needs for this patient group vary greatly, sometimes in ways which can be predicted. Using a patient-centred approach to elicit information around an individual's coping strategies, desire for knowledge and empowerment may be helpful. The data supports a proactive approach to making available (to those who want them) clear, concise and attractive leaflets.
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Affiliation(s)
- Kim Tomlinson
- School of Medicine and Health Practice, University of East Anglia, Norfolk, Norwich, UK.
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22
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Choi KH, Park JH, Park JH, Park JS. Psychosocial needs of cancer patients and related factors: a multi-center, cross-sectional study in Korea. Psychooncology 2012; 22:1073-80. [DOI: 10.1002/pon.3105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 04/17/2012] [Accepted: 04/17/2012] [Indexed: 11/07/2022]
Affiliation(s)
- Kyung-Hyun Choi
- Department of Family Medicine; Dongnam Institute of Radiological & Medical Sciences; Busan Korea
| | - Jae-Hyun Park
- Department of Social and Preventive Medicine, Samsung Biomedical Research Institute; Sungkyunkwan University School of Medicine; Suwon Korea
| | - Jong-Hyock Park
- Division of Cancer Policy and Management, National Cancer Control Research Institute; National Cancer Center; Goyang Korea
| | - Joo-Sung Park
- Department of Family Medicine; Dong-A University College of Medicine; Busan Korea
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Arraras JI, Manterola A, Hernández B, Arias de la Vega F, Martínez M, Vila M, Eito C, Vera R, Domínguez MÁ. The EORTC information questionnaire, EORTC QLQ-INFO25. Validation study for Spanish patients. Clin Transl Oncol 2011; 13:401-10. [DOI: 10.1007/s12094-011-0674-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Uchida M, Akechi T, Okuyama T, Sagawa R, Nakaguchi T, Endo C, Yamashita H, Toyama T, Furukawa TA. Patients' Supportive Care Needs and Psychological Distress in Advanced Breast Cancer Patients in Japan. Jpn J Clin Oncol 2010; 41:530-6. [DOI: 10.1093/jjco/hyq230] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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25
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Mattila E, Kaunonen M, Aalto P, Ollikainen J, Åstedt-Kurki P. Support for hospital patients and associated factors. Scand J Caring Sci 2010; 24:734-45. [DOI: 10.1111/j.1471-6712.2010.00771.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Choi KH, Park JH, Park SM. Cancer patients' informational needs on health promotion and related factors: a multi-institutional, cross-sectional study in Korea. Support Care Cancer 2010; 19:1495-504. [PMID: 20694821 DOI: 10.1007/s00520-010-0973-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 07/27/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND As the survival rates of cancer patients increase, health promotion for cancer survivors becomes a more important issue. This study examines whether the informational needs on health promotion by cancer patients is being met and evaluates other factors associated with those informational needs. METHODS Questionnaires were collected from a total of 2,661 cancer patients at ten cancer centers in Korea from July to August 2008. The questionnaire was designed to elicit informational needs related to healthy behaviors, nutrition, and complementary and alternative medicine (CAM). Multiple logistic regression models were developed to identify factors affecting the informational needs of cancer survivors regarding health promotion. RESULTS In our study sample, we found that 64.83%, 66.38%, and 47.40% of patients have unmet informational needs regarding healthy behaviors, nutrition, and CAM, respectively. The desire for information about health promotion appears to be related to socio-demographic factors, clinical factors, behavioral factors, and quality of life. Younger patients with higher levels of education, shorter time since diagnosis, greater stress levels, previous experience using CAM, and problems identified on EQ5D expressed greater needs for health-related information. Cancer recurrence and smoking status were also associated with greater informational needs about nutrition and CAM. CONCLUSIONS A significant proportion of cancer patients have unmet informational needs on health promotion. We identified several factors that influence the desire for more health-related information. A tailored approach to providing informational resources to patient groups with unmet informational needs is recommended to enhance the quality of life of cancer patients.
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Affiliation(s)
- Kyung-Hyun Choi
- Department of Family Medicine, Dongnam Institute of Radiological and Medical Sciences, Pusan, South Korea
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27
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Arraras JI, Greimel E, Sezer O, Chie WC, Bergenmar M, Costantini A, Young T, Vlasic KK, Velikova G. An international validation study of the EORTC QLQ-INFO25 questionnaire: an instrument to assess the information given to cancer patients. Eur J Cancer 2010; 46:2726-38. [PMID: 20674333 DOI: 10.1016/j.ejca.2010.06.118] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 06/10/2010] [Accepted: 06/18/2010] [Indexed: 10/19/2022]
Abstract
AIM The EORTC Quality of Life (QOL) Group has developed an instrument to evaluate the information received by cancer patients. This study assessed the psychometric characteristics of the EORTC INFO module in a large international/multi-cultural sample of cancer patients. METHODS The provisional 26-item information module (EORTC INFO26) was administered with the EORTC QLQ-C30 and the information scales of the inpatient satisfaction module EORTC IN-PATSAT32 on two occasions during the patients' treatment and follow-up period. Questionnaire-hypothesised scale structure, reliability, validity and responsiveness to changes were evaluated through standard psychometric analyses. Patient acceptability was assessed with a debriefing questionnaire. RESULTS The study comprised 509 patients from 8 countries (7 European countries and Taiwan) with different cancers and disease stages. Multi-trait scaling analysis led to the deletion of one item but confirmed the hypothesised 4 multi-item scales (information about disease, medical tests, treatment and other services) and eight single items. Internal consistency for all scales was good (α>0.70), as was test-retest reliability (intraclass correlations>0.70). All items can be combined to generate a single score (α>0.90). Convergent validity was supported by significant correlations with related areas of IN-PATSAT32 (r>0.40). Low correlations with EORTC QLQ-C30 scales confirmed divergent validity (r<0.30) The EORTC INFO-25 module discriminated among groups based on gender, age, education, levels of anxiety and depression, information wishes and satisfaction. Only one scale captured changes over time. CONCLUSIONS The EORTC QLQ-INFO 25 is a reliable and valid self-reported instrument. The module can be used in cross-cultural observational and intervention studies.
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Levi BH, Green MJ. Too soon to give up: re-examining the value of advance directives. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:3-22. [PMID: 20379910 PMCID: PMC3766745 DOI: 10.1080/15265161003599691] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future, translates an individual's values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by (1) educating users about advance care planning; (2) helping individuals identify, clarify, and prioritize factors that influence their decision-making about future medical conditions; (3) explaining common end-of-life medical conditions and life-sustaining treatment; (4) helping users articulate a coherent set of wishes with regard to advance care planning-in the form of an advance directive readily interpretable by physicians; and (5) helping individuals both choose a spokesperson, and prepare to engage family, friends, and health care providers in discussions about advance care planning.
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Affiliation(s)
- Benjamin H Levi
- Penn State College of Medicine, Humanities & Pediatrics, Hershey, PA 17033, USA.
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Charalambous A, Papadopoulos (I, Beadsmoore A. Towards a theory of quality nursing care for patients with cancer through hermeneutic phenomenology. Eur J Oncol Nurs 2009; 13:350-60. [DOI: 10.1016/j.ejon.2009.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 04/22/2009] [Accepted: 04/25/2009] [Indexed: 11/17/2022]
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30
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Worster B, Holmes S. A phenomenological study of the postoperative experiences of patients undergoing surgery for colorectal cancer. Eur J Oncol Nurs 2009; 13:315-22. [DOI: 10.1016/j.ejon.2009.04.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 04/17/2009] [Accepted: 04/25/2009] [Indexed: 11/15/2022]
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31
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Fujisawa D, Park S, Kimura R, Suyama I, Koyama Y, Takeuchi M, Yoshikawa H, Hashiguchi S, Shirahase J, Kato M, Takeda J, Kashima H. Unmet supportive needs of cancer patients in an acute care hospital in Japan—a census study. Support Care Cancer 2009; 18:1393-403. [DOI: 10.1007/s00520-009-0761-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 10/01/2009] [Indexed: 11/12/2022]
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32
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Friberg F, Öhlen J. Searching for knowledge and understanding while living with impending death—a phenomenological case study. Int J Qual Stud Health Well-being 2009. [DOI: 10.1080/17482620701523777] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Michiels E, Deschepper R, Bilsen J, Mortier F, Deliens L. Information disclosure to terminally ill patients and their relatives: self-reported practice of Belgian clinical specialists and general practitioners. Palliat Med 2009; 23:345-53. [PMID: 19251830 DOI: 10.1177/0269216308102043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective of this study is to examine physicians' practices regarding information disclosure to terminally ill patients and to their relatives, without informing the patient. A questionnaire had been sent to a random sample of 3014 Belgian physicians from different specialties frequently involved in end-of-life care. Responses were analysed using weighted percentages, Chi-square, Mann-Whitney U-tests and a multivariate ordinal logistic regression. Response rate was 58%. Both clinical specialists and general practitioners (GPs) discuss most topics related to terminal illness with their patients except end-of-life hastening options, spirituality, life expectancy and options to withhold/withdraw life-sustaining treatment. The topics which most physicians always discuss with relatives without informing the patient are the aim of treatment, palliative care and incurability. There is a significant difference between clinical specialists and GPs. Clinical specialists and GPs discuss most end-of-life topics with the patient but omit important issues such as end-of-life hastening options and life-expectancy.
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Affiliation(s)
- E Michiels
- Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, End-of-Life Care Research Group, Brussels, Belgium
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Harrison JD, Young JM, Price MA, Butow PN, Solomon MJ. What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer 2009; 17:1117-28. [PMID: 19319577 DOI: 10.1007/s00520-009-0615-5] [Citation(s) in RCA: 618] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 02/02/2009] [Indexed: 11/25/2022]
Affiliation(s)
- James D Harrison
- Surgical Outcomes Research Centre (SOuRCe), Sydney South West Area Health Service & School of Public Health, Royal Prince Alfred Hospital, University of Sydney, PO Box M157, Missenden Road, NSW 2050, Sydney, Australia.
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Cervical cancer patient information-seeking behaviors, information needs, and information sources in South Korea. Support Care Cancer 2009; 17:1277-83. [PMID: 19172301 DOI: 10.1007/s00520-009-0581-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 01/12/2009] [Indexed: 10/21/2022]
Abstract
GOALS The aim of this study was to explore the cancer information needs, utilization, and source preferences in South Korean women with cervical cancer. PATIENTS AND METHODS This was a multicenter descriptive study comprising 968 cervical cancer patients (stages 0-IVb; mean age, 55 years; response rate, 34.4% of those who agreed to participate) who had been treated from 1983 through 2004 at any of the six South Korean hospitals. The study data were obtained through a mail-in self-response questionnaire that asked about the patients' cancer information needs, cancer-information-seeking behavior, information sources, and type of information needed. It also collected data about anxiety and depression. RESULTS Of the 968 cervical cancer patients, 404 (41.7%) had sought cancer information. When patients felt a need for information, their information-seeking behavior increased (overall risk = 4.053, 95% confidence interval = 2.139-7.680). Television and/or radio were the most frequently cited sources, and narratives about cancer experiences were the most easily understood forms of cancer information. More younger patients preferred booklets and pamphlets, while more older patients preferred television and radio. The most needed cancer information at the time of diagnosis and treatment involved diagnosis, stage, and prognosis while after treatment ended it involved self-care techniques. CONCLUSIONS Cervical cancer patients' need of cancer information varied with age and treatment phase. These findings should help guide the development of educational materials tailored to the needs of individual patients.
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The preoperative experience of patients undergoing surgery for colorectal cancer: a phenomenological study. Eur J Oncol Nurs 2008; 12:418-24. [PMID: 18842456 DOI: 10.1016/j.ejon.2008.05.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 05/03/2008] [Accepted: 05/08/2008] [Indexed: 11/22/2022]
Abstract
Colorectal cancer is associated with significant morbidity and mortality; many patients undergo surgical resection following which they are discharged home to await adjuvant therapy. Using a phenomenological approach, patients' experiences during this period were investigated arising from a concern that their needs may be overlooked. However, though post-discharge experience was the primary focus, informants chose first to talk about their preoperative experiences; these are reported here. As this was not the primary focus, we cannot claim that the data is complete though the findings suggest that this area warrants further investigation. Preoperative experiences, characterised by fear, questions, isolation and uncertainty, exerted significant influence on the respondents. Some believed that cancer was 'their problem', no-one could help them with it although support from the Clinical Nurse Specialist was highly valued. Such reactions are not specific to colorectal disease and it was rarely evident that respondents had this form of cancer. Patients exhibited a desire to protect others from their diagnosis. The findings also show considerable variation in the requirement for information indicating that professionals should take their lead from the individual concerned. Patients with cancer are the 'experts' in living with the disease and their experiences can make a significant contribution to the planning and delivery of care. These findings have the potential to impact on the care received by those with colorectal cancer.
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Collins S, de Vogel-Voogt E, Visser A, van der Heide A. Presence, communication and treatment of fatigue and pain complaints in incurable cancer patients. PATIENT EDUCATION AND COUNSELING 2008; 72:102-108. [PMID: 18395392 DOI: 10.1016/j.pec.2008.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 02/08/2008] [Accepted: 02/16/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This study describes the experiences of fatigue and pain in incurable cancer patients and the treatment they receive. METHODS Patients were recruited via medical specialists from hospitals in the South and Southwest of the Netherlands. Hundred and twenty-five incurable cancer patients filled out a written questionnaire and were also interviewed at home. RESULTS Ninety percent reported to suffer from fatigue and 48% had pain. Forty-five percent had discussed fatigue with a healthcare professional and 55% had discussed pain. Fifteen percent reported to receive medical treatment for their fatigue and 29% received pain treatment. Treatment for fatigue and pain treatment had been recently adjusted in 4% of the patients with fatigue complaints and 21% of the patients with pain complaints. CONCLUSION Although fatigue is a more common problem than pain in patients with incurable cancer, less attention in the care is paid to fatigue and its treatment than to pain. PRACTICE IMPLICATIONS Fatigue deserves more attention in the care policy for incurable cancer patients and more research should be focused on interventions to address fatigue in this group of cancer patients.
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Affiliation(s)
- Susan Collins
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Lebret T, Bouregba A. Roles of the urologist and nurse from the perspective of patients with prostate cancer receiving luteinizing hormone-releasing hormone analogue therapy. BJU Int 2008; 102:1419-24. [PMID: 18549431 DOI: 10.1111/j.1464-410x.2008.07785.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To establish the roles of the urologist, general practitioner (GP) and nurse from the perspective of the patient with prostate cancer receiving hormone therapy, and to assess patient satisfaction, in particular with management and information needs. PATIENTS AND METHODS Patients with prostate cancer receiving luteinizing hormone-releasing hormone analogue (LHRH-a) therapy were recruited by a representative sample of 58 French urologists (March to April 2007) and invited to complete a 42-item questionnaire. RESULTS In all, 350 representative patients participated in the study; >90% were totally or quite satisfied with the information given by their urologist at diagnosis and the start of treatment. Their main contact during treatment was with the nurse who gave the injection (84% of patients). The nurse's main role was to provide clarity (60% of patients), guidance (35%) and support to the family (28%). Fewer patients discussed disease stage and progression with their nurse (29%) than with a doctor (urologist, 63%; or GP, 61%). Fewer also discussed treatment (24% vs 32%) but as many patients discussed the impact of their disease and treatment with their nurse as with their doctor (e.g. 33% discussed general health and fatigue with the nurse, vs 26% with the urologist). The need for contact with a health professional was greater during the early stages of treatment. Patients treated for <12 months with 3-monthly injections were less likely to be in favour of spacing injections than patients treated for >or=3 years. CONCLUSION The patient consults the urologist for reliable information on disease and treatment, and to the GP for further support, if needed, but the nurse has the pivotal role. A 3-monthly injection schedule enables regular face-to-face contact between the nurse and the patient and their family, and contributes towards the patient's coping strategies and quality of life.
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Faithfull S, White I. Delivering sensitive health care information: challenging the taboo of women's sexual health after pelvic radiotherapy. PATIENT EDUCATION AND COUNSELING 2008; 71:228-233. [PMID: 18339512 DOI: 10.1016/j.pec.2007.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 12/10/2007] [Accepted: 12/18/2007] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The aim of this study was to elicit current practice with regard to the content and delivery of patient education for women undergoing pelvic radiotherapy. METHODS A 38-item questionnaire was sent to all radiotherapy departments (n=65) and a convenience sample of specialist gynaecological oncology nurses (n=166), with response rates of 62% (n=40) and 42% (n=52), respectively. Data analysis of 32 different patient education leaflets from individual cancer units, cancer networks and vaginal dilator manufacturers was conducted. Content was evaluated on the inclusion and accuracy of the key knowledge women should receive before completing pelvic radiotherapy. RESULTS Patient education focused on the technical aspects of vaginal dilation with minimal content on psychosocial 6% (n=2) or sexual health components 44% (n=14). It was evident from the information leaflets reviewed and questionnaire responses that there was duplication of verbal and written information provision in the clinical setting as opposed to using different information strategies to provide more comprehensive coverage of knowledge gaps in post-treatment sexual rehabilitation. CONCLUSION Results suggest the provision of vaginal dilation advice and sexual health information may benefit from being placed in the wider context of assessing treatment impact on women's health. PRACTICE IMPLICATIONS It is important to analyse the management of sensitive content, within both written information materials and verbal consultations, to determine the most effective information provision strategies that support sexual health interventions in cancer practice.
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Affiliation(s)
- Sara Faithfull
- Faculty of Health & Medical Sciences, Division of Health and Social Care, University of Surrey, Duke of Kent Building, Stag Hill Campus, Guildford, Surrey GU2 7TE, United Kingdom.
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O’Regan P, Drummond E. Cancer information needs of people with intellectual disability: A review of the literature. Eur J Oncol Nurs 2008; 12:142-7. [DOI: 10.1016/j.ejon.2007.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 11/22/2007] [Accepted: 11/26/2007] [Indexed: 11/27/2022]
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Iredale R, Rapport F, Sivell S, Jones W, Edwards A, Gray J, Elwyn G. Exploring the requirements for a decision aid on familial breast cancer in the UK context: a qualitative study with patients referred to a cancer genetics service. J Eval Clin Pract 2008; 14:110-5. [PMID: 18211652 DOI: 10.1111/j.1365-2753.2007.00811.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
RATIONALE Patients concerned about a family history of breast cancer can face difficult decisions about screening, prophylactic surgery and genetic testing. Decision aids can facilitate patient decision making and currently include leaflets and computerized tools. These are largely aimed at the North American market. However, no decision aids concerning familial breast cancer exist in the UK. METHODS Focus groups were held with 39 women over 18 years of age referred to a cancer genetics clinic, and who had been given a risk assessment for developing breast cancer. Each focus group examined three existing North American decision aids (1 paper-based and 2 CD-ROMs) and explored what a decision aid in a UK context should look like and the information it should contain. RESULTS There was enthusiasm for the development of decision aids that suit the local context in terms of its health care policy, in paper-based and CD-ROM formats. This paper identifies areas of agreement and disagreement in terms of both content and presentation styles, and also reports some of the suggestions received about where, when and with whom decision aids should be used. Participants suggested that decision aids would be most effective when they allowed a user-selected range of formats. CONCLUSION There is still significant unmet demand for information and decision support in the context of publicly funded health care. The patient perspective provides a unique insight into issues of design, style and communication.
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Affiliation(s)
- Rachel Iredale
- Institute of Medical Genetics, Cardiff University School of Medicine, Cardiff, UK.
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Surbone A. Cultural aspects of communication in cancer care. Support Care Cancer 2008; 16:235-40. [PMID: 18196291 DOI: 10.1007/s00520-007-0366-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 11/13/2007] [Indexed: 10/22/2022]
Abstract
Cultural competence in oncology requires the acquisition of specific knowledge, clinical skills, and attitudes that facilitate effective cross-cultural negotiation in the clinical setting, thus, leading to improved therapeutic outcomes and decreased disparities in cancer care. Cultural competence in oncology entails a basic knowledge of different cultural attitudes and practices of communication of the truth and of decision-making styles throughout the world. Cultural competence always presupposes oncology professionals' awareness of their own cultural beliefs and values. To be able to communicate with cancer patients in culturally sensitive ways, oncologists should have knowledge of the concept of culture in its complexity and of the risks of racism, classism, sexism, ageism, and stereotyping that must be avoided in clinical practice. Oncologists should develop a sense of appreciation for differences in health care values, based on the recognition that no culture can claim hegemony over others and that cultures are evolving under their reciprocal influence on each other. Medical schools and oncology training can teach communication skills and cultural competence, while fostering in all students and young doctors those attitudes of humility, empathy, curiosity, respect, sensitivity, and awareness that are needed to deliver effective and culturally sensitive cancer care.
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Affiliation(s)
- Antonella Surbone
- Department of Medicine, New York University, New York, NY 10016, USA.
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Abstract
Attitudes and practices of truth-telling to people with cancer have shifted substantially in the past few years. However, cultural and individual differences persist, and some difficulties common to all medical specialties are magnified in oncology. In this Personal View, I review and analyse data for attitudes and practices of truth-telling worldwide. I also assess ethical justifications, with special reference to interpersonal aspects of patients' autonomy and the dynamic nature of truth in the clinical context. Examples are provided to show how this ethical perspective can help oncologists to frame the discourse on truth-telling and to find solutions to the dilemmas of whether, when, and how to tell the truth to their patients in clinical practice. Finally, I identify future targets for research.
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Affiliation(s)
- Antonella Surbone
- Teaching Research Development Department, European School of Oncology, 20122 Milan, Italy.
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Viklund P, Wengström Y, Lagergren J. Supportive care for patients with oesophageal and other upper gastrointestinal cancers: The role of a specialist nurse in the team. Eur J Oncol Nurs 2006; 10:353-63. [PMID: 16807106 DOI: 10.1016/j.ejon.2006.01.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 01/24/2006] [Accepted: 01/30/2006] [Indexed: 11/22/2022]
Abstract
The care pathway of patients with upper gastrointestinal cancers is complex. We retrospectively evaluated the patients' opinions of support and supportive care given by a specialist nurse who led the care of such patients. A study-specific questionnaire addressed the support given by the specialist nurse and other professionals in the team before, during and after treatment. Virtually all 73 responders considered the support of the specialist nurse important (87-94%). This support seemed more appreciated than that of outpatient clinic (P = 0.00) and surgical ward staff (P = 0.01) during the diagnostic phase, and during the follow-up it became more important than that of all other team professionals. A second study-specific questionnaire assessed the supportive care. Of 49 patients, 71-94% completely agreed that the supportive care given by the specialist nurse was satisfactory, and 90-100% considered it important. Whereas 10% had difficulty in understanding physicians' information, none had such problems regarding information given by the nurse (P = 0.09). Review of documented contacts between the specialist nurse and 75 patients with oesophago-gastric cancer revealed that contacts were frequent during follow-up, and nutritional problems predominated. Thus, specialist nurses can be recommended as leaders of the care pathway of patients with upper gastrointestinal cancers.
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Affiliation(s)
- Pernilla Viklund
- Unit of Esophageal and Gastric Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
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Surbone A. Communication preferences and needs of cancer patients: the importance of content. Support Care Cancer 2006; 14:789-91. [PMID: 16541235 DOI: 10.1007/s00520-006-0027-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Accepted: 01/12/2006] [Indexed: 10/24/2022]
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Abstract
Cancer is increasing in incidence and prevalence worldwide, and the WHO has recently included cancer and its treatments as a health priority in developed and developing countries. The cultural diversity of oncology patients is bound to increase, and cultural sensitivity and competence are now required of all oncology professionals. A culturally competent cancer care leads to improved therapeutic outcome and it may decrease disparities in medical care. Cultural competence in medicine is a complex multilayered accomplishment, requiring knowledge, skills and attitudes whose acquisition is needed for effective cross-cultural negotiation in the clinical setting. Effective cultural competence is based on knowledge of the notion of culture; on awareness of possible biases and prejudices related to stereotyping, racism, classism, sexism; on nurturing appreciation for differences in health care values; and on fostering the attitudes of humility, empathy, curiosity, respect, sensitivity and awareness. Cultural competence in healthcare relates to individual professionals, but also to organizations and systems. A culturally competent healthcare system must consider in their separateness and yet in there reciprocal influences social, racial and cultural factors. By providing a framework of reference to interpret the external world and relate to it, culture affects patients' perceptions of disease, disability and suffering; degrees and expressions of concern about them; their responses to treatments and their relationship to individual physicians and to the healthcare system. Culture also influences the interpretation of ethical norms and principles, and especially of individual autonomy, which can be perceived either as synonymous with freedom or with isolation depending on the cultural context. This, in turn, determines the variability of truth-telling attitudes and practices worldwide as well as the different roles of family in the information and decision-making process of the cancer patient. Finally, culture affects individual views of the patient-doctor relationship in different contexts.
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Affiliation(s)
- A Surbone
- Teaching Research Development Department, European School of Oncology, Milan, Italy
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Cox A, Jenkins V, Catt S, Langridge C, Fallowfield L. Information needs and experiences: an audit of UK cancer patients. Eur J Oncol Nurs 2005; 10:263-72. [PMID: 16376146 DOI: 10.1016/j.ejon.2005.10.007] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Revised: 10/06/2005] [Accepted: 10/21/2005] [Indexed: 11/30/2022]
Abstract
As part of a multi-centred UK study evaluating multidisciplinary team communication, the information needs, decision making preferences and information experiences of 394 cancer patients were audited. A majority of patients (342/394, 87%) wanted all possible information, both good and bad news. Assuming that all clinicians had equal skill, the majority of patients (350/394, 89%) expressed no preference for the sex of their doctor. The largest proportion of patients (153/394, 39%) wanted to share responsibility for decision making, preference was significantly influenced by age (chi2=17.42, df=4 P=0.002) with older patients more likely to prefer the doctor to make the decisions. A majority of patients reported receiving information regarding their initial tests (313/314, 100%), diagnosis (382/382, 100%), surgery (374/375, 100%) and prognosis (308/355, 87%), fewer recalled discussions concerning clinical trials (119/280, 43%), family history (90/320, 28%) or psychosocial issues, notably sexual well-being (116/314, 37%). Cancer patients want to be fully informed and share decision making responsibility, but do not report receiving sufficient information in all areas. Multidisciplinary cancer teams need to ensure that where appropriate, someone provides patients with information about clinical trials, familial risk and psychosocial issues. Regular audits highlight gaps and omissions in the information given to patients.
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Affiliation(s)
- Anna Cox
- Cancer Research UK Psychosocial Oncology Group, Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex BN1 9QG, UK
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