Establishment of a nurse-led clinic for late complications after colorectal and anal cancer surgery: a descriptive study

Good Equivalence Between Electronic and Paper Versions of the Measure Yourself Medical Outcome Profile 2 and the Measure Yourself Concerns and Wellbeing: A Mixed Methods Study

Aim/background Measure Yourself Medical Outcome Profile 2 (MYMOP2) and Measure Yourself Concerns and Wellbeing (MyCaW) are two questionnaires that allow patients to define symptoms and concerns that are important to them. As the equivalence between the electronic and paper versions has not been assessed, we aimed to determine the measurement equivalence of electronic and paper versions of MYMOP2 and MYCaW among a group of adult patients treated for colorectal or anal cancer. We also aimed to investigate the patients' experiences of filling out the questionnaires. Methods A mixed methods approach was chosen to investigate measurement equivalence and to ensure a thorough investigation of the patients' experiences. The intra-rater reliability for ordinal data was assessed using the Intraclass Correlation Coefficient (ICC) and median difference. Agreement in descriptive data was assessed by two researchers independently. To capture the patients' experiences, we conducted semi-structured interviews over the phone. Interviews were transcribed verbatim and analyzed with content analysis. Results were presented as themes. Results A total of 30 patients were enrolled consecutively from a sequelae center treating patients after colorectal or anal cancer. Of these, 19 patients were also interviewed. The patients filled out MYMOP2 and MYCaW electronically and on paper. The intra-rater reliability for ordinal data was either excellent (n=11) or good (n=3) with ICCs ranging from 0.85 to 1. The median difference between ordinal data from electronic and paper versions was 0 (range -4 to 4). The agreement between the electronic and paper versions in the descriptive data ranged from 70% to 97%, with three-quarters being over 80%. Three themes emerged from the interviews: personal preferences, the importance of setup, and the availability of the questionnaires. Most patients preferred electronic versions as the advantages of electronic questionnaires outweighed the paper versions. Conclusion We found good intra-rater reliability and agreement in MYMOP2 and MYCaW questionnaires, demonstrating a high measurement equivalence. The interviews provided perspectives on the user experience and showed a preference for the electronic questionnaires as they had more advantages such as availability.

Establishing a Comprehensive Nursing Clinic Using the Case Management Model

OBJECTIVE

To explore the practical effect of the case management model in a comprehensive nursing clinic.

METHODS

Based on the case management model, the authors constructed a comprehensive nursing clinic providing wound care, ostomy care, peripherally inserted central catheter care, drainage tube care, nursing consultations, and home care. They evaluated the practical effect of the comprehensive nursing clinic according to workload, economic benefits, and satisfaction of the medical staff and patients.

RESULTS

Since the inception of the comprehensive nursing clinic, the number of visits has increased by 63.57%, and the satisfaction of patients and medical staff has also improved.

CONCLUSIONS

This comprehensive nursing clinic based on the case management model meets the medical needs of patients, has improved the satisfaction of patients and the medical staff, and enhances the professional sense of value and comprehensive quality of specialized nurses.

Effect of a telephone-based perioperative nurse-led counselling programme on unmet needs, quality of life and sexual function in colorectal cancer patients: A non-randomised quasi-experimental study

PURPOSE

To investigate the effect of perioperative nurse-led counselling intervention on unmet needs, sexual function and quality of life in colorectal cancer patients.

METHOD

This quasi-experimental study included 82 patients who underwent colorectal cancer surgery (control n = 45, intervention n = 37). The telephone-based perioperative nurse-led counselling intervention, which contained implementation, follow-up, and assessment, was applied to start from pre-surgery to post-surgery 3rd month. Data were collected with the Unmet Needs of Cancer Survivors Scale, European Organisation for Treatment and Research of Cancer Quality of Life Scale-30, Colorectal-29, Female Sexual Function Index, and International Index of Erectile Function pre- and post-surgery 3rd-6th months. The control data was collected before the pandemic, and the intervention group throughout the pandemic. The Mann-Whitney-U, Wilcoxon rank test was used.

RESULTS

Compared to the control group, intervention group patients reported lower unmet and total needs scores (p = 0.000); higher quality of life (p = 0.000), physical, emotional (p = 0.000), role (p = 0.001), and social functioning scores (p = 0.002); lower fatigue (p = 0.000), constipation (p = 0.034), pain (p = 0.018), nausea-vomiting (p = 0.004), and insomnia scores (p = 0.003); and higher body image, anxiety (p = 0.000) and weight scores (p = 0.003), lower urinary frequency buttock pain (p = 0.000), dysuria (p = 0.001), abdominal pain (p = 0.001), fluctuance (p = 0.000), stool frequency (p = 0.002), and faecal incontinence (p = 0.006) scores at the sixth month (p < 0.05). There were no statistically significant differences between male and female sexual function scores (p > 0.05).

CONCLUSIONS

Perioperative nurse-led counselling reduced unmet needs and increased the overall quality of life by decreasing symptom levels but did not affect sexual health outcomes in patients with colorectal cancer surgery.

Erectile Dysfunction Is Common after Rectal Cancer Surgery: A Cohort Study

Erectile dysfunction is a known late complication following surgery for rectal cancer. We aimed to determine the prevalence of erectile dysfunction after rectal cancer surgery and characterize it. This was a prospective observational cohort study. Data from men after surgery for rectal cancer were collected between October 2019 and April 2023. The primary outcome was the prevalence of erectile dysfunction following surgery based on the International Index of Erectile Function questionnaires, IIEF-5 and 15. Secondary outcomes were prevalence in subgroups and self-perceived erectile function. In total, 101 patients agreed to participate, while 67 patients (67%) responded after a median six-month follow-up after surgery. Based on IIEF-15, 84% of the patients had erectile dysfunction. For subgroups, 74% of patients who underwent robot-assisted surgery had erectile dysfunction, whereas all patients who underwent either laparoscopic or open surgery had erectile dysfunction (p = 0.031). Furthermore, half of the patients rated their self-perceived ability to obtain and keep an erection as very low. In conclusion, in our cohort, erectile dysfunction was common after rectal cancer surgery, and half of the patients were unconfident that they could obtain and keep an erection. Information regarding this finding should be given so that patients feel comfortable discussing therapeutic solutions if needed.

Exploring Patients' Perspectives on Late Complications after Colorectal and Anal Cancer Treatment: A Qualitative Study

BACKGROUND

Patients often experience late complications following treatment for colorectal and anal cancer. Although several measurement tools exist to classify the severity of these symptoms, little is known about how patients personally experience and adapt to these complications. This study aimed to investigate patients' experiences and coping strategies in relation to these symptoms.

METHODS

We conducted an explorative qualitative interview study to gather data.

RESULTS

Our findings revealed two main categories: How patients react after treatment for colorectal and anal cancer, and Experienced symptoms. Additionally, we identified four sub-categories: the period after discharge, coping strategies, stool symptoms, and other symptoms. Patients commonly feel abandoned once their surgical and oncological treatments are completed. It is typical for patients to turn to the internet for guidance on managing late complications, despite being aware that evidence-based options are limited. Stool-related issues significantly impact patients' personal and professional lives, requiring constant preparedness for accidents, the use of diapers, and the need for extra clothing at all times. Furthermore, patients experience additional troublesome symptoms such as urinary incontinence, fatigue, pain, and sexual dysfunction, which further affect their daily lives.

CONCLUSIONS

Patients experience multiple problems after colorectal cancer surgery, and this warrants more focused attention.

Providing Leadership Through Patients as Partners: Improving Australian Colorectal Survivorship Care Through Perspectives from a Nurse Who Became a Cancer Patient

OBJECTIVE

To provide contemporary real-world, real-life insights into gaps in supportive care experiences for people affected by colorectal cancer. For the first time, this article includes a patient as a coauthor, with the aim to identify future priorities to improve care and recovery in colorectal cancer survivorship.

DATA SOURCES

Electronic databases, peer-reviewed literature, and real-life professional and personal experiences were used.

CONCLUSION

There are several problematic areas in providing supportive care for people affected by colorectal cancer that could be improved by wider access to colorectal specialist nurses, coordinated multidisciplinary teams, patient collaboration, linking survivorship care outcomes to national standards, and developing supported self-management care plans.

IMPLICATIONS FOR NURSING PRACTICE

A patient-led insight has underscored some fundamental failings in current service delivery among people affected by colorectal cancer. Partnering with consumers in research and service redesign is essential to stratify future priorities to optimize care and person-centered recovery.