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Breistig S, Thorkildsen KM, Tveit Sekse RJ. Gynecological Cancer Survivors' Experiences and Desire for Follow-up After Recent Treatment: A Phenomenological Hermeneutic Study. Cancer Nurs 2024; 47:E327-E335. [PMID: 37272739 DOI: 10.1097/ncc.0000000000001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Gynecological cancer survivors experience a variety of challenges after discharge from hospital treatment. Cancer support and rehabilitation are recognized as significant facilitators for quality of life in survivorship but are reported to be insufficient by gynecological cancer survivors. OBJECTIVE To describe the lived experiences of gynecological cancer survivors and how their needs for follow-up should be met following recently completed treatment. METHOD This study used a phenomenological hermeneutic design with individual in-depth interviews with 20 women after recently completed cancer treatment. Transcribed interviews were analyzed with the Lindseth and Norberg phenomenological hermeneutic method. RESULTS Four themes were identified: "a brutal transition to life after cancer," "fear of recurrence overshadowing the existence," "a need for professional support," and "information is not given unless asked for." CONCLUSION After completing gynecological cancer treatment, the fear of cancer recurrence is dominating, regardless of prognosis and diagnosis. At the same time, information and support from healthcare professionals are described as lacking. Participants expressed a need to be contacted directly as a formal routine by healthcare professionals after cancer treatment with cancer-specific information as this may alleviate the existential suffering that the cancer experience brings. IMPLICATIONS FOR CLINICAL PRACTICE A person-centered, systematic follow-up rehabilitation is needed as a continuation of the care provided during cancer treatment. Future research is needed to explore the impact on women's quality of life when gynecologic-specific information is given in advance of hospital discharge after completing treatment.
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Affiliation(s)
- Sigrund Breistig
- Author Affiliations: Centre of Diaconia and Professional Practise (Ms Breistig) and Faculty of Health Sciences (Dr Tveit Sekse), VID Specialized University, Bergen; Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Stord (Dr Thorkildsen); and Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen (Dr Tveit Sekse), Norway
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Mandato VD, Paterlini M, Torricelli F, Rabitti E, Mastrofilippo V, Aguzzoli L. Perceived social support and quality of life in endometrial cancer patients: a longitudinal study. Front Oncol 2024; 14:1447644. [PMID: 39156703 PMCID: PMC11327120 DOI: 10.3389/fonc.2024.1447644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
Objective This study aimed to assess the influence of medical history, perceived physician-patient communication, and perceived social support on changes in the quality of life (QoL) during the first year of follow-up in patients undergoing surgery for endometrial cancer (EC), the most prevalent gynecological cancer in Western countries, especially in Central and Eastern Europe and North America. Methods This prospective longitudinal study included 98 EC patients. All participants completed the Short Form 36 (SF-36) and the Multidimensional Scale of Perceived Social Support (MSPSS) one month and one year after surgery. Additionally, one month after surgery, they responded to a questionnaire designed by the researchers concerning the key aspects of physician-patient communication. Results Our findings revealed that patients reporting high social support one month after surgery demonstrated significantly improved emotional well-being (EWB) at both one month and one year after the surgery, with statistically significant higher scores in the dimension of EWB (p<0.05). The support from a significant other at one year correlates with greater PF (p<0.005), fewer limitations due to physical health (p<0.05), less pain (p<0.05), less fatigue (p<0.05), and better general and EWB (p<0.05). Conclusion This study underscores the significance of perceived social support for patients cross endometrial cancer. The multifaceted nature of social support, encompassing emotional assistance and information sharing, emerges as a pivotal factor aiding patients in confronting the challenges inherent to EC. This form of support contributes to bolstering psychological well-being and enhancing overall QoL.
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Affiliation(s)
- Vincenzo Dario Mandato
- Obstetrics and Gynecological Oncology, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Marcella Paterlini
- Department of Obstetrics and Pediatrics, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Rabitti
- Psycho-oncology Unit, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina Mastrofilippo
- Obstetrics and Gynecological Oncology, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Obstetrics and Gynecological Oncology, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
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Voigt KR, Wullaert L, van Driel MHE, Goudberg M, Doornebosch PG, Schreinemakers JMJ, Verseveld M, Peeters KCMJ, Verhoef C, Husson O, Grünhagen DJ. The association of cognitive coping style with patient preferences in a patient-led follow-up study among colorectal cancer survivors. Support Care Cancer 2024; 32:564. [PMID: 39088088 PMCID: PMC11294378 DOI: 10.1007/s00520-024-08758-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Amidst the rising number of cancer survivors and personnel shortages, optimisation of follow-up strategies is imperative, especially since intensive follow-up does not lead to survival benefits. Understanding patient preferences and identifying the associated patient profiles is crucial. Coping style may be a key determinant in achieving this. Our study aims to evaluate preferences, identify coping styles and their associated factors, and explore the association between coping style and patients' preferences in colorectal cancer (CRC) follow-up. METHODS In a prospective multicentre implementation study, patients completed the Threatening Medical Situations Inventory (TMSI) to determine their coping style. Simultaneously patients choose their follow-up preferences for the CRC trajectory regarding frequency of tumour marker determination, location of blood sampling, and manner of contact. RESULTS A total of 188 patients completed the TMSI questionnaire after inclusion. A more intensive follow-up was preferred by 71.5% of patients. Of all patients, 52.0% had a coping style classified as 'blunting' and 34.0% as 'monitoring'. Variables such as a younger age, female gender, higher educational level, and lower ASA scores were associated with having higher monitoring scores. However, there were no significant associations between follow-up preferences and patients' coping styles. CONCLUSION This study suggests that none of the provided options in a patient-led follow-up are unsuitable for patients who underwent curative surgery for primary CRC, based on coping style determined at baseline. Low-intensity surveillance after curative resection of CRC may, therefore, be suitable for a wide range of patients independent of coping styles.
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Affiliation(s)
- Kelly R Voigt
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Lissa Wullaert
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - M H Elise van Driel
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Max Goudberg
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Pascal G Doornebosch
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel,, The Netherlands
| | | | - Maria Verseveld
- Department of Surgery, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Olga Husson
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, 1066 CX, Amsterdam, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
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Corish S, Fulton BA, Galbraith L, Coltart K, Duffton A. Impact of patient information format on the experience of cancer patients treated with radiotherapy. Tech Innov Patient Support Radiat Oncol 2024; 30:100252. [PMID: 38779037 PMCID: PMC11109017 DOI: 10.1016/j.tipsro.2024.100252] [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] [Received: 11/07/2023] [Revised: 04/23/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Radiotherapy (RT) stands as one of the main cancer treatments. The impact of RT and cancer treatment can have a physical and psychological impact on patients and their carers. To gain patient's trust, and ensure they feel valued, information should be provided before, during, and after RT. Patient and public involvement (PPI) has been lacking, and increased engagement with PPI groups could improve this. This rapid review aims to analyse the literature, and describe and report patient perception, experience, and satisfaction regarding the information received concerning their course of RT. Methods To allow the synthesis of results, a pragmatic decision was made to use a rapid review approach to analyse the literature, providing more timely information to inform future work. This rapid review utilised systematic review methods and was conducted according to a pre-defined protocol including clear inclusion criteria (PROSPERO registration: CRD42023415916).Electronic databases CINAHL, AMED, Pubmed/MEDLINE, EMBASE, and PsycINFO were searched using a comprehensive search for published studies from January 2012 to November 2023. Two independent reviewers applied the eligibility criteria. Evidence from literature was extracted and transcribed into qualitative data and Braun and Clarke's six-step thematic analysis (TA) was employed to determine themes by one reviewer and checked by a second [26]. Due to the heterogeneity of the included literature, the analysis of this review is presented primarily through narrative synthesis. Results Sixty eight articles met the inclusion criteria for this review. Emerging themes included; a desire for information based on patient characteristics, information format, patient preparedness, timing e.g. timing of information and changing priorities over time, health care professional (HCP) involvement, barriers to information, and motivators for better information delivery. Conclusions Several factors can influence a patient's desire for information, from whom and when they receive it, to what format they would prefer to receive it. There is benefit to be gained in employing PPI and patient advocacy to inform future studies that aim to further understand the themes that emerged from this review. Such studies can therefore inform HCPs in providing patient-specific information and support by utilising multiple teaching strategies available to them.
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Affiliation(s)
| | - Ben A Fulton
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | - Aileen Duffton
- Beatson West of Scotland Cancer Centre, Glasgow, UK
- Institute of Cancer Science, University of Glasgow, UK
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Elkefi S, Asan O. The health information technology preferences and perceptions of newly diagnosed patients with cancer. Int J Med Inform 2023; 180:105275. [PMID: 37922660 PMCID: PMC10872609 DOI: 10.1016/j.ijmedinf.2023.105275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND & GOALS Patients with new cancer diagnoses have unique needs. In this study, we explored the technological needs and preferences of new cancer patients and the challenges to technology use among these patients. METHODS We used qualitative data from semi-structured interviews to identify the new cancer patients' technology preferences. Interviews were recorded and then transcribed verbatim. A thematic analysis was conducted to identify the technology perceptions of new cancer patients, their technology needs, and the challenges of technology. RESULTS Most of the patients preferred mhealth technologies over other types of technologies to be used in their care management. The primary needs related to potential features in these technologies include access to information just in time, convenience, access to home care, self-management, privacy, interaction, and personalization. Patients also reported challenges of current technologies they utilized, including usability, impersonality, interoperability, and cost-effectiveness. CONCLUSION Addressing patients' needs to increase uptake and efficient use of technologies in cancer care is critical. Growing clinical and consumer informatics technologies can potentially help cancer management if designed by employing user-centered approaches.
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Affiliation(s)
- Safa Elkefi
- School of Nursing, Columbia University Irving Medical Center, Columbia University, NY, USA.
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ 07047, USA.
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Voigt KR, Wullaert L, Höppener DJ, Schreinemakers JMJ, Doornebosch PG, Verseveld M, Peeters K, Verhoef C, Husson O, Grünhagen D. Patient-led home-based follow-up after surgery for colorectal cancer: the protocol of the prospective, multicentre FUTURE-primary implementation study. BMJ Open 2023; 13:e074089. [PMID: 37827744 PMCID: PMC10582858 DOI: 10.1136/bmjopen-2023-074089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third most common type of cancer in the Netherlands. Approximately 90% of patients can be treated with surgery, which is considered potentially curative. Postoperative surveillance during the first 5 years after surgery pursues to detect metastases in an early, asymptomatic and treatable stage. Multiple large randomised controlled trials have failed to show any (cancer-specific) survival benefit of intensive postoperative surveillance compared with a minimalistic approach in patients with CRC. This raises the question whether an (intensive) in-hospital postoperative surveillance strategy is still warranted from both a patient well-being and societal perspective. A more modern, home-based surveillance strategy could be beneficial in terms of patients' quality of life and healthcare costs. METHODS AND ANALYSIS The multicentre, prospective FUTURE-primary study implements a patient-led home-based surveillance after curative CRC treatment. Here, patients are involved in the choice regarding three fundamental aspects of their postoperative surveillance. First regarding frequency, patients can opt for additional follow-up moments to the minimal requirement as outlined by the current Dutch national guidelines. Second regarding the setting, both in-hospital or predominantly home-based options are available. And third, concerning patient-doctor communication choices ranging from in-person to video chat, and even silent check-ups. The aim of the FUTURE-primary study is to evaluate if such a patient-led home-based follow-up approach is successful in terms of quality of life, satisfaction and anxiety compared with historic data. A successful implementation of the patient-led aspect will be assessed by the degree in which the additional, optional follow-up moments are actually utilised. Secondary objectives are to evaluate quality of life, anxiety, fear of cancer recurrence and cost-effectiveness. ETHICS AND DISSEMINATION Ethical approval was given by the Medical Ethics Review Committee of Erasmus Medical Centre, The Netherlands (2021-0499). Results will be presented in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05656326.
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Affiliation(s)
- Kelly Raquel Voigt
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Lissa Wullaert
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Diederik J Höppener
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, The Netherlands
| | | | - Pascal G Doornebosch
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Maria Verseveld
- Department of Surgery, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Koen Peeters
- Department of Surgery, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Olga Husson
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dirk Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, The Netherlands
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DeMari JA, Dressler EV, Foraker RE, Wells BJ, Smith S, Klepin H, Hundley WG, Lesser GJ, Shalowitz DI, Nightingale CL, Hernandez M, Weaver KE. Endometrial cancer survivors' perceptions of their cardiovascular disease risk (results from WF-1804CD AH-HA). Gynecol Oncol 2023; 174:208-212. [PMID: 37224793 PMCID: PMC10330616 DOI: 10.1016/j.ygyno.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Despite considerable burden of cardiovascular disease (CVD), data on endometrial cancer survivors' CVD perceptions are lacking. We assessed survivors' perspectives on addressing CVD risk during oncology care. METHODS This cross-sectional analysis utilized data from an ongoing trial of an EHR heart health tool (R01CA226078 & UG1CA189824) conducted through the NCI Community Oncology Research Program (NCORP, WF-1804CD). Endometrial cancer survivors post-potentially curative treatment were recruited from community practices and completed a pre-visit baseline survey, including American Heart Association Simple 7 CVD factors. Likert-type questions assessed confidence in understanding CVD risk, CVD risk perception, and desired discussion during oncology care. Medical record abstraction ascertained data on CVD and cancer characteristics. RESULTS Survivors (N = 55, median age = 62; 62% 0-2 years post-diagnosis) were predominately white, non-Hispanic (87%). Most agreed/strongly agreed heart disease poses a risk to their health (87%) and oncology providers should talk to patients about heart health (76%). Few survivors reported smoking (12%) but many had poor/intermediate values for blood pressure (95%), body mass index (93%), fasting glucose/A1c (60%), diet (60%), exercise (47%) and total cholesterol (53%). 16% had not seen a PCP in the last year; these survivors were more likely to report financial hardship (22% vs 0%; p = 0.02). Most reported readiness to take steps to maintain or improve heart health (84%). CONCLUSIONS Discussions of CVD risk during routine oncology care are likely to be well received by endometrial cancer survivors. Strategies are needed to implement CVD risk assessment guidelines and to enhance communication and referrals with primary care. Clinical Trials #: NCT03935282.
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Affiliation(s)
- Joseph A DeMari
- Section on Gynecologic Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America.
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Randi E Foraker
- Department of Medicine, Washington University in St. Louis School of Medicine, St Louis, MO, United States of America
| | - Brian J Wells
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Sydney Smith
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Heidi Klepin
- Section on Hematology-Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - William G Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Glenn J Lesser
- Section on Hematology-Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - David I Shalowitz
- Section on Gynecologic Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Marcia Hernandez
- Department of Women's Oncology, Mercy Hospital, Springfield, MO, United States of America
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
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Wullaert L, Voigt KR, Verhoef C, Husson O, Grünhagen DJ. Oncological surgery follow-up and quality of life: meta-analysis. Br J Surg 2023; 110:655-665. [PMID: 36781387 PMCID: PMC10364539 DOI: 10.1093/bjs/znad022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/23/2022] [Accepted: 01/10/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Previous trials found that more intensive postoperative surveillance schedules did not improve survival. Oncological follow-up also provides an opportunity to address psychological issues (for example anxiety, depression, and fear of recurrence). This systematic review assessed the impact of a less intensive surveillance strategy on health-related quality of life (HRQoL), emotional well-being, and patient satisfaction. METHODS A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, Cochrane database, PsycINFO, and Google Scholar to identify studies comparing different follow-up strategies after oncological surgery and their effect on HRQoL and patient satisfaction, published before 4 May 2022. A meta-analysis was conducted on the most relevant European Organisation for Research and Treatment of Cancer QLQ-C30 and Hospital Anxiety and Depression Scale subscales. RESULTS Thirty-five studies were identified, focusing on melanoma (4), colorectal (10), breast (7), prostate (4), upper gastrointestinal (4), gynaecological (3), lung (2), and head and neck (1) cancers. Twenty-two studies were considered to have a low risk of bias, of which 14 showed no significant difference in HRQoL between follow-up approaches. Five studies with a low risk of bias showed improved HRQoL or emotional well-being with a less intensive follow-up approach and three with an intensive approach. Meta-analysis of HRQoL outcomes revealed no negative effects for patients receiving less intensive follow-up. CONCLUSION Low-intensity follow-up does not diminish HRQoL, emotional well-being, or patient satisfaction.
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Affiliation(s)
- Lissa Wullaert
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Kelly R Voigt
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Olga Husson
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.,Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Sangeorzan I, Andriopoulou P, Davies BM, McNair A. The information needs of people with degenerative cervical myelopathy: A qualitative study to inform patient education in clinical practice. PLoS One 2023; 18:e0285334. [PMID: 37205664 DOI: 10.1371/journal.pone.0285334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/20/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Individuals with lifelong illnesses need access to adequate information about their condition to make optimal health decisions. Degenerative Cervical Myelopathy (DCM) is the most common form of spinal cord dysfunction in adults worldwide. Its chronic and debilitating nature, varied impact, clinical trajectory, and management options necessitate appropriate informational support to sustain effective clinical and self-directed care strategies. However, before clinicians can meet patients' information needs, they must first have an understanding of their baseline requirements. This study explores the information needs of people with DCM (PwCM). In doing so, it provides a starting point for the development of patient education and knowledge management strategies in clinical practice. METHODS Semi-structured interviews with PwCM were conducted using an interview guide. Interviews were audio-recorded and transcribed verbatim. Thematic analysis according to Braun and Clarke's six-phase approach was used to analyse the data. Findings were reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. RESULTS Twenty PwCM (65% female, 35% male), with ages ranging from 39 to 74 years old participated in the interviews. The findings indicated that the provision of information to PwCM during clinical interactions varies. Accordingly, PwCM's information needs were broad-ranging, as was the nature of the information they found useful. Three main themes were identified (1) Variation in the provision of information to PwCM during clinical interactions, (2) Variations in the information needs of PwCM, and (3) Information that PwCM find useful. CONCLUSION Efforts must turn to adequately educating patients at the time of the clinical encounter. A comprehensive and consistent patient-centered information exchange in DCM is necessary to achieve this.
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Affiliation(s)
| | | | - Benjamin M Davies
- Myelopathy.org, Cambridge, Cambridgeshire, United Kingdom
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
| | - Angus McNair
- Centre for Surgical Research, Bristol Medical School, University of Bristol, United Kingdom
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Fahmer N, Faller H, Engehausen D, Hass HG, Reuss-Borst M, Duelli K, Wöckel A, Heuschmann PU, Meng K. Patients' challenges, competencies, and perceived support in dealing with information needs - A qualitative analysis in patients with breast and gynecological cancer. PATIENT EDUCATION AND COUNSELING 2022; 105:2382-2390. [PMID: 34930628 DOI: 10.1016/j.pec.2021.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to investigate challenges, competencies, and support in breast and gynecological cancer patients when dealing with information needs and how health literacy as an interplay of these factors might be improved. METHODS Semi-structured interviews were conducted with patients in acute care (n = 19), undergoing rehabilitation (n = 20) or attending self-help groups (n = 16). Interviews were analyzed using content analysis. RESULTS Challenges: gain information according to own needs, internet as information source, information evaluation and decisions, doctor-patient communication, situationally limited information processing, difficult access to information. Competencies: self-regulation of information needs, media and social competencies, communication skills in the doctor-patient conversation, internet competencies, self-directed decisions according to own needs, interest/self-efficacy, previous knowledge, trust in the doctor. SUPPORT by professionals (e.g., patient-centered communication), relatives (e.g., support during consultations), peers (e.g., exchange), facilities (e.g., clinics). CONCLUSIONS Our findings provide insight into challenges and competencies relevant to patients' health literacy and the influence of support. The individuality of the interplay highlights the relevance of an active patient role and patient-centered care. PRACTICE IMPLICATIONS Patients' health literacy should be improved in (psycho)oncological work by both reducing challenges (e.g., by communication skills training, involving relatives) and promoting competencies (e.g., by needs- and competence-oriented information offers).
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Affiliation(s)
- Natascha Fahmer
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany.
| | - Hermann Faller
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany
| | | | - Holger G Hass
- Paracelsus Clinic Scheidegg, 88175 Scheidegg, Germany
| | - Monika Reuss-Borst
- Center for Rehabilitation and Prevention Bad Bocklet, 97708 Bad Bocklet, Germany
| | - Kristin Duelli
- Department of Gynecology and Obstetrics, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Karin Meng
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany
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11
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Who Knows? Information Received, and Knowledge about, Cancer, Treatment and Late Effects in a National Cohort of Long-Term Childhood, Adolescent and Young Adult Cancer Survivors. Cancers (Basel) 2022; 14:cancers14061534. [PMID: 35326685 PMCID: PMC8946204 DOI: 10.3390/cancers14061534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary With the growing population of cancer survivors, survivorship management has become central for both medical professionals and patients. This entails, among other factors, empowering survivors with the necessary knowledge about their medical history and their risk for late effects, because informed patients make better lifestyle and health choices. Although a lack of information and low satisfaction with information received are fairly well-documented phenomena among childhood cancer survivors, less is known about survivors of young adult cancer and populations of long-term survivors no longer engaged in follow-up care. This paper aims to fill this gap by investigating information provision in childhood, adolescent and young adult cancer survivors. Abstract Background: Knowledge of medical history and late effects is central in modern survivorship management, especially for long-term childhood, adolescent and young adult cancer survivors’ (CAYACS) with long life expectancy rates and high risks of late effects. Identifying information and knowledge gaps is, therefore, important. As part of the population-based NOR-CAYACS study, we investigated the following: (1) written information received about their disease and treatment, and any information about late effects; (2) satisfaction with this information and associated factors; (3) knowledge about late effects and factors associated with low knowledge of specific late effects. Material and methods: A questionnaire-based survey (Nor-CAYACS) was mailed to 5361 CAYACS (childhood cancers, breast and colorectal cancer, acute lymphatic leukemia, non-Hodgkin lymphoma and malignant melanoma) identified by the Cancer Registry of Norway (CRN). Of these, 2018 answered questions about disease and late effects information and knowledge. Exposure variables were extracted from the questionnaire and CRN. Unfortunately, it was not possible to stratify by treatment in the analyses. We ran descriptive statistics for comparisons and logistic regressions to identify factors associated with outcomes of interest. Results: Overall, 50% to 60% of survivors reported not having received written information about their disease and treatment, or any information about late effects. There was a large variation in reported knowledge across 17 late effects. Lower levels of knowledge were associated with male sex, lower education and poorer health literacy in multivariable regression models. Conclusions: Knowledge of cancer history and risks of late effects is essential for effective self-management, yet significant information and knowledge gaps were reported in this population-based sample of long-term CAYACS. Systematic approaches to making (up-to-date) information available to long-term survivors are needed to ensure that information does not get lost in medical and life transitions.
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12
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Hwang S, Bozkurt B, Huson T, Asad S, Richardson L, Ogbansiegbe JA, Viera L, Buse C, James TA, Mayer DK, Shulman LN, Birken SA. Identifying Strategies for Robust Survivorship Program Implementation: A Qualitative Analysis of Cancer Programs. JCO Oncol Pract 2022; 18:e304-e312. [PMID: 34606296 PMCID: PMC8932497 DOI: 10.1200/op.21.00357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The Commission on Cancer seeks to promote robust survivorship programs among accredited cancer programs. In practice, cancer programs' survivorship programs range from cursory (eg, developing care plans without robust services) to robust (eg, facilitating follow-up care). To inform cancer programs' future efforts, in this study, we identified the implementation strategies that cancer programs used to achieve robust survivorship programs, distinguishing them from cursory programs. METHODS We sampled 39 cancer programs across the United States with approaches to survivorship program implementation ranging from cursory to robust on the basis of LIVESTRONG survivorship care consensus elements. Within sampled cancer programs, we conducted in-depth semistructured interviews with a total of 42 health care professionals. We used template analysis to distinguish implementation strategies used in cancer programs with robust survivorship programs from strategies that yielded cursory survivorship programs. RESULTS Cancer programs with robust survivorship programs established clear systems survivorship care and formal committees to improve the survivorship care processes. They sought buy-in from multiple stakeholders to leverage cancer program resources and defined clear roles with shared accountability among multidisciplinary groups. By contrast, cancer programs with cursory survivorship programs reported less consistency in survivorship care processes and lacked buy-in from key stakeholders. They had limited resources, faced persistent structural concerns, and had insufficient clarity in roles among team members. CONCLUSION Accrediting bodies may consider incorporating the implementation strategies that robust survivorship programs have used as guidance for supporting cancer programs in operationalizing survivorship care and evaluating the use of these strategies during the accreditation and review process.
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Affiliation(s)
- Soohyun Hwang
- Health Policy and Management, University of North Carolina Chapel Hill, Chapel Hill, NC,Soohyun Hwang, MPH, Health Policy and Management, University of North Carolina Chapel Hill, 135 Dauer Drive, Chapel Hill, NC;
| | - Burcu Bozkurt
- Health Policy and Management, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Tamara Huson
- Health Policy and Management, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Sarah Asad
- Health Policy and Management, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Lauren Richardson
- Health Policy and Management/Kenan-Flagler Business School, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Laura Viera
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caroline Buse
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ted A. James
- Breast Center/Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Deborah K. Mayer
- University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Sarah A. Birken
- Wake Forest University School of Medicine, Winston-Salem, NC
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13
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Afiyanti Y, Milanti A, Rosdiana M, Juliastuti D. Deficient Health Care Services as Barriers to Meet Care Needs of Gynecological Cancer Survivors in Indonesia: A Qualitative Inquiry. Semin Oncol Nurs 2021; 37:151206. [PMID: 34465499 DOI: 10.1016/j.soncn.2021.151206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/23/2021] [Accepted: 07/31/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study aimed to gain insight into the unmet care needs and health care service barriers experienced by Indonesian gynecological cancer survivors after cancer therapy. DATA SOURCES Twenty purposively selected women who had completed gynecological cancer therapy for at least 1 year participated in a descriptive qualitative study. Data were collected through in-depth interviews and thematically analyzed. CONCLUSION The analysis constructed two themes and seven subthemes: (a) unmet care needs (subthemes: late side effects; cancer recurrence; stigma of cancer transmission; social-economic concerns), (b) deficient functions of health care services (subthemes: short consultation time; unempathetic health professionals; and inefficient time and cost for the health care services). The gynecological cancer survivors experienced shortages of informational, psychological, and socioeconomic support after cancer therapy because of the deficient quality of the health care services. IMPLICATION FOR NURSING PRACTICE Nursing interventions could mitigate the unmet care needs of gynecological cancer survivors after cancer therapy through patient-centered care services and multidisciplinary collaboration.
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Affiliation(s)
- Yati Afiyanti
- Faculty of Nursing, Universitas Indonesia, Depok, Indonesia.
| | - Ariesta Milanti
- Nethersole School of Nursing, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Meyke Rosdiana
- Faculty of Nursing, Universitas Indonesia, Depok, Indonesia; Nursing Program, Sekolah Tinggi Ilmu Kesehatan Stella Maris, Makassar, Indonesia
| | - Dyah Juliastuti
- Nursing Program, Sekolah Tinggi Ilmu Kesehatan Ichsan Medical Center Bintaro, South Tangerang, Indonesia
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14
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Abstract
Introduction The internet is an important source of health information, and yet the quality of the resources that patients’ access can vary widely. Previous research has evaluated the quality of information for several types of cancer; however, this has not yet been done for cervical cancer beyond treatment information. The goal of this project was to systematically evaluate the quality of resources for cervical cancer information available against a range of metrics, including content breadth and accuracy, readability, and accountability. Methods An internet search was performed using the term “cervical cancer” using Google and two meta-search engines, Dogpile and Yippy. The top-100 websites returned across all three engines were evaluated using a validated structured rating tool. Results Only 32% of websites disclosed their author and only 38% used citations, while 64% of websites had been updated in the last two years. Readability was at university-level or higher for 19% of websites, and high-school level for 78%. Coverage was highest for etiology and risk factors (93% of websites) and prevention strategies such as pap smears and vaccines (92%); coverage was lowest for prognosis (49%), staging (52%), side effects (47%), and follow-up (25%). When a topic was covered the information was predominantly accurate, and few websites had inaccurate information. At least one social-media platform was linked to by 79% of websites. Conclusions This project highlights the strengths and limitations in the quality of the top-100 informational cervical cancer websites. These findings can inform the dialogue between health care providers and patients around selecting and evaluating information resources. These findings can also inform specific improvements to make online resources for cervical cancer more accessible, comprehensive, and relevant to patients.
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Affiliation(s)
- Jessica Q Dawson
- Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, CAN
| | - Janine M Davies
- Medical Oncology, British Columbia Cancer Agency, Vancouver, CAN.,Faculty of Medicine, University of British Columbia, Vancouver, CAN
| | - Paris-Ann Ingledew
- Radiation Oncology, British Columbia Cancer Agency, Vancouver, CAN.,Surgery, Faculty of Medicine, University of British Columbia, Vancouver, CAN
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15
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Birken SA, Raskin S, Zhang Y, Lane G, Zizzi A, Pratt-Chapman M. Survivorship Care Plan Implementation in US Cancer Programs: a National Survey of Cancer Care Providers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:614-622. [PMID: 29948925 PMCID: PMC6294719 DOI: 10.1007/s13187-018-1374-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Survivorship care plans (SCPs)-documents intended to improve care for cancer survivors who have completed active treatment-are required, yet implementation is poor. We sought to understand SCP implementation in cancer programs in the USA with the objective of identifying opportunities for improvement. We recruited cancer care providers in the USA via several cancer care networks to participate in a survey regarding SCP implementation. We used descriptive statistics to analyze the data. Three hundred ninety-five providers from diverse cancer programs in 47 states and Washington, DC responded to the survey. The timing of SCP implementation varied across and within cancer programs, with approximately 40% of respondents reporting developing SCPs more than 3 months after primary treatment or adjuvant therapy completion. Nurse navigators were responsible for 48-58% of each stage of SCP implementation. Processes that could have been automated often occurred in-person or via phone and vice versa. Respondents reported spending more than 2 h per SCP to complete all stages of implementation, of which less than a third was reimbursed by third-party payers. We identified several opportunities for improving SCP implementation, including broadening the base of responsibility, optimizing modes of communication, decreasing the time required and increasing the funding available, and limiting variation in SCP implementation across and within cancer programs. Future work should assess the influence of approaches to SCP implementation on desired outcomes.
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Affiliation(s)
- Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
| | - Sarah Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | - Yuqing Zhang
- Institute for Patient-Centered Initiatives & Health Equity, The George Washington University Cancer Center, Washington, DC, USA
| | - Gema Lane
- Institute for Patient-Centered Initiatives & Health Equity, The George Washington University Cancer Center, Washington, DC, USA
| | - Alexandra Zizzi
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA
| | - Mandi Pratt-Chapman
- Institute for Patient-Centered Initiatives & Health Equity, The George Washington University Cancer Center, Washington, DC, USA
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16
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Thong MSY, Mols F, Kaptein AA, Boll D, Vos C, Pijnenborg JMA, van de Poll-Franse LV, Ezendam NPM. Illness perceptions are associated with higher health care use in survivors of endometrial cancer-a study from the population-based PROFILES registry. Support Care Cancer 2019; 27:1935-1944. [PMID: 30215142 DOI: 10.1007/s00520-018-4451-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/30/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVES According to the Common Sense Model of self-regulation, cancer survivors construct perceptions of their illness as a (mal)adaptive mechanism. These perceptions might impact on health care use. We aimed to explore the association between illness perceptions and health care use in stage I-II endometrial cancer (EC) survivors, and whether these associations differed by time since diagnosis. METHODS A survey was conducted in 2008 by the population-based PROFILES registry among EC survivors diagnosed between 1999 and 2007. Survivors (n = 742, 77% response) completed the Brief Illness Perception Questionnaire (BIPQ) and questions on health care use in the past 12 months. Clinical data were accessed from the Netherlands Cancer Registry. Multiple logistic regression was used to evaluate the relationship between illness perceptions and health care use. RESULTS Between 15 and 22% of the survivors had negative illness perceptions. Survivors with more negative perceptions on consequences, timeline, treatment control, identity, cognitive representation, concern, emotion, and emotional representation were more likely to make ≥ 1 visit to their family physician/general practitioner in relation to their cancer when compared with survivors with more positive illness perceptions. More negative perceptions on consequences, timeline, identity, and concern were associated with ≥ 2 general or cancer-related visits to the medical specialists. The association between negative illness perceptions and health care use was more prominent among long-term (>5 years post-diagnosis) EC survivors. CONCLUSIONS Negative illness perceptions among EC survivors were associated with higher health care use. For individuals with maladaptive illness perceptions, visits to their health care provider may reduce worry about their illness. Future research might address the effects of intervening in maladaptive illness perceptions on use of health care in this category of survivors.
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Affiliation(s)
- Melissa S Y Thong
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location AMC, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Floortje Mols
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Adrian A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorry Boll
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Caroline Vos
- Department of Obstetrics and Gynecology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lonneke V van de Poll-Franse
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nicole P M Ezendam
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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17
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Faller H, Hass HG, Engehausen D, Reuss-Borst M, Wöckel A. Supportive care needs and quality of life in patients with breast and gynecological cancer attending inpatient rehabilitation. A prospective study. Acta Oncol 2019; 58:417-424. [PMID: 30632891 DOI: 10.1080/0284186x.2018.1543947] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Among patients with breast or gynecological cancer, supportive care needs are both highly prevalent and enduring. However, little is known about whether meeting patients' needs is accompanied by increased quality of life (QoL). We aimed to explore patients' supportive care needs reported at the beginning of inpatient rehabilitation and examined whether meeting these needs resulted in improved QoL. MATERIAL AND METHODS In a multicenter, prospective cohort study with 2 measurement occasions (beginning and end of inpatient rehabilitation), 292 patients with breast and gynecological cancer (mean age 55 years; 71% breast cancer) were enrolled. In 73%, time since diagnosis was longer than 6 months. We obtained self-reports of supportive care needs in 12 domains and measured QoL using the EORTC QLQ-C30 functioning subscales. RESULTS At the beginning of inpatient rehabilitation, top-ranking severe supportive care needs concerned coordination of care (48%), medical information (45%), alleviation of physical symptoms (42%) and support with improving health behaviors (36%). At the end of inpatient rehabilitation, all needs assessed declined significantly, although many patients still expressed strong needs in some domains. However, meeting patients' needs was accompanied by improvements in all functioning subscales. CONCLUSIONS This is the first study to show that meeting breast and gynecological cancer patients' supportive care needs during inpatient rehabilitation resulted in improved QoL. Given the considerable proportions of patients still reporting unmet needs at the end of their stay, stronger and continuing efforts seem warranted to meet these needs and thus further increase QoL.
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Affiliation(s)
- Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | | | - Dirk Engehausen
- Sinntal Clinic Bad Brückenau, German Statutory Pension Insurance of Northern Bavaria, Bad Brückenau, Germany
| | - Monika Reuss-Borst
- Center for Rehabilitation and Prevention Bad Bocklet, Bad Bocklet, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
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18
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van Eenbergen MC, van den Hurk C, Mols F, van de Poll-Franse LV. Usability of an online application for reporting the burden of side effects in cancer patients. Support Care Cancer 2019; 27:3411-3419. [DOI: 10.1007/s00520-019-4639-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/07/2019] [Indexed: 12/16/2022]
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19
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de Rooij BH, Thomas TH, Post KE, Flanagan J, Ezendam NPM, Peppercorn J, Dizon DS. Survivorship care planning in gynecologic oncology-perspectives from patients, caregivers, and health care providers. J Cancer Surviv 2018; 12:762-774. [PMID: 30209681 PMCID: PMC6244937 DOI: 10.1007/s11764-018-0713-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/28/2018] [Indexed: 11/24/2022]
Abstract
Purpose This qualitative study sought to describe the challenges following treatment and the preferences regarding survivorship care among patients treated for gynecological cancer, their caregivers, and health care providers. Methods Between July and August 2017, in-depth semi-structured interviews regarding survivorship were conducted at a large academic hospital in the USA among patients who recently completed treatment (< 12 months) for a gynecological cancer (ovarian, endometrial, cervical, and vulvar) and their primary caregivers. A focus group was conducted among health care providers (oncologists, nurses, and fellows). Main themes were identified using descriptive content analysis. Results A total of 30 individuals participated in this study (13 patients, 9 caregivers, 8 health care providers). Almost all participants reported a desire for more information on how to address survivorship needs, specifically as they related to side effects, follow-up schedule, and psychological assistance. Despite this uniformly identified need for more information, preferences for survivorship care planning differed across cancer types and individuals, with respect to content, timing, and mode of delivery. Health care providers expressed challenges in communicating with patients about survivorship, a desire to shift post-treatment conversations to the goal of improving quality of life as opposed to focusing on disease recurrence, and an unmet need for disease specific and individualized survivorship care planning. Conclusions Patients, caregivers, and health care providers each expressed a need for gynecologic cancer-tailored survivorship care resources. Implications for Cancer Survivors The variation of disease types and patient and caregiver needs may require multi-faceted, individualized survivorship care planning. Electronic supplementary material The online version of this article (10.1007/s11764-018-0713-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Belle H de Rooij
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA. .,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands. .,The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
| | | | - Kathryn E Post
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.,Boston College William F. Connell School of Nursing, Boston, MA, USA
| | - Jane Flanagan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.,Boston College William F. Connell School of Nursing, Boston, MA, USA
| | - Nicole P M Ezendam
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Jeffrey Peppercorn
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Don S Dizon
- Lifespan Cancer Institute/Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
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20
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Birken SA, Clary AS, Bernstein S, Bolton J, Tardif-Douglin M, Mayer DK, Deal AM, Jacobs SR. Strategies for Successful Survivorship Care Plan Implementation: Results From a Qualitative Study. J Oncol Pract 2018; 14:e462-e483. [PMID: 30004824 PMCID: PMC6804914 DOI: 10.1200/jop.17.00054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Care for US cancer survivors is often fragmented, contributing to poor health outcomes. Care and outcomes may improve when survivors and follow-up care providers receive survivorship care plans (SCPs), written documents containing information regarding cancer diagnosis, treatment, surveillance plans, and health promotion. However, implementing SCPs is challenging. As such, we sought to identify strategies for successfully implementing SCPs. METHODS We measured SCP implementation using performance data from cancer programs participating in the American Society of Clinical Oncology Quality Oncology Practice Initiative, an oncologist-led quality assessment and improvement program. We used semistructured interviews with cancer program employees (eg, physicians) to identify strategies for successfully implementing SCPs by comparing approaches in cancer programs that, according to Quality Oncology Practice Initiative performance indicators, developed and delivered SCPs to a relatively small proportion of eligible survivors and their follow-up care providers (ie, low performers; n = 6 participants in five programs) with approaches among programs with better performance (ie, moderate performers; n = 15 participants in nine programs). RESULTS Ten of 14 cancer programs developed SCPs for ≥ 50% of eligible survivors; two of 14 delivered SCPs to any survivors; and eight of 14 delivered SCPs to ≥ 25% of follow-up care providers. We found that moderate performers proactively addressed SCP requirements, leveraged requirements to improve survivorship care, set internal targets, automated implementation, had active leaders and champions, and tasked appropriate employees with SCP implementation. CONCLUSION SCP implementation remains challenging. We identified strategies for successfully implementing SCPs. Future research should examine how cancer programs have achieved these strategies; findings could contribute to an understanding of the changes needed to implement comprehensive survivorship care.
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Affiliation(s)
- Sarah A. Birken
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Alecia S. Clary
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Shampa Bernstein
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Jamiyla Bolton
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Miriam Tardif-Douglin
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Deborah K. Mayer
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Allison M. Deal
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
| | - Sara R. Jacobs
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and RTI International, Research Triangle Park, NC
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21
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Akkuzu G, Kurt G, Guvenc G, Kok G, Simsek S, Dogrusoy S, Ayhan A. Learning Needs of Gynecologic Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:544-550. [PMID: 27743314 DOI: 10.1007/s13187-016-1118-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
To define the learning needs of patients with gynecological oncology. The study was performed as a descriptive study. A total of 92 patients were participated. Data were collected using Patient Learning Needs Scale (PLNS). The Pearson correlation test, independent sample t test, and analysis of one-way of variance (ANOVA) followed by Tukey's-B post hoc tests were used for statistical analyses by the SPSS 15.0 software package. The mean age of women's was 50.37 ± 12.20 years. The women's diagnoses were cervical (45.7 %), ovarian (27.2 %), and endometrial (19.6 %) cancers. The most frequently stated learning needs topics were coping with pain (47.8 %), daily living activities (46.2 %), and psychological support (44.6 %). The mean PLNS score of women was 212.56 ± 35.83. The mean subscales scores of PLNS were 34.06 ± 7.29 for medicines, 38.34 ± 6.74 for daily living activities, and 24.68 ± 5.41 for community subscales. Women who graduated from elementary school needed more education than the women with higher education (p < 0.001). Learning needs level of the women are high and related to increase quality of life, medicine usage, complications of treatment, skin problems, pain management, and supportive care. As a healthcare professional, we should plan and develop educational programs in order to adequately inform patients about their learning needs.
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Affiliation(s)
- Gulcihan Akkuzu
- Department of Nursing, Faculty of Health Sciences, Baskent University, Ankara, Turkey.
| | - Gonul Kurt
- Department of Obstetrics and Gynecology Nursing, Gulhane School of Nursing, University of Health Sciences, Ankara, Turkey
| | - Gulten Guvenc
- Department of Obstetrics and Gynecology Nursing, Gulhane School of Nursing, University of Health Sciences, Ankara, Turkey
| | - Gulsah Kok
- Department of Obstetrics and Gynecology Nursing, Gulhane School of Nursing, University of Health Sciences, Ankara, Turkey
| | - Sevgi Simsek
- Nursing Services Directorate of Adult Hospital, Hacettepe University, Ankara, Turkey
| | - Safiye Dogrusoy
- Obstetrics and Gynecology Service, Gazi University Hospital, Ankara, Turkey
| | - Ali Ayhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
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22
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Rietveld MJA, Husson O, Vos MCC, van de Poll-Franse LV, Ottevanger PBN, Ezendam NPM. Association between information provision and supportive care needs among ovarian cancer survivors: A cross-sectional study from the PROFILES registry. Psychooncology 2018; 27:1922-1929. [PMID: 29683231 DOI: 10.1002/pon.4742] [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: 06/27/2017] [Revised: 04/09/2018] [Accepted: 04/12/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the association between satisfaction with perceived information provision during diagnosis and treatment and supportive care needs in ovarian cancer survivors. METHODS In 2012, women (n = 348) diagnosed with ovarian cancer, as registered between 2000 and 2010 in the Netherlands Cancer Registry, received a questionnaire including questions on the perceived level of, and satisfaction with, information received (EORTC QLQ-INFO25) and supportive care needs (Cancer Survivors' Unmet Needs Measure). RESULTS Of 348 women, 191 (55%) responded. Of all participants, 35% were not satisfied (n = 65) with the perceived amount of information received. Participants who were satisfied with the amount of information reported significantly higher levels of perceived information on disease, medical tests, treatment, and other services. Patients not satisfied with information provision had a higher total number of needs and a higher number of unmet needs than women satisfied with information provision. Multivariable linear regression analysis showed that satisfaction with information provision was negatively associated with the total number of unmet needs (β = -0.20, P = .03) after adjustment for potential confounding clinical and sociodemographic factors. CONCLUSION Ovarian cancer survivors satisfied with the information provision during treatment reported fewer unmet needs during survivorship. Optimization of information provision for ovarian cancer patients during initial diagnosis and treatment may contribute to a decrease in unmet needs during survivorship.
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Affiliation(s)
- Mark J A Rietveld
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands
| | - M C Caroline Vos
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Lonneke V van de Poll-Franse
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands.,Department of Medical Psychology, Tilburg University, Tilburg, Netherlands.,Division of Psychosocial Oncology and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - P B Nelleke Ottevanger
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nicole P M Ezendam
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands.,Department of Medical Psychology, Tilburg University, Tilburg, Netherlands
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23
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Thomas TH, Nauth-Shelley K, Thompson MA, Attai DJ, Katz MS, Graham D, Sparacio D, Lizaso C, Utengen A, Dizon DS. The Needs of Women Treated for Ovarian Cancer: Results From a #gyncsm Twitter Chat. J Patient Cent Res Rev 2018; 5:149-157. [PMID: 31413999 DOI: 10.17294/2330-0698.1592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Ovarian cancer is the most fatal of all gynecologic cancers, with a high relapse rate regardless of stage. Women treated for ovarian cancer, therefore, likely have supportive care needs that extend well beyond the time frame of first-line therapy. Unfortunately, there is minimal data describing these needs. The purpose of this qualitative study is to understand the supportive care needs of women with ovarian care at the end of treatment. Methods To better understand the issues faced by women with ovarian cancer, we conducted a public Twitter chat in collaboration with gynecologic cancer social media (#gyncsm). Both quantitative and qualitative analyses were performed. Results The chat occurred over a 1-hour time frame on Twitter and resulted in more than 300 unique and original tweets from 43 participants during the chat and an additional 60 unique participants following the chat. Survivors and physicians represented 32% and 11% of participants, respectively; caregivers, advocates, and other clinicians represented the remaining participants. Participants noted deep interest in receiving support during survivorship and dissatisfaction with currently available resources. Sentiment analysis showed that participants viewed the support from social media in a positive light and also revealed negative sentiment around the lack of support from health care providers at the end of treatment. Conclusions Themes derived from the Twitter chat revealed the unique experiences of individuals with ovarian cancer after treatment, including a heightened sense of vulnerability. Understanding these themes represents an opportunity for clinicians to better understand and address the needs of this patient community.
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Affiliation(s)
| | | | | | | | | | - David Graham
- Levine Cancer Institute-Mallard Creek, Charlotte, NC
| | | | | | | | - Don S Dizon
- Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI
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24
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Ezendam NPM, de Rooij BH, Kruitwagen RFPM, Creutzberg CL, van Loon I, Boll D, Vos MC, van de Poll-Franse LV. ENdometrial cancer SURvivors' follow-up carE (ENSURE): Less is more? Evaluating patient satisfaction and cost-effectiveness of a reduced follow-up schedule: study protocol of a randomized controlled trial. Trials 2018; 19:227. [PMID: 29661218 PMCID: PMC5902894 DOI: 10.1186/s13063-018-2611-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/27/2018] [Indexed: 11/12/2022] Open
Abstract
Background It has often been hypothesized that the frequency of follow-up visits for patients with early-stage endometrial cancer could be decreased. However, studies evaluating effects of a reduced follow-up schedule among this patient group are lacking. The aim of this study is to assess patient satisfaction and cost-effectiveness of a less frequent follow-up schedule compared to the schedule according to the Dutch guideline. Methods In this multicenter randomized controlled trial, patients diagnosed in the Netherlands with stage 1A and 1B low-risk endometrial cancer, for whom adjuvant radiotherapy is not indicated (n = 282), are randomized. Patients allocated to the intervention group receive four follow-up visits during three years. Patients allocated to the control group receive 10–13 follow-up visits during five years, according to the Dutch guideline. Patients are asked to fill out a questionnaire at baseline and after 6, 12, 36, and 60 months. Primary outcomes include patient satisfaction with follow-up care and cost-effectiveness. Secondary outcomes include healthcare use, adherence to schedule, health-related quality of life, fear of recurrence, anxiety and depression, information provision, recurrence, and survival. Linear regression analyses will be used to assess differences in patient satisfaction with follow-up care between intervention and control group. Discussion We anticipate that patients in the intervention arm have a similar satisfaction with follow-up care and overall outcomes, but lower healthcare use and costs than patients in the control arm. No differences are expected in quality-adjusted life-years and satisfaction, but the reduced schedule is expected to be cost-saving when implemented in the Netherlands. Trial registration ClinicalTrials.gov, NCT02413606. Registered on 10 April 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2611-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicole P M Ezendam
- The Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands. .,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
| | - Belle H de Rooij
- The Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Roy F P M Kruitwagen
- Department of Gynecology and GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Carien L Creutzberg
- Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ingrid van Loon
- Department of Obstetrics and Gynaecology, Amphia hospital, Breda, The Netherlands
| | - Dorry Boll
- Department of Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - M Caroline Vos
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk, The Netherlands
| | - Lonneke V van de Poll-Franse
- The Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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25
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Birken SA, Urquhart R, Munoz-Plaza C, Zizzi AR, Haines E, Stover A, Mayer DK, Hahn EE. Survivorship care plans: are randomized controlled trials assessing outcomes that are relevant to stakeholders? J Cancer Surviv 2018; 12:495-508. [PMID: 29572602 DOI: 10.1007/s11764-018-0688-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/09/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to compare outcomes assessed in extant randomized controlled trials (RCTs) to outcomes that stakeholders expect from survivorship care plans (SCPs). To facilitate the transition from active treatment to follow-up care for the 15.5 million US cancer survivors, many organizations require SCP use. However, results of several RCTs of SCPs' effectiveness have been null, possibly because they have evaluated outcomes on which SCPs should be expected to have limited influence. Stakeholders (e.g., survivors, oncologists) may expect outcomes that differ from RCTs' outcomes. METHODS We identified RCTs' outcomes using a PubMed literature review. We identified outcomes that stakeholders expect from SCPs using semistructured interviews with stakeholders in three healthcare systems in the USA and Canada. Finally, we mapped RCTs' outcomes onto stakeholder-identified outcomes. RESULTS RCT outcomes did not fully address outcomes that stakeholders expected from SCPs, and RCTs assessed outcomes that stakeholders did not expect from SCPs. RCTs often assessed outcomes only from survivors' perspectives. CONCLUSIONS RCTs of SCPs' effectiveness have not assessed outcomes that stakeholders expect. To better understand SCPs' effectiveness, future RCTs should assess outcomes of SCP use that are relevant from the perspective of multiple stakeholders. IMPLICATIONS FOR CANCER SURVIVORS SCPs' effectiveness may be optimized when used with an eye toward outcomes that stakeholders expect from SCPs. For survivors, this means using SCPs as a map to guide them with respect to what kind of follow-up care they should seek, when they should seek it, and from whom they should seek it.
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Affiliation(s)
- Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg Hall, 135 Dauer Dr., Chapel Hill, NC, 27599, USA.
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Corrine Munoz-Plaza
- Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA, USA
| | - Alexandra R Zizzi
- Department of Health Policy and Management, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg Hall, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Emily Haines
- Department of Health Policy and Management, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg Hall, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Angela Stover
- Department of Health Policy and Management, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg Hall, 135 Dauer Dr., Chapel Hill, NC, 27599, USA
| | - Deborah K Mayer
- School of Nursing, Lineberger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill, NC, USA
| | - Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA, USA
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26
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Beesley VL, Alemayehu C, Webb PM. A systematic literature review of the prevalence of and risk factors for supportive care needs among women with gynaecological cancer and their caregivers. Support Care Cancer 2017; 26:701-710. [DOI: 10.1007/s00520-017-3971-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/09/2017] [Indexed: 01/23/2023]
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27
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Faller H, Brähler E, Härter M, Keller M, Schulz H, Wegscheider K, Weis J, Boehncke A, Reuter K, Richard M, Sehner S, Koch U, Mehnert A. Unmet needs for information and psychosocial support in relation to quality of life and emotional distress: A comparison between gynecological and breast cancer patients. PATIENT EDUCATION AND COUNSELING 2017; 100:1934-1942. [PMID: 28592366 DOI: 10.1016/j.pec.2017.05.031] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/09/2017] [Accepted: 05/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We compared gynecological and breast cancer patients regarding their needs for information and psychosocial support, quality of life (QoL), and emotional distress and the relationship among these constructs. METHODS In a multicenter, cross-sectional study in Germany, we evaluated 1214 female cancer patients (317 with gynecological cancer, 897 with breast cancer). We obtained self-reports of unmet needs, using a self-developed measure. We measured QoL with the EORTC QLQ-C30, symptoms of depression with the Patient Health Questionnaire (PHQ-9), and symptoms of anxiety with the Generalized Anxiety Disorder Scale (GAD-7). RESULTS Compared to breast cancer patients, gynecological cancer patients felt less informed about several aspects of their disease, particularly regarding psychological support (p<0.001), tended to have more unmet information needs, and reported lower QoL levels. Lower emotional functioning, but higher physical functioning were independent correlates of the level of unmet information needs. Depressive symptoms and higher physical functioning (only in breast cancer) were independent correlates of higher needs for psychosocial support. CONCLUSION Compared to breast cancer, gynecological cancer patients were less satisfied with the information received and reported lower levels of QoL. PRACTICE IMPLICATIONS Both clinicians and policy makers should take efforts to address the higher needs of gynecological cancer patients.
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Affiliation(s)
- Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Klinikstrasse 3, 97070 Würzburg, Germany.
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Strasse 55, 04103 Leipzig, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Untere Zahlbacherstrasse 8, 55131 Mainz, Germany
| | - Martin Härter
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Monika Keller
- Division of Psychooncology, Department for Psychosomatic and General Clinical Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 155, 69120 Heidelberg, Germany
| | - Holger Schulz
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Joachim Weis
- Department of Psychooncology, Clinic for Oncological Rehabilitation, University Medical Center Freiburg, Breisacher Strasse 117, 79106 Freiburg, Germany
| | - Anna Boehncke
- Department of Psychooncology, Clinic for Oncological Rehabilitation, University Medical Center Freiburg, Breisacher Strasse 117, 79106 Freiburg, Germany
| | - Katrin Reuter
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104 Freiburg, Germany
| | - Matthias Richard
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Klinikstrasse 3, 97070 Würzburg, Germany
| | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Uwe Koch
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Strasse 55, 04103 Leipzig, Germany
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28
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Jones G, Leclair CS, Petricone-Westwood D, Lefebvre M, Morash R, Liska C, Jolicoeur L, Lebel S. An implementation evaluation of a wellness beyond cancer program survivorship class: Who is attending? Can Oncol Nurs J 2017; 27:268-274. [PMID: 31148799 DOI: 10.5737/23688076273268274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast and endometrial cancer survivors referred to the Wellness Beyond Cancer Program were invited to a survivorship education class. As not all survivors attended the class, this study aimed to identify socio-demographic and medical characteristics, and survivorship needs that predict attendance. A chart review was conducted on survivors who completed a needs assessment survey between 2012 and 2014 (n=144 endometrial; n=170 breast). Class attendees' characteristics were compared to those of non-attendees using t-tests, chi-square analyses, and regression analysis. Univariate analyses showed that age, distance from hospital, emotional and physical needs, and receiving chemotherapy and/or radiation therapy were associated with class attendance. Distance from hospital and physical needs were identified as multivariate predictors. The results of this study will help inform class content, improve class attendance, and identify attendees' characteristics.
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Affiliation(s)
- Georden Jones
- School of Psychology, University of Ottawa, 136 Jean Jacques Lussier PVT, Room 4016, Ottawa, ON K1N 6N5
| | - Caroline Séguin Leclair
- School of Psychology, University of Ottawa, 136 Jean Jacques Lussier PVT, Room 4016, Ottawa, ON K1N 6N5
| | | | - Monique Lefebvre
- The Ottawa Hospital Cancer Centre, The Ottawa Hospital, Ottawa, ON
| | - Robin Morash
- The Ottawa Hospital Cancer Centre, The Ottawa Hospital, Ottawa, ON
| | - Carrie Liska
- The Ottawa Hospital Cancer Centre, The Ottawa Hospital, Ottawa, ON
| | - Lynne Jolicoeur
- The Ottawa Hospital Cancer Centre, The Ottawa Hospital, Ottawa, ON
| | - Sophie Lebel
- School of Psychology, University of Ottawa, 136 Jean Jacques Lussier PVT, Room 4016, Ottawa ON K1N 6N5
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29
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Nunstedt H, Rudolfsson G, Alsén P, Pennbrant S. Strategies for healthcare professionals to facilitate patient illness understanding. J Clin Nurs 2017; 26:4696-4706. [PMID: 28334458 DOI: 10.1111/jocn.13820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Håkan Nunstedt
- Department of Health Sciences; University West; Trollhättan Sweden
| | - Gudrun Rudolfsson
- NORD university; Faculty of Nursing and Health Sciences; Bodø Norway
| | - Pia Alsén
- Department of Health Sciences; University West; Trollhättan Sweden
| | - Sandra Pennbrant
- Department of Health Sciences; University West; Trollhättan Sweden
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30
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Hébert J, Fillion L. Assessment of the feasibility and acceptability, and pre-test of the utility of an individualized survivorship care plan (ISCP) for women with endometrial cancers during the transition of the end of active treatment to cancer survivorship. Can Oncol Nurs J 2017; 27:153-163. [PMID: 31148628 PMCID: PMC6516223 DOI: 10.5737/23688076272153163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The transition from the end of active treatment to survivorship holds many challenges for women with endometrial cancer (WEC) and for the organization of health services. The feasibility and acceptability of implementing an individualized survivorship care plan (ISCP) at the end of treatment are documented as potential solutions. The utility of an ISCP on three indicators (SUNS, FCRI, and HeiQ) was pre-tested by comparing two groups of WEC (control and exposed to the ISCP). The WEC exposed to the ISCP had fewer needs, a lesser intensity of fear of cancer recurrence, and better health-related empowerment skills three months after the end of treatment, as compared to the control group. Obstacles of time, resources, and organization were raised. BACKGROUND The transition from the end of active treatment to cancer survivorship is a time of imbalance and turbulence for women with endometrial cancer (WEC). The transition to survivorship continues to be uncoordinated and the need for information about the side effects to watch for and the health risks is unmet. The implementation of an individualized survivorship care plan (ISCP) is suggested as an information and communication tool that could be a solution for facilitating the transition from the end of treatment to the beginning of survivorship. RESEARCH OBJECTIVE AND METHOD To assess and document the feasibility and acceptability of implementing an ISCP, qualitative data were gathered from WEC, oncology nurse navigators (ONN), and family doctors. A pre-experimental research design with a non-equivalent control group, an end of treatment (T0), and a three-month follow-up (T1) allowed us to pre-test its utility according to three indicators: (1) overall needs (SUNS); (2) fear of cancer recurrence (FCRI); and (3) empowerment (HeiQ) according to exposure to ISCP (control versus exposed) and to the time of measurement in the transition period (T0 versus T1). RESULTS The sample was made up of 18 WEC for the group exposed to the ISCP and 13 WEC for the control group, 12 general practitioners, and two ONN. After ONN training, the ISCP completion time varied between 60 and 75 minutes, and the meeting for providing the ISCP lasted 45-60 minutes. The WEC supported the idea that meetings with the ONN and the ISCP were useful in meeting their needs for information and support. The family doctors supported its relevancy in favouring follow-up and better subsequent healthcare management, as well as in reassuring patients and avoiding a sense of abandonment at the end of treatment. Comparing the group exposed to the ISCP versus the control group, fewer reported needs can be observed: information: 35% versus 74%, p = .030; professional and financial: 6% versus 19%, p = .057; access and continuity: 9% versus 25%, p = .078; support: 18% versus 50%, p = .007, emotional: 13% versus 28%, p = .044). Moreover, at T1, empowerment according to the skill and technique acquisition sub-scale shows a higher trend (M = 75.00 (10.21) versus M = 64.06 (10.67), p = .097). The level of fear of recurrence remains above the clinically significant score of 13 for both groups at the two times of measurement. DISCUSSION The ISCP is an informational tool that seeks to facilitate care-related communication and coordination between specialized and primary care. It is intended to facilitate the transition from the end of treatment to survivorship and survivors' commitment to health-related empowerment behaviours. The feasibility and utility of implementing an ISCP are supported if additional professional, organizational, and financial resources are specified and mobilized.
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Affiliation(s)
- Johanne Hébert
- Professor, Department of Nursing, Université du Québec à Rimouski (UQAR)
| | - Lise Fillion
- Full professor, Faculty of Nursing, Université Laval
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31
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Guldhav KV, Jepsen R, Ytrehus S, Grov EK. Access to information and counselling - older cancer patients' self-report: a cross-sectional survey. BMC Nurs 2017; 16:18. [PMID: 28428732 PMCID: PMC5397690 DOI: 10.1186/s12912-017-0211-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 04/11/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An increasingly older population, improved diagnostics and treatment increase the number of older cancer survivors, thus more than 60% of those affected by cancer are over the age of 65. Symptom relief and the prevention of functional impairment are important tasks for home care nursing, considering that patients can live a long time with their cancer disease and related side effects. The aim of this study was to investigate the extent to which cancer patients over the age of 65 reported access to information and counselling from home care nursing services, including those offered by the cancer coordinator. METHODS A cross-sectional survey was used. The survey consisted of 174 cancer patients from two regions in Norway living at home (101 women; 66-92 years). The questionnaire contained questions of various sequences including information and advices given and data on access to and use of home health care services. The questions focused on the extent to which home health care services provided the following: 1) information about the disease and treatment, 2) information about consequences and complications of the cancer disease, 3) nutritional advice and 4) advice on physical activity. Demographic, clinical and organizational variables were used. SPSS program version 22 was employed to perform descriptive and inferential statistics including correlation and logistic regression analysis. For ethical reasons, patients who were dying, delirious or with presence of cognitive impairment (any kind of dementia) were excluded. RESULTS The results showed that a majority (67-77%) of the respondents reported low levels of information and counselling offered. Low levels represents in this study medium, small and very small degree (Likert scale). Women, those above 85 years of age and patients with a gynecological or hematological cancer diagnosis experienced less access to information and counselling. Respondents facing availability of a cancer coordinator reported significantly higher access to information about the disease and treatment (p = 0.03), nutritional advice (p = 0.04) and advice on physical activity (p = 0.04) compared to those who only had contact with a home health care nurse or home health care assistant. CONCLUSIONS The results indicated that the availability of a cancer coordinator facilitated personalized information and counselling for older cancer patients.
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Affiliation(s)
| | - Randi Jepsen
- Nykøbing Falster Hospital, Region Sjælland, Fjordvej 15, DK-4800 Nykøbing F., Denmark
- Faculty of Health Studies, Sogn og Fjordane University College, PO Box 523, 6803 Førde, Norway
| | - Siri Ytrehus
- Faculty of Health Studies, Sogn og Fjordane University College, PO Box 523, 6803 Førde, Norway
| | - Ellen Karine Grov
- Faculty of Health Studies, Sogn og Fjordane University College, PO Box 523, 6803 Førde, Norway
- Oslo and Akershus University College of Applied Sciences Faculty of Health, Institute of Nursing and Health Promotion, PO Box 4, St. Olavs plass, 0130 Oslo, Norway
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32
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Nunstedt H, Rudolfsson G, Alsen P, Pennbrant S. Patients´ Variations of Reflection About and Understanding of Long-Term Illness- Impact of Illness Perception on Trust in Oneself or Others. Open Nurs J 2017; 11:43-53. [PMID: 28567169 PMCID: PMC5420171 DOI: 10.2174/1874434601711010043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/19/2017] [Accepted: 02/20/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Patients' understanding of their illness is of great importance for recovery. Lacking understanding of the illness is linked with the patients' level of reflection about and interest in understanding their illness. Objective: To describe patients’ variations of reflection about and understanding of their illness and how this understanding affects their trust in themselves or others. Method: The study is based on the “Illness perception” model. Latent content analysis was used for the data analysis. Individual, semi-structured, open-ended and face-to-face interviews were conducted with patients (n=11) suffering from a long-term illness diagnosed at least six months prior to the interview. Data collection took place in the three primary healthcare centres treating the participants. Results: The results show variations in the degree of reflection about illness. Patients search for deeper understanding of the illness for causal explanations, compare different perspectives for preventing complication of their illness, trust healthcare providers, and develop own strategies to manage life. Conclusion: Whereas some patients search for deeper understanding of their illness, other patients are less reflective and feel they can manage the illness without further understanding. Patients' understanding of their illness is related to their degree of trust in themselves or others. Patients whose illness poses an existential threat are more likely to reflect more about their illness and what treatment methods are available.
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33
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Corsini N, Fish J, Ramsey I, Sharplin G, Flight I, Damarell R, Wiggins B, Wilson C, Roder D, Eckert M. Cancer survivorship monitoring systems for the collection of patient-reported outcomes: a systematic narrative review of international approaches. J Cancer Surviv 2017; 11:486-497. [DOI: 10.1007/s11764-017-0607-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 02/14/2017] [Indexed: 01/23/2023]
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34
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Hébert J, Fillion L. Development and validation of an individualized survivorship care plan (ISCP) for women with endometrial cancer during the transition of the end of active treatment to the cancer survivorship. Can Oncol Nurs J 2017; 27:33-42. [PMID: 31148653 DOI: 10.5737/236880762713342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Many cancer survivors finish their treatment without knowing the associated health risks and few are prepared to handle their health needs in the survivorship phase. Moreover, practical guides for follow- up care are not available and survivors' psychological and social needs often go unassessed. In this article, we propose the development and implementation of an individualized follow-up care plan (IFCP) after active treatment for women with endometrial cancers (WEC) to meet their needs for information and to facilitate the transition to the survivorship phase. Background The after-treatment phase is a distinct phase that is still neglected in the oncological continuum of care. It is the transition between two phases in the care trajectory-treatment and survivorship-that gives rise to many challenges for survivors, care providers and the healthcare system alike. Research goal Aiming to facilitate the transition between the end of active treatment and the cancer survivorship phases, we pursued two objectives: 1) Develop an individualized follow-up care plan (IFCP) based on both the literature and the perspective of WEC, healthcare professionals involved with the target clientele and oncology outreach managers, and 2) Have this IFCP validated by an interdisciplinary team. Methodology For the first objective, WEC-related needs at the end of active treatment (immediate end, three months and six months), as well as the perceptions of health professionals and oncology outreach managers were gathered by interview and group discussion on the benefit of an IFCP, its content and desired format. A content analysis of the interview data was performed using the Miles and Huberman approach (2003). For the second objective, an iterative consultation process with health professionals allowed for validation by consensus. These two objectives are the first qualitative phase of a mixed-methods sequential exploratory design that will make the development of an IFCP possible. In the second phase, we conducted a feasibility study of the implementation of the IFCP during the end of active treatment transition to cancer survivorship transition. This will be the subject of a second article. Results The interviews (n=47) revealed WECs' lack of preparation for the transition from the end of active treatment to the cancer survivorship. The following needs were specified: information (80%), emotional support, particularly to overcome their fear of recurrence (75%), the management of physical symptoms (45%), and support for adapting to change (45%). The data gathered from healthcare professionals and outreach managers support the utility of an IFCP in meeting these needs. The iterative validation process by the interdisciplinary team made consensus on the format and content possible. The final version of the IFCP is seen as a tool for information and communication in the survivorship phase. Some obstacles to its transfer to clinical practice are reported. Conclusion This study presents the entire process that led to the development of an IFCP that integrates both the needs of endometrial cancer survivors and the opinions of healthcare professionals and the oncology outreach managers organizing this care. Indications on how the IFCP could be implemented within this organization are also formulated.
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Affiliation(s)
- Johanne Hébert
- Professor, Department of Nursing, Université du Québec à Rimouski (UQAR)
| | - Lise Fillion
- Full professor, Faculty of Nursing, Université Laval
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Patients with multimorbidity and their experiences with the healthcare process: a scoping review. JOURNAL OF COMORBIDITY 2017; 7:11-21. [PMID: 29090185 PMCID: PMC5556434 DOI: 10.15256/joc.2017.7.97] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/09/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND The number of patients with multimorbidity (two or more conditions) is increasing. Observational research has shown that having multiple health problems is associated with poorer outcomes in terms of health, quality of care, and costs. Thus, it is imperative to understand how patients with multimorbidity experience their healthcare process. Insight into patient experiences can be used to tailor healthcare provision specifically to the needs of patients with multimorbidity. OBJECTIVE To synthesize self-reported experiences with the healthcare process of patients with multimorbidity, and identify overarching themes. DESIGN A scoping literature review that evaluates both qualitative and quantitative studies published in PubMed, Embase, MEDLINE, and PsycINFO. No restrictions were applied to healthcare setting or year of publication. Studies were included if they reported experiences with the healthcare process of patients with multimorbidity. Patient experiences were extracted and subjected to thematic analysis (interpretative), which revealed overarching themes by mapping their interrelatedness. RESULTS Overall, 22 empirical studies reported experiences of patients with multimorbidity. Thematic analysis identified 12 themes within these studies. The key overarching theme was the experience of a lack of holistic care. Patients also experienced insufficient guidance from healthcare providers. Patients also perceived system-related issues such as problems stemming from poor professional-to-professional communication. CONCLUSIONS Patients with multimorbidity experience a range of system- and professional-related issues with healthcare delivery. This overview illustrates the diversity of aspects that should be considered in designing healthcare services for patients with multimorbidity.
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Brant J, Blaseg K, Aders K, Oliver D, Gray E, Dudley W. Navigating the Transition From Cancer Care to Primary Care: Assistance of a Survivorship Care Plan. Oncol Nurs Forum 2016; 43:710-719. [DOI: 10.1188/16.onf.710-719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Prostate cancer survivors with a passive role preference in treatment decision-making are less satisfied with information received: Results from the PROFILES registry. Urol Oncol 2016; 34:482.e11-482.e18. [DOI: 10.1016/j.urolonc.2016.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/29/2016] [Accepted: 06/18/2016] [Indexed: 11/19/2022]
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Koutoukidis D, Beeken R, Lopes S, Knobf M, Lanceley A. Attitudes, challenges and needs about diet and physical activity in endometrial cancer survivors: a qualitative study. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12531] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 02/01/2023]
Affiliation(s)
- D.A. Koutoukidis
- Department of Women's Cancer; EGA Institute for Women's Health; University College London; London UK
| | - R.J. Beeken
- Department of Epidemiology & Public Health; Health Behaviour Research Centre; University College London; London UK
| | - S. Lopes
- Department of Epidemiology & Public Health; Health Behaviour Research Centre; University College London; London UK
| | - M.T. Knobf
- Acute Care/Health Systems Division; Yale University School of Nursing; New Haven CT USA
| | - A. Lanceley
- Department of Women's Cancer; EGA Institute for Women's Health; University College London; London UK
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Hinchey J, Goldberg J, Linsky S, Linsky R, Jeon S, Schulman-Green D. Knowledge of Cancer Stage among Women with Nonmetastatic Breast Cancer. J Palliat Med 2016; 19:314-7. [PMID: 26855201 DOI: 10.1089/jpm.2015.0133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Discrepancies may exist between what oncologists communicate and what patients understand about their cancer stage and its implications. OBJECTIVE We explored patients' ability to identify their stage of breast cancer. METHODS As part of a study testing a cancer self-management intervention we asked women to identify their stage of disease and compared responses to the electronic medical record (EMR) for validation. The sample included women with recently diagnosed nonmetastatic (stage I-III) disease. We calculated descriptive statistics and used logistic regression to examine relationships between knowledge of stage, demographic and clinical variables, and study outcomes. Measurement instruments were the Control Preferences Scale (CPS), Knowledge of Care Options Test (KOCO), Measurement of Transitions Scale (MOT), Medical Communication Competence Scale (MCCS), Chronic Disease Self-Efficacy Scale (CDSE), Uncertainty in Illness Scale (MUIS-C), and Hospital Anxiety and Depression Scale (HADS). RESULTS Participants (n = 98) had a mean age of 52.3 years (range 27-72). Per the EMR, 19 participants (19.4%) had stage I breast cancer, 56 (57.1%) had stage II, and 23 (23.5%) had stage III. Of the 28 participants (28.6%) unable to identify their stage of cancer correctly, 11 (39.3%) provided vague responses, 11 (39.3%) reported an incorrect stage, and 6 (21.4%) did not know their stage. Younger age (p = 0.0412) and earlier cancer stage (p = 0.0136) were predictive of correctly identifying stage. Participants who at baseline had a greater knowledge of care options (curative, palliative, and hospice care) were more likely to correctly identify their stage (KOCO, p = 0.0345). CONCLUSIONS Clinicians should revisit conversations about cancer stage and care options to ensure patients' understanding and support self-management.
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Mekuria AB, Erku DA, Belachew SA. Preferred information sources and needs of cancer patients on disease symptoms and management: a cross-sectional study. Patient Prefer Adherence 2016; 10:1991-1997. [PMID: 27729777 PMCID: PMC5047714 DOI: 10.2147/ppa.s116463] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed at identifying the information needs of cancer patients, their preferences for the means of receiving health information, and the perceived level of satisfaction of existing possibilities for acquiring cancer-related information in Ethiopia. MATERIALS AND METHODS An institutional-based cross-sectional survey was employed on 556 cancer patients undergoing chemotherapy in the oncology wards of Gondar University Referral Hospital and Tikur Anbesa Specialized Hospital. Data were collected through interviewer-administered questionnaire. RESULTS The principal information regarded as the most important by the majority of them (67.26%) concerned information on the specific type of cancer (name and stage of cancer), followed by the side effects of chemotherapy and their management (63.29%) and "prognosis (survival)" (51.8%). Doctors were the overwhelming information source about cancer (88.8%), followed by nurses (34%). The majority of respondents (70.3%) were not satisfied at all or satisfied a little, while 15.6% of respondents reported that they were "quite" or "very" satisfied with the existing possibilities for acquiring information regarding cancer. CONCLUSION Medical practitioners other than doctors and nurses such as clinical pharmacists should support and identify measures that can enhance patients' satisfaction level regarding the existing possibilities for acquiring information regarding cancer. Periodic assessment of cancer patient's information requirements is also crucial, considering the ever-changing dynamics of priorities of such information desires.
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Affiliation(s)
- Abebe Basazn Mekuria
- Department of Pharmacology
- Correspondence: Abebe Basazn Mekuria, Department of Pharmacology, School of Pharmacy, University of Gondar, PO Box 196, Gondar, Ethiopia, Fax +251 58 114 1240, Email
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Health-related quality of life after robotic-assisted laparoscopic hysterectomy for women with endometrial cancer — A prospective cohort study. Gynecol Oncol 2016; 140:107-13. [DOI: 10.1016/j.ygyno.2015.10.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/30/2015] [Accepted: 10/31/2015] [Indexed: 11/22/2022]
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Mayer DK, Birken SA, Chen RC. Avoiding Implementation Errors in Cancer Survivorship Care Plan Effectiveness Studies. J Clin Oncol 2015; 33:3528-30. [DOI: 10.1200/jco.2015.62.6937] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Deborah K. Mayer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Sarah A. Birken
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Ronald C. Chen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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Stiggelbout AM, Pieterse AH, De Haes JCJM. Shared decision making: Concepts, evidence, and practice. PATIENT EDUCATION AND COUNSELING 2015; 98:1172-1179. [PMID: 26215573 DOI: 10.1016/j.pec.2015.06.022] [Citation(s) in RCA: 484] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/27/2015] [Accepted: 06/29/2015] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is advocated as the model for decision-making in preference-sensitive decisions. In this paper we sketch the history of the concept of SDM, evidence on the occurrence of the steps in daily practice, and provide a clinical audience with communication strategies to support the steps involved. Finally, we discuss ways to improve the implementation of SDM. RESULTS The plea for SDM originated almost simultaneously in medical ethics and health services research. Four steps can be distinguished: (1) the professional informs the patient that a decision is to be made and that the patient's opinion is important; (2) the professional explains the options and their pros and cons; (3) the professional and the patient discuss the patient's preferences and the professional supports the patient in deliberation; (4) the professional and patient discuss the patient's wish to make the decision, they make or defer the decision, and discuss follow-up. In practice these steps are seen to occur to a limited extent. DISCUSSION Knowledge and awareness among both professionals and patients as well as tools and skills training are needed for SDM to become widely implemented. PRACTICE IMPLICATIONS Professionals may use the steps and accompanying communication strategies to implement SDM.
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Affiliation(s)
- A M Stiggelbout
- Department of Medical Decision Making/Quality of Care, Leiden University Medical Center, Leiden, The Netherlands.
| | - A H Pieterse
- Department of Medical Decision Making/Quality of Care, Leiden University Medical Center, Leiden, The Netherlands
| | - J C J M De Haes
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
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Levesque JV, Lambert SD, Girgis A, Turner J, McElduff P, Kayser K. Do men with prostate cancer and their partners receive the information they need for optimal illness self-management in the immediate post-diagnostic phase? Asia Pac J Oncol Nurs 2015; 2:169-175. [PMID: 27981111 PMCID: PMC5123470 DOI: 10.4103/2347-5625.160969] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/11/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To (a) determine whether the information provided to men with prostate cancer and their partners in the immediate postdiagnostic phase met their needs; and (b) examine patient and partner satisfaction with the information received. METHODS Pre-intervention survey data from a pilot randomized controlled trial of a self-directed coping skills intervention involving 42 patients with prostate cancer, and their partners were collected to examine their psychosocial concerns/needs. RESULTS The main concerns for patients and partners were psychosocial in nature such as managing emotions, concern about the future, and losing control. Overall, patients and partners received most information about tests and treatment options. Partners reported receiving significantly less information about support services (P = 0.03) and self-care strategies (P = 0.03) compared to patients. Partners also reported being significantly less satisfied with the information they received (P = 0.007). CONCLUSIONS Whereas medical information is routinely given, patients and partners may benefit from greater information about psychosocial issues arising from cancer. Despite increased recognition of partner's information needs these still remain unmet.
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Affiliation(s)
- Janelle V. Levesque
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Medicine, UNSW Sydney, Australia
| | | | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Medicine, UNSW Sydney, Australia
| | - Jane Turner
- School of Medicine, University of Queensland, Queensland, Australia
| | - Patrick McElduff
- School of Medicine and Public Health, John Hunter Hospital, The University of Newcastle, New South Wales, Australia
| | - Karen Kayser
- Kent School of Social Work, University of Louisville, Louisville, USA
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The Experience of Robotic-Assisted Laparoscopic Hysterectomy for Women Treated for Early-Stage Endometrial Cancer: A Qualitative Study. Cancer Nurs 2015; 39:125-33. [PMID: 25881811 DOI: 10.1097/ncc.0000000000000260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND An increasing number of women are offered robotic-assisted laparoscopic hysterectomy as treatment for early-stage endometrial cancer in the developed world. OBJECTIVE The aim of this study was to explore how women diagnosed with early-stage endometrial cancer experienced robotic-assisted laparoscopic hysterectomy. METHODS Semistructured interviews were carried out with 12 women, and interview data were analyzed by qualitative content analysis. RESULTS Four overarching themes emerged: "surgery was a piece of cake," "recovering physically after surgery," "going from being off guard to being on guard," and "preparing oneself by seeking information." The women had confidence in the robotic technique and experienced fast recovery after robotic-assisted laparoscopic hysterectomy; however, they had uncertainties and unanswered questions concerning the postoperative course. Shortly after discharge, the women did not consider themselves surviving cancer patients but as cured. The women searched for information from various sources, for example, the Internet and the online patient chart, to prepare for surgery and to come to terms with the diagnosis. CONCLUSIONS Although the women had confidence in the robotic technique and recovered quickly physically, they lacked information about what went on in the operation theatre and about their new anatomy. IMPLICATIONS FOR PRACTICE Patient education about the normal postoperative course in regard to vaginal bleeding, bowel function, and level of physical activity is needed. Individualized information about anatomical changes after surgery is warranted, preferably using anatomical drawings. Potentially, the women could benefit from attending a nursing clinic during the first postoperative months.
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Husson O, Mols F, van de Poll-Franse L, de Vries J, Schep G, Thong MSY. Variation in fatigue among 6011 (long-term) cancer survivors and a normative population: a study from the population-based PROFILES registry. Support Care Cancer 2015; 23:2165-74. [PMID: 25556703 DOI: 10.1007/s00520-014-2577-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/18/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE Cancer survivors commonly experience fatigue, related to disease and its treatment. This study aimed to compare fatigue severity among survivors of different cancer types with a normative population and also to identify variations in fatigue among cancer survivors according to clinical and demographic variables. METHODS We used cancer survivorship data from the population-based PROFILES registry. We included survivors of endometrial (EC, n = 741) or colorectal cancer (CRC, n = 3878) (1998-2007), thyroid cancer (TC, n = 306) (1990-2008), Hodgkin (HL, n = 150) or non-Hodgkin lymphoma (NHL, n = 716), or multiple myeloma (MM, n = 120) (1999-2008). A representative Dutch normative population (n = 2040) was also assessed. Participants completed the Fatigue Assessment Scale. RESULTS Cancer survivors were more often classified as fatigued (EC/CRC 39%, HL 40%, NHL 43%, MM 51%, TC 44%) compared with the normative population (21 %; p < 0.001). MM survivors were more often classified as fatigued than all other cancer groups, except NHL (overall p = 0.02). Shorter times since diagnosis (<5 years, 41 versus 38%; p < 0.05), younger age (≤65 years, 42 versus 39%; p < 0.01), being female (43 versus 36%; p < 0.01), chemotherapy treatment (43 versus 39%; p < 0.01), comorbidity (no (27%) versus 1 (35%) versus ≥2 (52%); p < 0.01), educational level (low (44%) versus medium (41%) versus high (32%); p < 0.01), and absence of a partner (47 versus 38%; p < 0.01) were associated with fatigue. CONCLUSIONS Fatigue levels are substantial in (long-term) cancer survivors and vary depending on cancer type, time since diagnosis, age, gender, treatment with chemotherapy, number of comorbid conditions, educational level, and partnership. Since significantly more cancer survivors feel fatigued in comparison with the normative population, appropriate information, assessment, and interventions for fatigue are needed during or after oncologic treatment. Furthermore, focus on better control or management of comorbid conditions of cancer survivors is recommended.
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Affiliation(s)
- Olga Husson
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands
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Birken SA, Deal AM, Mayer DK, Weiner BJ. Determinants of survivorship care plan use in US cancer programs. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:720-7. [PMID: 24706174 PMCID: PMC4186915 DOI: 10.1007/s13187-014-0645-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Cancer programs are increasingly required to use survivorship care plans (SCPs). Compliance with SCP use requirements will be evaluated at the cancer program level. Cancer program-level determinants of SCP use may suggest strategies for compliance. The objective of this study was to describe SCP use and identify its cancer program-level determinants. We surveyed employees knowledgeable about survivorship practices in cancer programs throughout the USA with a wide range of annual incident cancers, program types, and cancer care quality improvement organization memberships (81/100 response rate). We used descriptive statistics to describe SCP use and bivariate statistics to identify its cancer program-level determinants. Most respondents (56 %) reported that SCPs were not used. In programs reporting use, SCP use is restricted primarily to breast (82 %) and colorectal (55 %) cancer survivors, and few providers use SCPs. When developed, SCPs seldom reach survivors and their primary care providers. Most respondents (78 %) reported beginning to use SCPs because of requirements. Frequently cited barriers included insufficient resources (76 %), perceived difficulty using SCPs (29 %), and lack of advocacy for SCP use from influential people (24 %). SCP use was positively associated with academic program type (p = .009) and membership in the National Cancer Institute's Community Cancer Centers Program (p = .009) and negatively associated with freestanding program type (p = .02). SCP use in the US cancer programs is highly inconsistent. Many cancer programs plan to implement SCPs to comply with SCP use requirements. Support specifically intended to facilitate SCP use may be more effective than non-specific resources.
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Affiliation(s)
- Sarah A Birken
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7411, USA,
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Birken SA, Deal AM, Mayer DK, Weiner BJ. Following through: the consistency of survivorship care plan use in United States cancer programs. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:689-97. [PMID: 24577781 PMCID: PMC4148470 DOI: 10.1007/s13187-014-0628-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The Institute of Medicine suggests that consistent survivorship care plan (SCP) use involves developing and delivering SCPs to all cancer survivors and their primary care providers (PCPs). We describe the consistency of SCP use in US cancer programs and assess its relationship with cancer-program-level determinants. We surveyed employees knowledgeable about survivorship practices in cancer programs reporting current SCP use (n = 36, 81 % response rate). We operationalized consistent SCP use as whether SCPs were (1) developed for ≥75 % survivors, (2) delivered to ≥75 % survivors, (3) delivered to ≥75 % PCPs, and (4) all of the above. We use descriptive statistics to report SCP use consistency and evaluate associations using Fisher's exact and Wilcoxon rank sum tests. SCPs were developed for ≥75 % survivors in five programs (15 %), eight (25 %) delivered ≥75 % SCPs to survivors, seven (23 %) delivered ≥75 % SCPs to PCPs, and only one program (4 %) met all three criteria. We found relationships between SCP use consistency and geographic region (p = .05), initiating SCP use in response to survivors' requests (p = .03), and membership in the National Cancer Institute's National Community Cancer Centers Program (p = .01). SCP use is highly inconsistent. Survivors and cancer care quality improvement organizations may play a key role in improving the consistency of SCP use in US cancer programs. Survivors can initiate SCP use. Cancer care quality improvement organizations can specify how cancer programs' compliance with SCP guidelines will be assessed. Future research should identify mechanisms underlying the relationships that we found.
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Affiliation(s)
- Sarah A Birken
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 1107A McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA,
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Decision consultations on preoperative radiotherapy for rectal cancer: large variation in benefits and harms that are addressed. Br J Cancer 2014; 112:39-43. [PMID: 25333343 PMCID: PMC4453602 DOI: 10.1038/bjc.2014.546] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/23/2014] [Accepted: 09/25/2014] [Indexed: 01/04/2023] Open
Abstract
Background: For shared decision making to be successful, patients should receive sufficient information on possible benefits and harms of treatment options. The aim of this study was to evaluate what information radiation oncologists provide during the decision consultation about preoperative radiotherapy with rectal cancer patients. Methods: Decision consultations of 17 radiation oncologists with 81 consecutive primary rectal cancer patients, eligible for short-course radiotherapy followed by a low-anterior resection, were audio taped. Tapes were transcribed and analysed using the ACEPP (Assessing Communication about Evidence and Patient Preferences) coding scheme. Results: A median of seven benefits/harms were addressed per consultation (range, 2–13). This number ranged within and between oncologists and was not clearly associated with the patient's characteristics. A total of 30 different treatment outcomes were addressed. The effect of radiotherapy on local control was addressed in all consultations, the effect on survival in 16%. The most important adverse effects are bowel and sexual dysfunction. These were addressed in 82% and 85% of consultations, respectively; the latter significantly less often in female than in male patients. Four out of five patients did not initiate discussion on any benefits/harms. Conclusions: Our results showed considerable inconsistency between and within oncologists in information provision, which could not be explained by patient characteristics. This variation indicates a lack of clarity on which benefits/harms of radiotherapy should be discussed with newly-diagnosed patients. This suboptimal patient information hampers the process of shared decision making, in which the decision is based on each individual patients' weighing of benefits and harms.
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Halpern MT, Viswanathan M, Evans TS, Birken SA, Basch E, Mayer DK. Models of Cancer Survivorship Care: Overview and Summary of Current Evidence. J Oncol Pract 2014; 11:e19-27. [PMID: 25205779 DOI: 10.1200/jop.2014.001403] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION This article, derived from a Technical Brief prepared for the Agency for Healthcare Research and Quality, presents an overview on current models of care for survivors of adult-onset cancer who have completed active treatment. METHODS This article integrates reviewed literature on background, context, research gaps, and future research directions for survivorship care models. We also conducted a systematic literature review of current evidence from studies of survivorship care models. RESULTS Our systematic review identified nine empirical studies of survivorship care models, covering multiple models types and illustrating the heterogeneity in this field. The literature review indicated considerable heterogeneity in models of survivorship care, components of models, survivor populations, and target outcomes. Models of survivorship care are highly individualized to the institution or setting where they are provided. "Usual care" is often uncoordinated and highly varied across cancer survivors and within cancer programs. Anticipated shortages in the oncology workforce may require the expanded use of nurse practitioners and physician assistants and shared care with primary care providers to deliver survivorship care to the growing number of survivors. Concerns associated with survivorship care models include payment considerations, adequacy of training, and the potential for lack of coordination and fragmented care. CONCLUSION There is substantial variation in survivorship care models. The optimal nature, timing, intensity, format, and outcomes of survivorship care models are uncertain and require further research. Specific research questions need to be addressed by the survivorship community to better understand the advantages and limitations of survivorship models.
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Affiliation(s)
- Michael T Halpern
- RTI International, Washington, DC, and Research Triangle Park, NC; and University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Meera Viswanathan
- RTI International, Washington, DC, and Research Triangle Park, NC; and University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Tammeka S Evans
- RTI International, Washington, DC, and Research Triangle Park, NC; and University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Sarah A Birken
- RTI International, Washington, DC, and Research Triangle Park, NC; and University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Ethan Basch
- RTI International, Washington, DC, and Research Triangle Park, NC; and University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Deborah K Mayer
- RTI International, Washington, DC, and Research Triangle Park, NC; and University of North Carolina-Chapel Hill, Chapel Hill, NC
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