Survivorship in new harbors

ePRO-based individual follow-up care for women treated for early breast cancer: impact on service use and workflows

PURPOSE

The increasing population of breast cancer survivors highlights the need to (re)consider how we utilize available services for survivorship care in oncology clinics. Electronic Patient-Reported Outcomes (ePROs) can be used to identify patients' individual care needs and triage them to the right services. We examined the impact on service use, workflow and workload following the introduction of an ePRO-based individual follow-up (PIFU) for women treated for early breast cancer.

METHODS

A multi-method approach was used. In a pilot randomized controlled trial, the use of consultations, telephone calls, and specialist referrals were systematically recorded. Comparison was done between PIFU and standard follow-up care (SFU). Focus group interviews with nurse navigators evaluated the impact on workflow and workload qualitatively.

RESULTS

The 64 women randomized to attend SFU used a mean of 3.8 (95% CI: 3.5-4.1) planned consultations during the 2-year study period compared with a mean of 1.9 consultations (95% CI: 1.4-2.4) for the 60 women randomized to PIFU (P < 0.001). Urgent appointments were more frequent in SFU (mean of 0.47 vs 0.22 per patient, P = 0.03). No statistically significant differences were observed in the use of telephone calls and specialist referrals. The nurse navigators did not experience an increase in their workload, but implementation of PIFU may require a re-structured workflow.

CONCLUSIONS

The ePRO-based individual follow-up could change organization of care and re-allocate services for those in need of it.

IMPLICATIONS FOR CANCER SURVIVORS

ePRO-based individual follow-up could potentially ensure more time for those most in need of face-to-face care.

An assessment of survivorship care needs of patients with colorectal cancer: The experiences and perspectives of hospital nurses

PURPOSE

To describe and analyse hospital nurses' experiences and perspectives of needs assessment in relation to colorectal cancer patients' survivorship care and rehabilitation needs.

METHOD

The methodology and design of this study was phenomenological-hermeneutic, and the analysis was performed by Ricoeur's theory of interpretation. Twelve hospital nurses working within the care of patients with colorectal cancer participated in four focus group interviews between February-March 2018. Focus group interviews were recorded, transcribed and analysed. The study adhered to the COREQ checklist.

RESULTS

Our analysis showed that nurses experienced challenges and barriers in conducting needs assessment. These challenges were described in three main themes. Encountering paradigms brought to light the difficulties relating to implementation of needs assessment into daily practice in the complex context of a hospital setting. Patient involvement could be challenging because of insufficient involvement and inadequate health literacy of patients in relation to needs assessment. A negative attitude towards systematic needs assessment among nurses could present a barrier because of their role as gatekeepers.

CONCLUSION

The findings point to important elements that are necessary to consider when planning cancer survivorship care in the hospital setting so that all patients experience the best possible cancer trajectory. These insights can guide future clinical practice in the endeavour to ensure more systematic initiatives towards cancer rehabilitation.

RELEVANCE TO CLINICAL PRACTICE

Based on our findings, cancer survivorship care needs assessment in the hospital setting should encompass specific guidelines on needs assessment and systematic implementation of these guidelines by involving hospital management, nurses and patients through use of visionary information and communication. Implementation of these guidelines would be supported by securing knowledge on cancer survivorship care for all hospital health professionals. Health literacy should be considered in formulating guidelines that enhance involvement of patients by use of patient-centred communication.

Hospital Based Psychosocial Support Program for Children with ALL and their Families: A Comprehensive Triad's Perspective

OBJECTIVES

To elucidate potential target areas of intervention and mechanisms for implementation of intervention for children with cancer during the treatment phase.

METHODS

Focused group discussion (FGDs) served as a primary source of providing phenomenal perspectives to explore the key objective. Eight focus groups of 45-60 min each were held with 5-9 members in each discussion. The participants were either patients, their caregivers or health care providers. The focus group audio recordings were professionally transcribed after all identifiers were removed. Employing a constructivist paradigm with a phenomenological approach, also known as emergent-systematic focus group design the study reported on families' experiences of childhood cancer as construction of objective reality. Investigator triangulation method was adopted to ensure trustworthiness.

RESULTS

Using constant comparison analysis, multistage process analysis was done which resulted in 849 codes, 32 subthemes, 20 themes and 5 domains. A total of 64 participants participated: 4 FGDs with parents of children with ALL (n = 31); 1 FGD with professionals working in the field of cancer (n = 10) and 3 FGDs with children with ALL (n = 23). Participant's mean age at the time of study was 10 y (+3.3) for children; 37 y (+4.93) for caregivers and 35 y (+3.5) for professionals. The number of participants and their age range at study varied slightly between the eight focus groups.

CONCLUSIONS

Caregivers presented care burden and compromised aspects of Quality of life (QOL). An effective and culturally sensitive psychosocial support for patients and their families during and post treatment, in addition to medical therapy, is strongly recommended.