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Almeida AM, Lima L, Martins T. Monitoring Patient-Reported Outcomes in Self-management of Postsurgical Symptoms in Oncology: A Scoping Review. Cancer Nurs 2024; Publish Ahead of Print:00002820-990000000-00147. [PMID: 37232525 DOI: 10.1097/ncc.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Surgery is used widely for cancer treatment, and in most types, after discharge, patients usually report multiple symptoms, which, if not controlled, can put postoperative recovery at risk. Understanding which patient-reported outcomes (PROs) should be monitored could have a significant impact on reducing the symptom burden associated with cancer and its treatment by playing a pivotal role in developing symptom self-management plans and designing tailored approaches to optimize patients' symptom self-management behaviors. OBJECTIVE To map the PROs used for patients' postsurgical symptom self-management after hospital discharge following cancer surgery. INTERVENTIONS/METHODS Our scoping review process was guided by the steps for conducting scoping reviews recommended by the Joanna Briggs Institute. RESULTS The search identified 97 potentially relevant studies, with 27 articles meeting the inclusion criteria. The most frequently assessed and monitored PROs were problems with surgical wounds, more general physical symptoms, psychological functioning outcomes, and quality of life. CONCLUSIONS Our results showed an overall uniformity among the PROs selected to be monitored in surgical cancer patients after hospital discharge. Monitoring through electronic platforms is widely used and seems useful to self-manage symptoms and optimize the recovery of cancer patients after discharge following surgery. IMPLICATIONS FOR PRACTICE This study provides knowledge about PROs that can be applied in oncologic patients after surgery to self-report their symptoms following discharge.
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Affiliation(s)
- Ana M Almeida
- Author Affiliations: Institute of Biomedical Sciences Abel Salazar of the University of Porto-ICBAS (Mrs Almeida); Imaging Sciences and Radiooncology Department, Portuguese Institute of Oncology of Porto (Mrs Almeida); Nursing School of Porto (Drs Martins and Lima); and Center for Health Technology and Services Research, (CINTESIS@RISE)(Drs Martins and Lima), Porto, Portugal
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Yoon J, Lee H, Son H. Effects of an interactive coaching intervention on quality of life and psychological factors for colorectal cancer survivors: A single group pre and posttest design. Eur J Oncol Nurs 2023; 66:102413. [PMID: 37776600 DOI: 10.1016/j.ejon.2023.102413] [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: 05/23/2023] [Revised: 07/25/2023] [Accepted: 09/07/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE To develop and evaluate the effects of an interactive coaching intervention, using a self-management mobile application, on quality of life and physical and psychological factors for colorectal cancer survivors. METHODS We developed a self-management mobile application providing social support services for post-treatment CRC survivors and evaluated its effects through baseline and post-intervention surveys. Using the biopsychosocial holistic model as the theoretical framework, automated interactive coaching technology was applied for six weeks to provide supportive services tailored for each user. To evaluate the effects of the application, self-efficacy, health practice index, depression, fear of cancer recurrence, and quality of life measures were administered to participants. A total of 34 men and 5 women were included in the analysis. RESULTS Participants' mean age were 54.10 years and 78% of them had been diagnosed within the last five years. There were significant increases in self-efficacy (z = 2.09, p = .04), health practice index (t = 2.35, p = .02), and quality of life (t = 2.03, p = .05). More specifically, the emotional functional score increased (z = 2.23, p = .03) while both of the total symptom score (t = 2.10, p = .04) and the fatigue symptom score (z = 2.54, p = .01) decreased after six weeks of using the mobile application. CONCLUSIONS Interventions supporting colorectal cancer survivors' self-management are critical for addressing the challenges they face after treatment and improving their quality of life. Providing social support through mobile applications could be a good strategy in terms of usability and effectiveness.
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Affiliation(s)
- Jaehee Yoon
- Wolchon Elementary School, 132, Mokdongjungang-ro, Yangcheon-gu, Seoul, 07989, South Korea.
| | - HyunHae Lee
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, South Korea
| | - Heesook Son
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, South Korea.
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Yu S, Wan R, Bai L, Zhao B, Jiang Q, Jiang J, Li Y. Transformation of chronic disease management: Before and after the COVID-19 outbreak. Front Public Health 2023; 11:1074364. [PMID: 37064686 PMCID: PMC10090362 DOI: 10.3389/fpubh.2023.1074364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
Adults with chronic diseases often experience a decline in their quality of life along with frequent exacerbations. These diseases can cause anxiety and impose a significant economic burden. Self-management is a crucial aspect of treatment outside of the hospital and can improve quality of life and reduce the financial burden resulting from unexpected hospitalizations. With the COVID-19 pandemic, telehealth has become a vital tool for both medical professionals and patients; many in-person appointments have been canceled due to the pandemic, leading to increased reliance on online resources. This article aimed to discuss various methods of chronic disease management, both traditional self-management and modern telehealth strategies, comparing before and after the COVID-19 outbreak and highlighting challenges that have emerged.
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Affiliation(s)
- Steven Yu
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Rongjun Wan
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Lu Bai
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Bingrong Zhao
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Qiaoling Jiang
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Juan Jiang
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Juan Jiang,
| | - Yuanyuan Li
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- *Correspondence: Yuanyuan Li,
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Ulibarri-Ochoa A, Sánchez-Gómez S, Gamboa-Moreno E, Duo-Trecet I, Garate-Echenique L, Belarra-Tellechea B, de Retana-García LO. Impact of the "Looking after my health after cancer" peer-led active patient education program on cancer survivors and their caregivers: A qualitative study. PLoS One 2023; 18:e0282018. [PMID: 36827237 PMCID: PMC9955581 DOI: 10.1371/journal.pone.0282018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Cancer survival has doubled and is likely to continue increasing in the near future. Cancer survivors experience long-term adverse effects, with associated psychological changes, and often they have needs that are yet to be met. Recognizing the lack of continuity-of-care initiatives for cancer survivors and caregivers, Osakidetza Basque Health Service has started to implement through primary care a peer-led active patient education program called "Looking after my health after cancer". This study explores how cancer survivors and their caregivers rate the experience of participating in the program, to what extent the program helps them understand and address their unmet felt needs, and helps them improve their activation for self-care and self-management. METHODS A qualitative exploratory phenomenological study was conducted using five focus groups: four with cancer survivors (n = 29) and caregivers (n = 2), and one with peer leaders (n = 7). Narrative content analysis was performed using the constant comparison method, facilitated by Atlas-ti software. Descriptive analysis of sociodemographic and clinical data was performed. The study was developed according to the Consolidated criteria for reporting qualitative research (COREQ) checklist. RESULTS Five main themes emerged from the content analysis: 1) satisfaction with the program as a positive learning experience; 2) peer sharing and learning ("if they can, so can I"); 3) fears prior to attending the program; 4) becoming more aware of unmet felt needs and feeling understood in the "new normal"; and 5) a more positive view of their experience, helping them become active in self-care and empowered in the self-management of their condition. CONCLUSIONS The peer education program has shown to have a positive impact on cancer survivors and caregivers. It is necessary to design, implement and evaluate interventions of this type to address unmet felt needs during cancer survivorship and improve their quality of life.
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Affiliation(s)
- Ainhoa Ulibarri-Ochoa
- Bioaraba Health Research Institute, Clinical Nursing and Community Health Research Group, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Araba Integrated Health Organisation, Vitoria-Gasteiz, Spain
- Vitoria-Gasteiz School of Nursing, University of the Basque Country, Vitoria-Gasteiz, Spain
- * E-mail:
| | - Sheila Sánchez-Gómez
- Bioaraba Health Research Institute, Healthcare Research Group, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Araba Integrated Health Organisation, Directorate for Healthcare Integration, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, General Directorate, Nursing Subcommittee, Araba Multidisciplinary Teaching Unit for Family and Community Healthcare, Vitoria-Gasteiz, Spain
| | - Estíbaliz Gamboa-Moreno
- Biodonostia Health Research Institute, Primary Care Research Unit, San Sebastián-Donostia, Spain
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, San Sebastián-Donostia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)
| | - Irene Duo-Trecet
- Biodonostia Health Research Institute, Primary Care Research Unit, San Sebastián-Donostia, Spain
- Osakidetza Basque Health Service, Active Patient Program (Paziente Bizia-Paciente Activo), Subdirectorate for Primary Care Coordination, San Sebastián-Donostia, Spain
| | - Lucia Garate-Echenique
- Osakidetza Basque Health Service, Coordination of Strategic Plans, Subdirectorate for Nursing, Vitoria-Gasteiz, Spain
| | - Begoña Belarra-Tellechea
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Osakidetza Basque Health Service, School of Health (Osasun Eskola), Subdirectorate for Primary Care Coordination, Vitoria-Gasteiz, Spain
| | - Lourdes Ochoa de Retana-García
- Biodonostia Health Research Institute, Primary Care Research Unit, San Sebastián-Donostia, Spain
- Osakidetza Basque Health Service, Active Patient Program (Paziente Bizia-Paciente Activo), Subdirectorate for Primary Care Coordination, San Sebastián-Donostia, Spain
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Salmani H, Nahvijou A, Sheikhtaheri A. Smartphone-based application for self-management of patients with colorectal cancer: development and usability evaluation. Support Care Cancer 2022; 30:3249-3258. [PMID: 34984548 DOI: 10.1007/s00520-021-06754-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Self-management is considered essential for improving the treatment and management of colorectal cancer patients. This study was conducted to develop and evaluate the usability of a smartphone-based application for the self-management of patients with colorectal cancer. METHODS We developed an Android-based application called "Colorectal Cancer Along (ColorectAlong)" for the self-management of colorectal cancer. Seventeen patients, from the Cancer Institute of Iran, evaluated the usability of this application for 2 weeks using a standard questionnaire for user interaction satisfaction (QUIS) version 5.5. The obtained data was analyzed using SPSS software version 26. RESULTS The ColorectAlong application was developed with features covering several areas of colorectal cancer self-management. The areas available for evaluation in the app are patient profile; medication management; nutrition and diet management; pain management; mental health; smoking cessation and alcohol reduction; educational content; and adding reminders, questions, and notes. Our results indicate that the usability of this application is good with an average QUIS score of 8.03 out of 9. CONCLUSION The ColorectAlong application can improve self-management, assist patients, and facilitate access to required information without the need for internet access.
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Affiliation(s)
- Hosna Salmani
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center of Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. .,Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
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Lung Cancer and Self-Management Interventions: A Systematic Review of Randomised Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010536. [PMID: 35010796 PMCID: PMC8744740 DOI: 10.3390/ijerph19010536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 02/01/2023]
Abstract
Background: Lung cancer is the most common cancer worldwide. Evidence suggests self-management (SM) interventions benefit cancer patients. This review aims to determine the effectiveness of SM interventions for lung cancer patients. Method: Searches occurred in PubMed, Cinahl, ProQuest, Psych Info, Scopus, and Medline, using predefined criteria, assessing randomised controlled trials (RCTs). Results: Five hundred and eighty-seven studies were yielded, 10 RCTs met criteria. Of the total patient pool, 1001 of 1089 had Non-Small Cell Lung Cancer (NSCLC). Six studies tested home-based SM exercise, two studies SM education, and one each for diary utilisation and symptom reporting. Fatigue was the most targeted function. Other functions targeted included exercise capacity, anxiety, depression, quality of life (QoL), sleep quality, and symptom burden. Six studies met their primary endpoints (five SM exercise, one SM education). Positive outcomes are described for fatigue, anxiety/depression, sleep quality, self-efficacy, and exercise capacity. With exception to fatigue, early-stage NSCLC, younger age, female, never smokers, partnered patients experienced increased treatment effect. Conclusions: SM interventions improve outcomes among some lung cancer patients. Interventions targeting fatigue yield benefit despite histology, stage or gender and could encourage broader cohort engagement. Consideration of patient characteristics may predict SM effect. Effectiveness of home-based SM exercise by NSCLC stage and SM tailored to sociodemographic variables requires further research.
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Ching SSY, Mok ESB. Adoption of healthy lifestyles among Chinese cancer survivors during the first five years after completion of treatment. ETHNICITY & HEALTH 2022; 27:137-156. [PMID: 31238712 DOI: 10.1080/13557858.2019.1634182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 06/07/2019] [Indexed: 06/09/2023]
Abstract
Objectives: The number of cancer survivors is increasing as a result of advances in detection and treatment. Lifestyle is a significant modifiable factor in the development of cancer. Most studies on healthy lifestyles have been conducted in Western countries. Cultural influences on the pursuit of healthy lifestyles among Chinese cancer survivors remain largely unexplored. The objectives of this qualitative study are to explore the experiences of Chinese cancer survivors in adopting healthy lifestyles, with a focus on their goals, the challenges they face, and the influences of Chinese culture.Design: Thirty-two Chinese breast and colorectal cancer survivors in their first five years after treatment were recruited from a hospital in Hong Kong to participate in eight focus groups. Qualitative content analysis was adopted to analyse the data.Results: The adoption of a healthy lifestyle was a strategy through which the participants exercised choice to restore balance in their health after developing cancer. Diet, exercise, psychological well-being, the use of traditional Chinese medicine (TCM) and health/dietary supplements, and attending medical consultations/follow-up visits were the behaviours adopted by the participants, with the goal of improving their health, controlling their cancer and preventing relapse, and managing the residual physical symptoms of their illness. In adopting a healthy lifestyle, the participants encountered challenges such as a lack of reliable and practical instructions from healthcare professionals. Chinese cultural beliefs concerning the nature of food, TCM, minimizing social disturbances, and collaborative control influenced their lifestyle.Conclusions: The cancer survivors adopted a range of healthy lifestyles but encountered challenges. Clarifying the principles of food choice while addressing Chinese beliefs regarding therapeutic food and the use of TCM, clarifying queries about conflicting information, and developing plans according to the needs, and competing demands of survivors can facilitate collaborative control between healthcare professionals and cancer survivors.
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Affiliation(s)
- S S Y Ching
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - E S B Mok
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
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Pal T, Hull PC, Koyama T, Lammers P, Martinez D, McArthy J, Schremp E, Tezak A, Washburn A, Whisenant JG, Friedman DL. Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery. BMC Cancer 2021; 21:1262. [PMID: 34814868 PMCID: PMC8609269 DOI: 10.1186/s12885-021-08949-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite lower cancer incidence rates, cancer mortality is higher among rural compared to urban dwellers. Patient, provider, and institutional level factors contribute to these disparities. The overarching objective of this study is to leverage the multidisciplinary, multispecialty oncology team from an academic cancer center in order to provide comprehensive cancer care at both the patient and provider levels in rural healthcare centers. Our specific aims are to: 1) evaluate the clinical effectiveness of a multi-level telehealth-based intervention consisting of provider access to molecular tumor board expertise along with patient access to a supportive care intervention to improve cancer care delivery; and 2) identify the facilitators and barriers to future larger scale dissemination and implementation of the multi-level intervention. METHODS Coordinated by a National Cancer Institute-designated comprehensive cancer center, this study will include providers and patients across several clinics in two large healthcare systems serving rural communities. Using a telehealth-based molecular tumor board, sequencing results are reviewed, predictive and prognostic markers are discussed, and treatment plans are formulated between expert oncologists and rural providers. Simultaneously, the rural patients will be randomized to receive an evidence-based 6-week self-management supportive care program, Cancer Thriving and Surviving, versus an education attention control. Primary outcomes will be provider uptake of the molecular tumor board recommendation and patient treatment adherence. A mixed methods approach guided by the Consolidated Framework for Implementation Research that combines qualitative key informant interviews and quantitative surveys will be collected from both the patient and provider in order to identify facilitators and barriers to implementing the multi-level intervention. DISCUSSION The proposed study will leverage information technology-enabled, team-based care delivery models in order to deliver comprehensive, coordinated, and high-quality cancer care to rural and/or underserved populations. Simultaneous attention to institutional, provider, and patient level barriers to quality care will afford the opportunity for us to broadly share oncology expertise and develop dissemination and implementation strategies that will enhance the cancer care delivered to patients residing within underserved rural communities. TRIAL REGISTRATION Clinicaltrials.gov , NCT04758338 . Registered 17 February 2021 - Retrospectively registered, http://www.clinicaltrials.gov/.
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Affiliation(s)
- Tuya Pal
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 536 Robinson Research Building, Nashville, TN, 37232, USA
| | - Pamela C Hull
- University of Kentucky Markey Cancer Center, 800 Rose Street, Lexington, KY, 40536, USA
- Department of Behavioral Science, University of Kentucky College of Medicine, Rural and Underserved Health Research Center, Healthy Kentucky Research Building, 760 Press Avenue, Lexington, KY, 40536, USA
| | - Tatsuki Koyama
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Suite 1100, Nashville, TN, 37203, USA
| | - Phillip Lammers
- Baptist Cancer Center, 80 Humphreys Center Suite 330, Memphis, TN, 38120, USA
| | - Denise Martinez
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Jacob McArthy
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Emma Schremp
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Ann Tezak
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 536 Robinson Research Building, Nashville, TN, 37232, USA
| | - Anne Washburn
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Jennifer G Whisenant
- Division of Hematology & Oncology, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Debra L Friedman
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA.
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA.
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Adriaans DJ, Dierick-van Daele AT, van Bakel MJHM, Nieuwenhuijzen GA, Teijink JA, Heesakkers FF, van Laarhoven HW. Digital Self-Management Support Tools in the Care Plan of Patients With Cancer: Review of Randomized Controlled Trials. J Med Internet Res 2021; 23:e20861. [PMID: 34184997 PMCID: PMC8278296 DOI: 10.2196/20861] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/24/2020] [Accepted: 05/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Digital self-management support tools (DSMSTs)—electronic devices or monitoring systems to monitor or improve health status—have become increasingly important in cancer care. Objective The aim of this review is to analyze published randomized clinical trials to assess the effectiveness of DSMSTs on physical and psychosocial symptoms or other supportive care needs in adult patients with cancer. Methods Five databases were searched from January 2013 to January 2020. English or Dutch language randomized controlled trials comparing DSMSTs with no intervention, usual care, alternative interventions, or a combination and including patients aged ≥18 years with pathologically proven cancer in the active treatment or survivorship phases were included. The results were summarized qualitatively. Results A total of 19 publications describing 3 types of DSMSTs were included. Although the content, duration, and frequency of interventions varied considerably across studies, the commonly used elements included an assessment component, tailored symptom self-management support, an information section, a communication section, and a diary. Significant positive effects were observed on quality of life in 6 (out of 10) studies, on anxiety in 1 (out of 5) study and depression in 2 (out of 8) studies, on symptom distress in 5 (out of 7) studies, on physical activity in 4 (out of 6) studies, on dietary behavior in 1 (out of 4) study, and on fatigue in 2 (out of 5) studies. Moreover, significant negative effects were observed on anxiety in 1 (out of 5) study and depression in 1 (out of 8) study. Most interventions were web-based interventions; 2 studies used mobile apps, and 1 study used a game as a DSMST. The overall quality of the studies was found to be good, with 13 out of 19 studies classified as high quality. Conclusions This review suggests that DSMSTs have a beneficial effect on the quality of life. For effects on other patient outcomes (eg, anxiety and depression, symptom distress, physical activity, dietary behavior, and fatigue), the evidence is inconsistent and limited or no effect is suggested. Future research should focus on specific tumor types, study different types of interventions separately, and assess the effects of specific interventions at different stages of disease progression.
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Affiliation(s)
- Danielle Jm Adriaans
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands.,Fontys University of Applied Sciences, Eindhoven, Netherlands
| | - Angelique Tm Dierick-van Daele
- Fontys University of Applied Sciences, Eindhoven, Netherlands.,Department of Education and Research, Catharina Hospital, Eindhoven, Netherlands.,Fontys School of People and Health Studies, Eindhoven, Netherlands
| | | | | | - Joep Aw Teijink
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
| | | | - Hanneke Wm van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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10
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Reiter M, Gerken M, Lindberg-Scharf P, Fuerst A, Liebig-Hörl G, Ortmann O, Eberl I, Bartholomeyczik S. Health services research in colorectal cancer: a quasi-experimental interventional pilot study on in- and outpatient oncology. J Cancer Res Clin Oncol 2020; 147:1789-1802. [PMID: 33373026 PMCID: PMC8076149 DOI: 10.1007/s00432-020-03454-w] [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: 02/20/2020] [Accepted: 11/05/2020] [Indexed: 12/02/2022]
Abstract
Introduction Due to frequent treatment side effects and weight loss, colorectal cancer patients require oncologic care and nutritional counseling both during and after hospitalization. The current study evaluated differences in discharge and side effects management and nutritional behavior between colorectal cancer patients of a control group without systematic counseling and of an intervention group with access to structured in- and outpatient oncology nurse and nutritional counseling. Methods The presented explorative, quantitative, single-center, interventional pilot study is a health services research project with a quasi-experimental design. Using a self-designed standardized questionnaire, data were collected from the control group (n = 75) before and from the intervention group (n = 114) after the introduction of in- and outpatient oncology nurse and structured systematic nutritional counseling. The in- and outpatient counseling services were developed and evaluated in the form of a structured nurse-led counseling concept. Results Intervention group patients profited significantly from inpatient oncology nurse counseling in seven different areas of discharge management. No differences were observed concerning patient-reported general and gastrointestinal side effects except for xerostomia and dysphagia, but of the patients participating in both in- and outpatient oncology nurse counseling, 90.0% were better able to cope with general side effects of treatment. Patients with in- and outpatient structured systematic nutritional counseling more frequently received nutritional information (p = 0.001), were better at gauging food intolerances (p = 0.023), and followed the dietician's advice in cases of gastrointestinal side effects significantly more often (p = 0.003) than control patients. Counselor-reported outcomes concerning gastrointestinal side effects showed improvement in most of the patients taking part in systematic in- and outpatient nutritional counseling, except for weight loss in 4 patients. Conclusion In- and outpatient counseling in discharge and side effects management and nutrition improve the outcomes of colorectal cancer patients. Outpatient counseling should be further developed and evaluated in future studies.
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Affiliation(s)
- Margarete Reiter
- Diplom-Kauffrau, Faculty of Health, School of Nursing Science, PhD Student at the Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany. .,Caritas-Hospital Sankt Josef, Landshuter Straße 65, 93053, Regensburg, Germany.
| | - Michael Gerken
- Tumor Center Regensburg-Institute of Quality Management and Health Services Research of the University of Regensburg, Coordination, Epidemiology, Am Biopark 9, 93053, Regensburg, Germany
| | - Patricia Lindberg-Scharf
- Tumor Center Regensburg-Institute of Quality Management and Health Services Research of the University of Regensburg, Section Quality of Life, Am Biopark 9, 93053, Regensburg, Germany
| | - Alois Fuerst
- Director of the Department of General and Visceral Surgery, Caritas-Hospital Sankt Josef, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Gudrun Liebig-Hörl
- Medical Coordinator of Colon Cancer Center, Caritas-Hospital Sankt Josef, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Olaf Ortmann
- Director of the Department of Gynecology and Obstetrics, University Medical Center Regensburg, Caritas-Hospital Sankt Josef, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Ingeborg Eberl
- Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Kapuzinergasse 2, 85072, Eichstätt, Germany
| | - Sabine Bartholomeyczik
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany
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11
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Zhu S, Liu F, Li J, Guan Y, Meng M, Li X, Zhou Z, Xu R, Li L. Development and validation of a self-management scale of type 1 diabetes for Chinese adults. J Int Med Res 2020; 48:300060520947588. [PMID: 32865059 PMCID: PMC7469726 DOI: 10.1177/0300060520947588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective Self-management is beneficial for improving health outcomes in adults with type 1 diabetes. However, there are no validated instruments to assess self-management in Chinese adults with type 1 diabetes. The aim of this study was to develop and validate the Self-Management of Type 1 Diabetes for Chinese Adults (SMOD-CA) scale. Methods Qualitative and quantitative methods were used to develop the SMOD-CA. We conducted a literature review and semi-structured interviews to generate an initial item pool. An expert panel examined the content validity. We conducted a cross-sectional survey to evaluate scale reliability and validity. A total of 243 participants were recruited. Exploratory factor analyses were used to test the construct validity, and internal consistency and test-retest reliability were assessed. Results The expert panel determined that the SMOD-CA content validity index was satisfactory. The final 30-item scale consisted of four factors explaining 49.50% of the total variance in the data. Cronbach’s α was 0.901 for the total scale and 0.911 for test–retest reliability. Conclusions The SMOD-CA demonstrated good reliability and validity. The scale is a credible and effective instrument that can be used by social workers and health care professionals to assess self-management in Chinese adults with type 1 diabetes. Trial registration number NCT03610984
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Affiliation(s)
- Song Zhu
- Clinic Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Fang Liu
- Clinic Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Ministry of Education, National Clinical Research Center for Metabolic Disease, Changsha, China
| | - Jina Li
- Clinic Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yuzhu Guan
- Xiangya Nursing School, Central South University, Changsha, Hunan Province, China
| | - Meng Meng
- Xiangya Nursing School, Central South University, Changsha, Hunan Province, China
| | - Xia Li
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Zhiguang Zhou
- Ministry of Education, National Clinical Research Center for Metabolic Disease, Changsha, China
| | - Rong Xu
- Clinic Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Lezhi Li
- Clinic Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
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12
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Nelson D, McGonagle I, Jackson C, Kane R. What is known about the role of rural-urban residency in relation to self-management in people affected by cancer who have completed primary treatment? A scoping review. Support Care Cancer 2020; 29:67-78. [PMID: 32747989 PMCID: PMC7398290 DOI: 10.1007/s00520-020-05645-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
Abstract
Purpose Despite wide acknowledgement of differences in levels of support and health outcomes between urban and rural areas, there is a lack of research that explicitly examines these differences in relation to self-management in people affected by cancer following treatment. This scoping review aimed to map the existing literature that examines self-management in people affected by cancer who were post-treatment from rural and urban areas. Methods Arksey and O’Malley’s framework for conducting a scoping review was utilised. Keyword searches were performed in the following: Academic Search Complete, CINAHL, MEDLINE, PsycINFO, Scopus and Web of Science. Supplementary searching activities were also conducted. Results A total of 438 articles were initially retrieved and 249 duplicates removed leaving 192 articles that were screened by title, abstract and full text. Nine met the eligibility criteria and were included in the review. They were published from 2011 to 2018 and conducted in the USA (n = 6), Australia (n = 2) and Canada (n = 1). None of the studies offered insight into self-managing cancer within a rural-urban context in the UK. Studies used qualitative (n = 4), mixed methods (n = 4) and quantitative designs (n = 1). Conclusion If rural and urban populations define their health in different ways as some of the extant literature suggests, then efforts to support self-management in both populations will need to be better informed by robust evidence given the increasing focus on patient-centred care. It is important to consider if residency can be a predictor of as well as a barrier or facilitator to self-management.
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Affiliation(s)
- David Nelson
- School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS UK
| | - Ian McGonagle
- School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS UK
| | - Christine Jackson
- School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS UK
| | - Ros Kane
- School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS UK
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13
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ReActivate—A Goal-Orientated Rehabilitation Program for Adolescent and Young Adult Cancer Survivors. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Turner J, Yates P, Kenny L, Gordon LG, Burmeister B, Hughes BGM, McCarthy AL, Perry C, Chan RJ, Paviour A, Skerman H, Batstone M, Mackenzie L. The ENHANCES study: a randomised controlled trial of a nurse-led survivorship intervention for patients treated for head and neck cancer. Support Care Cancer 2019; 27:4627-4637. [DOI: 10.1007/s00520-019-04748-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
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15
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Nguyen LT, Alexander K, Yates P. Psychoeducational Intervention for Symptom Management of Fatigue, Pain, and Sleep Disturbance Cluster Among Cancer Patients: A Pilot Quasi-Experimental Study. J Pain Symptom Manage 2018; 55:1459-1472. [PMID: 29505795 DOI: 10.1016/j.jpainsymman.2018.02.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To assess the feasibility of conducting a trial of a psychoeducational intervention involving the provision of tailored information and coaching to improve management of a cancer-related symptom cluster (fatigue, pain, and sleep disturbance) and reduce symptom cluster impacts on patient health outcomes in the Vietnamese context and to undertake a preliminary evaluation of the intervention. METHODS A parallel-group single-blind pilot quasi-experimental trial was conducted with 102 cancer patients in one Vietnamese hospital. The intervention group received one face-to-face session and two phone sessions delivered by a nurse one week apart, and the comparison group received usual care. Patient outcomes were measured at baseline before the chemotherapy cycle and immediately preceding the next chemotherapy cycle. Separate linear mixed models were used to evaluate the impact of the intervention on total symptom cluster severity, symptom scores, functional status, depressive symptoms, and health-related quality of life. RESULTS The study design was feasible with a recruitment rate of 22.6% and attrition rate of 9.8%. Compared to the control group, the intervention group showed a significant reduction in symptom cluster severity, fatigue severity, fatigue interference, sleep disturbance, depression, and anxiety. Significant differences were not observed for pain severity, pain interference, functional status, and health-related quality of life. The intervention was acceptable to the study population, with a high attendance rate of 78% and adherence rate of 95.7%. CONCLUSION On the basis of the present study findings, future randomized controlled trials are needed to test the effectiveness of a symptom cluster psychoeducational intervention in Vietnam.
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Affiliation(s)
- Ly Thuy Nguyen
- School of Nursing, Queensland University of Technology, Brisbane, Australia; Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam.
| | - Kimberly Alexander
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Patsy Yates
- School of Nursing, Queensland University of Technology, Brisbane, Australia
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16
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Brett J, Boulton M, Watson E. Development of an e-health app to support women prescribed adjuvant endocrine therapy after treatment for breast cancer. Patient Prefer Adherence 2018; 12:2639-2647. [PMID: 30587936 PMCID: PMC6294163 DOI: 10.2147/ppa.s187692] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Adjuvant endocrine therapy (AET) is prescribed to women for 5-10 years after treatment for estrogen receptor positive (ER+ve), early-stage breast cancer. AET has proven effectiveness in reducing the risk of recurrence of breast cancer and mortality. However, adherence is known to be suboptimal with around 20% discontinuing by 2 years and up to 50% discontinuing by 5 years. Interventions are needed to support women taking AET after breast cancer. The aim of this study was to develop and pilot test an e-health app for this population. METHODS Two focus groups (n=15) and five interviews were conducted with women following treatment for early-stage breast cancer to assess the likely acceptability of an e-health app and to inform the content (Phase I). Following development of a prototype e-health app, a simple heuristic usability test was completed by five women in order to identify any design usability problems (Phase II). A further 18 women used the app for 1 month between July and August 2016, after which they were interviewed by telephone to collect their experiences and views of the app (Phase III). RESULTS The prototype e-health app included evidence-based information on effectiveness of AET, an electronic side-effects diary, a peer support forum, a repeat prescription reminder, suggested strategies for facilitating adherence and managing any side effects that occur, and a link to further evidence and useful organizations for further information and support. The app was received positively by women. Women found the app useful as it emphasized the importance of taking AET, helped them manage their side effects and provided details of support organizations, while offering empathy and exchange of suggestions for self-management strategies through the peer support forum. CONCLUSION Overall, findings suggest that this novel e-health app has potential as a feasible medium for promoting adherence to AET. Future research should evaluate the efficacy of the app in supporting women and promoting adherence.
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Affiliation(s)
- Jo Brett
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford OX3 0FL, UK,
| | - Mary Boulton
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford OX3 0FL, UK,
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford OX3 0FL, UK,
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17
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Self-management interventions for cancer survivors: a systematic review. Support Care Cancer 2017; 26:1585-1595. [PMID: 29199362 DOI: 10.1007/s00520-017-3999-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/24/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE Many cancer survivors experience problems with persisting symptoms such as pain, fatigue, anxiety and depression post-treatment. Self-management interventions are recommended for cancer patients as they can help individuals identify and manage these continuing symptoms. This systematic review examines the type, content and impact of self-management interventions for cancer survivors on health outcomes such as activity participation, self-efficacy, quality of life and symptom management. METHODS This was a systematic review of the English language scientific literature searched for randomised controlled trials (RCT), systematic reviews and meta-analyses of self-management programmes conducted with cancer survivors. Six databases were systematically searched. RESULTS Initial searches yielded 2633 citations. Following screening and a risk of bias assessment, six studies were included in the final review. Heterogeneity of the interventions precluded meta-analysis. Three studies reported significant differences between groups in a number of areas including fatigue, physical functioning, distress and self-efficacy at their first follow-up assessment. These studies included two psychosocial interventions and one exercise and diet intervention. Not all findings were sustained across studies at follow-up assessment. CONCLUSION It is not possible to draw definitive conclusions as to the impact the different types of self-management programme had on cancer survivors. The sustainability of the interventions reviewed was poor, suggesting that cancer survivors require interventions that can be applied into their daily activities.
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18
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Corbett T, Singh K, Payne L, Bradbury K, Foster C, Watson E, Richardson A, Little P, Yardley L. Understanding acceptability of and engagement with Web-based interventions aiming to improve quality of life in cancer survivors: A synthesis of current research. Psychooncology 2017; 27:22-33. [DOI: 10.1002/pon.4566] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/30/2017] [Accepted: 10/04/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Teresa Corbett
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP); University of Southampton; Southampton UK
| | - Karmpaul Singh
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP); University of Southampton; Southampton UK
| | - Liz Payne
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP); University of Southampton; Southampton UK
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP); University of Southampton; Southampton UK
| | - Claire Foster
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Eila Watson
- Department of Applied Health and Professional Development, Faculty of Health and Life Sciences; Oxford Brookes University; Oxford UK
| | - Alison Richardson
- Faculty of Health Sciences, University Hospital Southampton NHS Foundation Trust; University of Southampton; Southampton UK
| | - Paul Little
- Primary Care and Population Sciences; Aldermoor Health Centre, Aldermoor Close; Southampton UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP); University of Southampton; Southampton UK
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
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Typologies for Restructuring Relationships in Cancer Survivorship: Temporal Changes in Social Support and Engagement With Self-Management Practices. Cancer Nurs 2017; 41:E32-E40. [PMID: 28953505 DOI: 10.1097/ncc.0000000000000538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cancer survivors with good social support are generally more motivated to undertake self-management behaviors and make lifestyle changes. However, the impact of changes in social support over time, from prediagnosis through treatment and into survivorship, on the health and recovery of cancer survivors with a range of cancer diagnoses has not been explored. OBJECTIVE The aim of this study was to examine how temporal changes in social support offered to cancer survivors by family and friends influence their engagement with self-management practices and adaptation to lifestyle changes. METHODS The interview study took place in a teaching hospital in the West Midlands, United Kingdom. Forty participants were purposively sampled. A narrative approach to data collection was chosen, and data were thematically analyzed. RESULTS Six typologies of restructuring relationships postcancer were identified. A greater understanding of the changes to social relationships that a cancer diagnosis can incur and the impact of this on people's outlook and ability to self-manage was developed. CONCLUSION The restructuring of social relationships by cancer survivors over time can impact their outlook and ability to self-manage in survivorship, shaping their engagement with health promoting activities and reconciling cancer within the wider context of their lives. IMPLICATIONS FOR PRACTICE Appropriate clinical nursing processes and tailored interventions are required to support cancer survivors and promote engagement with self-management practices. Nurses are a vital component of the social support that enables patients to make the best health and lifestyle choices available to them.
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Exploring the Person-Centeredness of an Innovative E-Supportive System Aimed at Person-Centered Care: Prototype Evaluation of the Care Expert. Comput Inform Nurs 2017; 34:231-9. [PMID: 26909537 DOI: 10.1097/cin.0000000000000225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Integrated in a multiphase development project, the Care Expert is a prototype of a novel e-supportive system aiming to mediate person-centered care in the context of outpatient oncology. At this early stage of development, the current study was conducted aiming at exploring the person-centeredness concept underlying the Care Expert version 1.0 and its usability for patients receiving outpatient chemotherapy for breast cancer. Within a user-centered design, we followed a mixed-methods approach entailing subjective assessment and diagnostic evaluation of the prototype. Four women undergoing outpatient chemotherapy participated in individual sessions and rated highly the system's usability. Their accounts led to identifying three supportive functions: continuous communication, reinforcement of self-driven agency, and cooperative agency with a sense of being looked after. We discuss the results in relation to theoretical fields that might guide further the development of the supportive system and usability recommendations. Care Expert has the potential to mediate person-centered care in outpatient oncology. Nevertheless, additional cycles of iterative development with the software team and of participatory design focusing on oncology nurses' perspectives are required before departing to the feasibility phase in intervention research.
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Mizuno M, Kataoka J, Oishi F. Relationship between the Physical and Psychosocial Conditions of Postoperative Gastrointestinal Cancer Patients and their Responses to an Informational Material. Asia Pac J Oncol Nurs 2017; 4:53-60. [PMID: 28217731 PMCID: PMC5297233 DOI: 10.4103/2347-5625.199072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective: Postoperative patients with gastrointestinal (GI) cancer have multiple adaptation tasks and care needs to improve their quality of life (QOL). Whether their supportive care needs differ according to their physical and psychosocial conditions is unclear. This study investigated patients’ (1) physical and psychosocial conditions (QOL, fatigue, anxiety, cognitive plight, and resilience) and (2) responses to an informational booklet describing cancer patients’ problems and adaptation tasks, and examined the association between the two factors. Methods: A questionnaire survey was conducted to postoperative patients with GI cancer. Results: The mean age of the 69 respondents was 63 years; 59.4% of the respondents were men. Nine patients who did not read the booklet showed high fatigue and cognitive plight and low QOL. The patients (36.2%) who chose “I vaguely understood the content” showed low scores for resilience and cognitive plight while those (8.5%) who chose “I will deal with my tasks as described in the scenarios” showed high scores for both of these variables. Conclusions: The condition of some patients continued to be highly affected by their cancer. In terms of understanding the contents of the booklet, resilience was significant, and cognitive plight did not necessarily have a negative impact. The provision of information by means of a booklet might not be suitable for patients who are highly affected by their cancer. Patients may need additional support to be able to make good use of the information provided in such a booklet.
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Affiliation(s)
- Michiyo Mizuno
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Jun Kataoka
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Fumiko Oishi
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Self-management education interventions for patients with cancer: a systematic review. Support Care Cancer 2017; 25:1323-1355. [PMID: 28058570 DOI: 10.1007/s00520-016-3500-z] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/14/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE This systematic review was intended to identify the effectiveness and inclusion of essential components of self-management education interventions to support patients with cancer in developing the skills needed for effective self-management of their disease and the acute or immediate, long-term, and late harmful effects of treatments. METHODS Self-management education interventions were included if they were randomized controlled trials (RCTs) containing at least one of the eight core elements outlined by the research team. A systematic search was conducted in Ovid MEDLINE (2005 through April 2015), Embase (2005 to 2015, week 15), the Cochrane Database of Systematic Reviews (Issue 4, April 2015), CINAHL (2005 to 2015) and PsychINFO (2005 to 2015). Keywords searched include 'self-management patient education' or 'patient education'. RESULTS Forty-two RCTs examining self-management education interventions for patients with cancer were identified. Heterogeneity of interventions precluded meta-analysis, but narrative qualitative synthesis suggested that self-management education interventions improve symptoms of fatigue, pain, depression, anxiety, emotional distress and quality of life. Results for specific combinations of core elements were inconclusive. Very few studies used the same combinations of core elements, and among those that did, results were conflicting. Thus, conclusions as to the components or elements of self-management education interventions associated with the strength of the effects could not be assessed by this review. CONCLUSION Defining the core components of cancer self-management education and the fundamental elements for inclusion in supporting effective self-management will be critical to ensure consistent and effective provision of self-management support in the cancer system.
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Ose D, Winkler EC, Berger S, Baudendistel I, Kamradt M, Eckrich F, Szecsenyi J. Complexity of care and strategies of self-management in patients with colorectal cancer. Patient Prefer Adherence 2017; 11:731-742. [PMID: 28435231 PMCID: PMC5391842 DOI: 10.2147/ppa.s127612] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Given the inherent complexity of cancer care, in which personal, social, and clinical aspects accumulate and interact over time, self-management support need to become more comprehensive. This study has the following two aims: 1) to analyze and describe the complexity of individual patient situations and 2) to analyze and describe already established self-management strategies of patients to handle this complexity. METHODS A qualitative study was conducted. Ten focus groups were performed collecting perspectives of the following three user groups: patients with colorectal cancer (n=12) and representatives from support groups (n=2), physicians (n=17), and other health care professionals (HCPs; n=16). Data were analyzed using qualitative content analysis. RESULTS The results showed that cancer patients are struggling with the complexity of their individual situations characterized by the 1) "complexity of disease", 2) "complexity of care", and 3) "complexity of treatment-related data". To deal with these multifaceted situations, patients have established several individual strategies. These strategies are "proactive demanding" (eg, to get support and guidance or a meaningful dialog with the doctor), "proactive behavior" (eg, preparation of visits), and "proactive data management" (eg, in terms of merging treatment-related data and to disseminate these to their health care providers). CONCLUSION Patients with colorectal cancer have to handle a high complexity of individual situations within treatment and care of their disease. Private and social challenges have a culminating effect. This complexity increases as patients experience a longer duration of treatment and follow-up as patients have to handle a significantly higher amount of data over time. Self-management support should focus more on the individual complexity in a patient's life. This includes assisting patients with strategies that have already been established by themselves (like preparation of visits).
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Affiliation(s)
- Dominik Ose
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
- Department of Population Health, Health System Innovation and Research, University of Utah, Salt Lake City, UT, USA
- Correspondence: Dominik Ose, University of Utah, Department of Population Health Sciences, Health System Innovation and Research, Williams Building, 295 Chipeta Way, Salt Lake City, UT 84108, USA, Tel +1 801 587 2263, Fax +1 801 581 3623, Email
| | - Eva C Winkler
- Program for Ethics and Patient-oriented Care in Oncology, National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Sarah Berger
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Ines Baudendistel
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Martina Kamradt
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Felicitas Eckrich
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Gosselin TK, Beck S, Abbott DH, Grambow SC, Provenzale D, Berry P, Kahn KL, Malin JL. The Symptom Experience in Rectal Cancer Survivors. J Pain Symptom Manage 2016; 52:709-718. [PMID: 27697567 DOI: 10.1016/j.jpainsymman.2016.05.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 05/15/2016] [Accepted: 05/24/2016] [Indexed: 11/12/2022]
Abstract
CONTEXT As the number of rectal cancer survivors grows, it is important to understand the symptom experience after treatment. Although data show that rectal cancer survivors experience a variety of symptoms after diagnosis, little has been done to study the way these symptoms are grouped and associated. OBJECTIVES To determine symptom prevalence and intensity in rectal cancer survivors and if clusters of survivors exist, who share similar symptom-defined survivor subgroups that may vary based on antecedent variables. METHODS A secondary analysis of the Cancer Care and Outcomes Research and Surveillance database was undertaken. Cluster analysis was performed on 15-month postdiagnosis data to form post-treatment survivor subgroups, and these were examined for differences in demographic and clinical characteristics. Data were analyzed using cluster analysis, chi-square, and analysis of variance. RESULTS A total of 275 rectal cancer survivors were included who had undergone chemotherapy, radiation therapy, and surgery. Most frequently reported symptoms included feeling "worn out" (87%), feeling "tired" (85%), and "trouble sleeping" (66%). Four symptom-defined survivor subgroups (minimally symptomatic n = 40, tired and trouble sleeping n = 138, moderate symptoms n = 42, and highly symptomatic n = 55) were identified with symptom differences existing among each subgroup. Age and being married/partnered were the only two antecedents found to differ across subgroups. CONCLUSION This study documents differences in the symptom experience after treatment. The identification of survivor subgroups allows researchers to further investigate tailored, supportive care strategies to minimize ongoing symptoms in those with the greatest symptom burden.
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Affiliation(s)
- Tracy K Gosselin
- Duke University Health System, Duke Cancer Institute, Durham, North Carolina, USA.
| | - Susan Beck
- University of Utah, College of Nursing, Salt Lake City, Utah, USA
| | - David H Abbott
- Durham Veterans Affairs Epidemiologic Research and Information Center, Durham, North Carolina, USA
| | - Steven C Grambow
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Dawn Provenzale
- Durham Veterans Affairs Epidemiologic Research and Information Center, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Patricia Berry
- School of Nursing, Oregon Health and Science University, Portland, Oregon, USA
| | - Katherine L Kahn
- Division of General Internal Medicine, University of California, Los Angeles, Los Angeles, California, USA; RAND Corporation, Santa Monica, California, USA
| | - Jennifer L Malin
- Division of General Internal Medicine, University of California, Los Angeles, Los Angeles, California, USA; Anthem, Thousand Oaks, California, USA; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Truccolo I, Cipolat Mis C, Cervo S, Dal Maso L, Bongiovanni M, Bearz A, Sartor I, Baldo P, Ferrarin E, Fratino L, Mascarin M, Roncadin M, Annunziata MA, Muzzatti B, De Paoli P. Patient-Centered Cancer Care Programs in Italy: Benchmarking Global Patient Education Initiatives. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:405-412. [PMID: 25773134 PMCID: PMC4831987 DOI: 10.1007/s13187-015-0805-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In Italy, educational programs for cancer patients are currently provided by the national government, scientific societies, and patient advocate organizations. Several gaps limit their effectiveness, including the lack of coordinated efforts, poor involvement of patient feedback in the planning of programs, as well as a lack of resources on innovative cancer-related topics. This process is parallel to a strong shift in the attitude of patients towards health in general and taking charge of their own health conditions in particular. The National Cancer Institute in the USA and the Organization of European Cancer Institutes encourage comprehensive cancer centers in providing educational programs conceived to overcome these gaps. The goal of this paper is to identify and describe the key elements necessary to develop a global patient education program and provide recommendations for strategies with practical examples for implementation in the daily activities of cancer institutes. A multidisciplinary committee was established for patient education, including patient representatives as equal partners, to define, implement, verify, and evaluate the fundamental steps for establishing a comprehensive education program. Six essential topics were identified for the program: appropriate communication of cancer epidemiology, clinical trial information, new therapeutic technologies, support in the use of medicines, psycho-oncological interventions, age-personalized approaches, and training programs for healthcare providers. Integration of these topics along with patient feedback is the key to a successful model for educational programs. An integrated educational program can transform a comprehensive cancer center to an institution that provides research and care for and with patients.
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Affiliation(s)
- Ivana Truccolo
- Scientific Directorate, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Chiara Cipolat Mis
- Scientific Directorate, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Silvia Cervo
- CRO-Biobank, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy.
- Clinical Cancer Pathology, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy.
| | - Luigino Dal Maso
- Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Marilena Bongiovanni
- Associazione Nazionale Guariti Lungoviventi Oncologici (ANGOLO), CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Alessandra Bearz
- Medical Oncology, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Ivana Sartor
- Scientific Directorate, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Paolo Baldo
- Pharmacy, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Emanuela Ferrarin
- Pharmacy, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Lucia Fratino
- Medical Oncology, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Maurizio Mascarin
- Radiotherapy, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Mario Roncadin
- Radiotherapy, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | | | - Barbara Muzzatti
- Psychooncology, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
| | - Paolo De Paoli
- Scientific Directorate, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
- CRO-Biobank, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081, Aviano, PN, Italy
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Cancer survivors’ perspectives on adjustment-focused self-management interventions: a qualitative meta-synthesis. J Cancer Surviv 2016; 10:1012-1034. [DOI: 10.1007/s11764-016-0546-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
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Smith-Turchyn J, Morgan A, Richardson J. The Effectiveness of Group-based Self-management Programmes to Improve Physical and Psychological Outcomes in Patients with Cancer: a Systematic Review and Meta-analysis of Randomised Controlled Trials. Clin Oncol (R Coll Radiol) 2016; 28:292-305. [DOI: 10.1016/j.clon.2015.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 09/14/2015] [Accepted: 09/30/2015] [Indexed: 11/28/2022]
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Chou FY, Kuang LY, Lee J, Yoo GJ, Fung LC. Challenges in Cancer Self-management of Patients with Limited English Proficiency. Asia Pac J Oncol Nurs 2016; 3:259-265. [PMID: 27981169 PMCID: PMC5123524 DOI: 10.4103/2347-5625.189815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: This paper summarizes the barriers and challenges in cancer care reported from a validation project of a self-management intervention handbook from Chinese-American cancer patients with limited English proficiency (LEP). Methods: Seven health-care providers (HCPs) and 16 Chinese-American cancer survivors with LEP were invited to validate a self-management intervention handbook through networking sampling method. Bilingual versions were developed and validated using the repeated translation process. Online and paper-based survey and interview were conducted to collect information on the perception of barriers and experiences on cancer care. Data were analyzed by the content analysis method. Results: The HCPs reported a bilingual self-management handbook which is useful and feasible for patient self-management. The challenges in giving cancer care to LEP patients included: patients do not engage in discussion, different cultural health beliefs, unable to speak to patients in their primary language, and patients are less likely to discuss emotional and social challenges during treatments. The common barriers and experiences during cancer care included: limited understanding about treatment/medication and side effects, language barriers such as unable to communicate to make the decision, unable to understand information related to resources and do not know what questions to ask, and do not know what to expect during their cancer treatment. Conclusions: The current findings highlight the need of cancer self-management support for culturally diverse LEP cancer patients. Further research can include applying the supportive intervention to all LEP cancer patients.
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Affiliation(s)
- Fang-Yu Chou
- School of Nursing, San Francisco State University, San Francisco, CA, USA
| | - Lily Y Kuang
- Department of Nursing, Chinese Hospital, San Francisco, CA, USA
| | - Jeannette Lee
- Physical Therapy, San Francisco State University, San Francisco, CA, USA
| | - Grace J Yoo
- Asian American Studies, San Francisco State University, San Francisco, CA, USA
| | - Lei-Chun Fung
- Health Education, Chinatown Public Health Center, San Francisco, CA, USA
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29
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Cnossen IC, van Uden-Kraan CF, Eerenstein SEJ, Jansen F, Witte BI, Lacko M, Hardillo JA, Honings J, Halmos GB, Goedhart-Schwandt NLQ, de Bree R, Leemans CR, Verdonck-de Leeuw IM. An online self-care education program to support patients after total laryngectomy: feasibility and satisfaction. Support Care Cancer 2015; 24:1261-8. [PMID: 26306518 PMCID: PMC4729815 DOI: 10.1007/s00520-015-2896-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/09/2015] [Indexed: 12/23/2022]
Abstract
Purpose The purpose of this study was to investigate the feasibility of an online self-care education program supporting early rehabilitation of patients after total laryngectomy (TLPs) and factors associated with satisfaction. Methods Health care professionals (HCPs) were invited to participate and to recruit TLPs. TLPs were informed on the self-care education program “In Tune without Cords” (ITwC) after which they gained access. A study specific survey was used (at baseline T0 and postintervention T1) on TLPs’ uptake. Usage, satisfaction (general impression, willingness to use, user-friendliness, satisfaction with self-care advice and strategies, Net Promoter Score (NPS)), sociodemographic, and clinical factors were analyzed. Results HCPs of 6 out of 9 centers (67 % uptake rate) agreed to participate and recruited TLPs. In total, 55 of 75 TLPs returned informed consent and the baseline T0 survey and were provided access to ITwC (73 % uptake rate). Thirty-eight of these 55 TLPs used ITwC and completed the T1 survey (69 % usage rate). Most (66 %) TLPs were satisfied (i.e., score ≥7 (scale 1–10) on 4 survey items) with the self-care education program (mean score 7.2, SD 1.1). NPS was positive (+5). Satisfaction with the self-care education program was significantly associated with (higher) educational level and health literacy skills (P = .004, P = .038, respectively). No significant association was found with gender, age, marital status, employment status, Internet use, Internet literacy, treatment modality, time since total laryngectomy, and quality of life. Conclusion The online self-care education program ITwC supporting early rehabilitation was feasible in clinical practice. In general, TLPs were satisfied with the program.
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Affiliation(s)
- Ingrid C Cnossen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Cornelia F van Uden-Kraan
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
- Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands
| | - Simone E J Eerenstein
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Birgit I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Martin Lacko
- Department of Otorhinolaryngology-Head and Neck Surgery, Maastricht University Medical Center (MUMC), PO Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - José A Hardillo
- Department of Otorhinolaryngology-Head and Neck Surgery, Erasmus University Medical Center (Erasmus MC), PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center (Radboud UMC), PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen (UMCG), PO Box 30001, 9700, RD, Groningen, The Netherlands
| | - Noortje L Q Goedhart-Schwandt
- Department of Otolaryngology-Head and Neck Surgery, Medical Center Leeuwarden (MCL), PO Box 888, 8901, BR, Leeuwarden, The Netherlands
| | - Remco de Bree
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center (UMCU), PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands.
- Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands.
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Boger E, Ellis J, Latter S, Foster C, Kennedy A, Jones F, Fenerty V, Kellar I, Demain S. Self-Management and Self-Management Support Outcomes: A Systematic Review and Mixed Research Synthesis of Stakeholder Views. PLoS One 2015; 10:e0130990. [PMID: 26162086 PMCID: PMC4498685 DOI: 10.1371/journal.pone.0130990] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/27/2015] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Self-management has received growing attention as an effective approach for long-term condition management. Little is known about which outcomes of supported self-management are valued by patients, their families, health professionals and those who commission self-management services. This study systematically reviewed published empirical evidence in accordance with PRISMA guidelines to determine the outcomes of self-management valued by these key stakeholder groups, using three prominent exemplar conditions: colorectal cancer, diabetes and stroke. AIM To systematically review the literature to identify which generic outcomes of self-management have been targeted and are considered important using three exemplar conditions (colorectal cancer, diabetes and stroke), which collectively have a range of features that are likely to be representative of generic self-management issues. METHODS Systematic searching of nine electronic databases was conducted in addition to hand searches of review articles. Abstracts were identified against inclusion criteria and appraised independently by two reviewers, using a critical appraisal tool. Synthesis of findings was conducted using mixed research synthesis. RESULTS Over 20,536 abstracts were screened. 41 studies which met the review criteria were fully retrieved and appraised. The majority of evidence related to diabetes. Few studies directly focussed on stakeholders' views concerning desired self-management outcomes; the majority of evidence was derived from studies focusing upon the experience of self-management. The views of health care commissioners were absent from the literature. We identified that self-management outcomes embrace a range of indicators, from knowledge, skills, and bio-psychosocial markers of health through to positive social networks. CONCLUSIONS Patients', families', health professionals' and commissioners' views regarding which outcomes of self-management are important have not been clearly elicited. The extent to which bio-psychosocial indicators relate to successful self-management from the perspectives of all groups of stakeholders is unknown. Further investigation regarding which self-management outcomes are considered important by all stakeholders is necessary to guide the commissioning and design of future self-management services.
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Affiliation(s)
- Emma Boger
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jaimie Ellis
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Sue Latter
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Claire Foster
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Anne Kennedy
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Fiona Jones
- Department of Social Care and Education, St George’s and Kingston University of London, London United Kingdom
| | - Vicky Fenerty
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Ian Kellar
- Institute of Psychological Sciences, University of Leeds, Leeds, United Kingdom
| | - Sara Demain
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
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Shneerson CL, Gale NK. Using mixed methods to identify and answer clinically relevant research questions. QUALITATIVE HEALTH RESEARCH 2015; 25:845-856. [PMID: 25854614 DOI: 10.1177/1049732315580107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The need for mixed methods research in answering health care questions is becoming increasingly recognized because of the complexity of factors that affect health outcomes. In this article, we argue for the value of using a qualitatively driven mixed method approach for identifying and answering clinically relevant research questions. This argument is illustrated by findings from a study on the self-management practices of cancer survivors and the exploration of one particular clinically relevant finding about higher uptake of self-management in cancer survivors who had received chemotherapy treatment compared with those who have not. A cross-sectional study generated findings that formed the basis for the qualitative study, by informing the purposive sampling strategy and generating new qualitative research questions. Using a quantitative research component to supplement a qualitative study can enhance the generalizability and clinical relevance of the findings and produce detailed, contextualized, and rich answers to research questions that would be unachievable through quantitative or qualitative methods alone.
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Affiliation(s)
| | - Nicola K Gale
- University of Birmingham, Birmingham, United Kingdom
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Risendal B, Dwyer A, Seidel R, Lorig K, Katzenmeyer C, Coombs L, Kellar-Guenther Y, Warren L, Franco A, Ory M. Adaptation of the chronic disease self-management program for cancer survivors: feasibility, acceptability, and lessons for implementation. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:762-771. [PMID: 24903138 DOI: 10.1007/s13187-014-0652-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Self-management in chronic disease has been shown to improve patient-reported and health care-related outcomes. However, relatively little information about its utility in cancer survivorship is known. We evaluated the feasibility and acceptability of the delivery of an adaptation of the evidence-based Chronic Disease Self-management Program (Stanford) called Cancer Thriving and Surviving (CTS). Triangulated mixed methods were used to capture baseline characteristics and post-program experiences using a combination of closed- and open-ended survey items; emergent coding and simple descriptive statistics were used to summarize the data. Twenty-seven workshops were delivered by 22 CTS leaders to 244 participants between August 2011 and January 2013 in a variety of settings (48 % community, 30 % health care, 22 % regional/community cancer center). Representing a variety of cancer types, about half the participants were 1-3 years post-diagnosis and 45 % were 4 or more years from diagnosis. Program attendance was high with 84 % of participants attending four or more of the six sessions in the workshop. Overall, 95 % of the participants were satisfied with the program content and leaders, and would recommend the program to friends and family. These results confirm the feasibility and acceptability of delivery of a high-fidelity, peer-led model for self-management support for cancer survivors. Expansion of the CTS represents a powerful tool toward improving health-related outcomes in this at-risk population.
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Affiliation(s)
- B Risendal
- Community and Behavioral Health, Colorado School of Public Health, University of Colorado Cancer Center, 13001 E. 17th Street, MS F538, Aurora, CO, 80045, USA,
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Shneerson C, Taskila T, Holder R, Greenfield S, Tolosa I, Damery S, Gale N. Patterns of self-management practices undertaken by cancer survivors: variations in demographic factors. Eur J Cancer Care (Engl) 2014; 24:683-94. [PMID: 25265011 DOI: 10.1111/ecc.12252] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2014] [Indexed: 11/26/2022]
Abstract
The study purpose was to examine self-management (SM) use among cancer survivors; and to explore variations in uptake of SM in survivorship and whether these differed in relation to age, income, gender, ethnicity, cancer type and treatment type. This is an important area for exploration as SM utilisation has the potential to impact on the health status, health behaviours and quality of life (QoL) of cancer survivors. A postal survey was conducted among 445 cancer survivors identified from a hospital in the West Midlands, UK. Demographic data were collected and respondents were asked to identify which practices across six SM categories - diet, exercise, complementary and alternative medicine (CAM), psychological therapies, support groups and spirituality/religion - they had used (if any). The findings indicate that the large majority (91%) had used some form of SM after their cancer treatment. Exercise (84%) and diet (56%) were the most popular SM interventions for cancer survivors and socio-demographic and cancer-related factors were associated with SM uptake. These findings can form the basis for designing and implementing appropriate SM interventions aimed at improving the health, well-being and QoL of cancer survivors.
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Affiliation(s)
- C Shneerson
- Public Health Building, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - T Taskila
- The Work Foundation, Centre for Workforce Effectiveness (Part of Lancaster University), London, UK
| | - R Holder
- Medical Statistician Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - S Greenfield
- Primary Care Clinical Sciences, Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - I Tolosa
- Birmingham and Solihull Mental Health NHS Foundation Trust, Nuffield House, University Hospitals Birmingham, Birmingham, UK
| | - S Damery
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N Gale
- HSMC, Park House, University of Birmingham, Birmingham, UK
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34
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Esteves MT, De Domenico EBL, Petito EL, de Gutiérrez MGR. [Educational intervention for self-management of continuous drainage in the postoperative period of mastectomy]. Rev Gaucha Enferm 2014; 34:75-83. [PMID: 25080703 DOI: 10.1590/s1983-14472013000400010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study assessed how well patients who had undergone breast cancer surgery monitored their continuous drainage system after receiving one-to-one instructions at the Mastology Outpatient Clinic of Hospital São Paulo at Federal University of São Paulo. Participants were 79 women who had undergone breast cancer surgery between May 2009 and March 2010, and were using a drain. It was found that the self-care training that the patients received in addition to the strategy used in that training, had a positive effect on their self-monitoring of the continuous drainage, which prevented the drain from clogging, evinced by the percentage of patients who maintained the permeability of the drainage system (84.2%).
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Turner J, Yates P, Kenny L, Gordon LG, Burmeister B, Thomson D, Hughes B, McCarthy AL, Perry C, Chan RJ, Fraser A, Skerman H, Batstone M, Carswell K. The ENHANCES study--Enhancing Head and Neck Cancer patients' Experiences of Survivorship: study protocol for a randomized controlled trial. Trials 2014; 15:191. [PMID: 24885486 PMCID: PMC4053405 DOI: 10.1186/1745-6215-15-191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/07/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Few cancers pose greater challenges than head and neck (H&N) cancer. Residual effects following treatment include body image changes, pain, fatigue and difficulties with appetite, swallowing and speech. Depression is a common comorbidity. There is limited evidence about ways to assist patients to achieve optimal adjustment after completion of treatment. In this study, we aim to examine the effectiveness and feasibility of a model of survivorship care to improve the quality of life of patients who have completed treatment for H&N cancer. METHODS/DESIGN This is a preliminary study in which 120 patients will be recruited. A prospective randomised controlled trial of the H&N Cancer Survivor Self-management Care Plan (HNCP) involving pre- and post-intervention assessments will be used. Consecutive patients who have completed a defined treatment protocol for H&N cancer will be recruited from two large cancer services and randomly allocated to one of three study arms: (1) usual care, (2) information in the form of a written resource or (3) the HNCP delivered by an oncology nurse who has participated in manual-based training and skill development in patient self-management support. The trained nurses will meet patients in a face-to-face interview lasting up to 60 minutes to develop an individualised HNCP, based on principles of chronic disease self-management. Participants will be assessed at baseline, 3 and 6 months. The primary outcome measure is quality of life. The secondary outcome measures include mood, self-efficacy and health-care utilisation. The feasibility of implementing this intervention in routine clinical care will be assessed through semistructured interviews with participating nurses, managers and administrators. Interviews with patients who received the HNCP will explore their perceptions of the HNCP, including factors that assisted them in achieving behavioural change. DISCUSSION In this study, we aim to improve the quality of life of a patient population with unique needs by means of a tailored self-management care plan developed upon completion of treatment. Delivery of the intervention by trained oncology nurses is likely to be acceptable to patients and, if successful, will be a model of care that can be implemented for diverse patient populations. TRIAL REGISTRATION ACTRN12613000542796 (registered on 15 May 2013).
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Affiliation(s)
- Jane Turner
- School of Medicine, University of Queensland, Herston Rd, Herston, QLD 4029, Australia
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston Rd, Herston, QLD 4029, Australia
| | - Patsy Yates
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Ave, Kelvin Grove, QLD 4059, Australia
| | - Lizbeth Kenny
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston Rd, Herston, QLD 4029, Australia
| | - Louisa G Gordon
- Centre for Applied Health Economics, Griffith Health Institute, Griffith University, University Drive, Meadowbrook, QLD 4131, Australia
| | - Bryan Burmeister
- Cancer Care Services, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD 4101, Australia
| | - Damien Thomson
- Cancer Care Services, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD 4101, Australia
| | - Brett Hughes
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston Rd, Herston, QLD 4029, Australia
| | - Alexandra L McCarthy
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Ave, Kelvin Grove, QLD 4059, Australia
- Cancer Services Southern Clinical Network, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD 4101, Australia
| | - Chris Perry
- Cancer Care Services, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD 4101, Australia
| | - Raymond J Chan
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston Rd, Herston, QLD 4029, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Ave, Kelvin Grove, QLD 4059, Australia
| | - Alana Fraser
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston Rd, Herston, QLD 4029, Australia
| | - Helen Skerman
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Ave, Kelvin Grove, QLD 4059, Australia
| | - Martin Batstone
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston Rd, Herston, QLD 4029, Australia
| | - Kathryn Carswell
- Cancer Care Services, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD 4101, Australia
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Stephens M, McKenzie H, Jordens CFC. The work of living with a rare cancer: multiple myeloma. J Adv Nurs 2014; 70:2800-9. [PMID: 24725097 DOI: 10.1111/jan.12430] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2014] [Indexed: 01/17/2023]
Abstract
AIM To report findings from a qualitative study of the experiences of long-term survivors of multiple myeloma. BACKGROUND Multiple Myeloma is a malignant disease of the bone marrow. Until recently, it was rapidly fatal. Although it remains incurable, people diagnosed with it are living longer on average, largely due to new treatments, some of which have onerous side effects. DESIGN Prospective descriptive study. METHOD A series of 47 in-depth interviews were conducted at 6-12 month intervals over 18 months in 2008-2010 with 10 long-term survivors of myeloma and their primary support person. Interviews were analysed using the constant comparative method (Grounded Theory). FINDINGS To adapt to the effects of both the disease and ongoing medical treatments, participants undertook extensive 'illness work'. Most of this work fell into two broad categories. Risk work aimed to mitigate risks to the well-being of both the person with myeloma and his/her carer. Emotion work aimed to manage the feelings of self and others in a protracted cycle of remission and relapse. CONCLUSION The experience of myeloma is increasingly characterized by issues associated with chronic disease and 'survivorship'. It is important for nurses working with people with myeloma to understand the overwhelming nature of illness work in this context. Nurses can put in place supportive measures to address the two main 'drivers' of this work: constant risk to well-being of survivors (including carers) and the recurrent need to manage emotions in social interactions.
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Affiliation(s)
- Moira Stephens
- School of Nursing and Midwifery, University of Wollongong, New South Wales, Australia; Centre for Values, Ethics & Law in Medicine (VELIM), School of Public Health, University of Sydney, New South Wales, Australia
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Fraser R, Ehde D, Amtmann D, Verrall A, Johnson KL, Johnson E, Kraft GH. Self-management for people with multiple sclerosis: report from the first international consensus conference, november 15, 2010. Int J MS Care 2014; 15:99-106. [PMID: 24453769 DOI: 10.7224/1537-2073.2012-044] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
People with multiple sclerosis (MS) must manage the day-to-day effects of the disease on their lives. Self-management interventions may be helpful in this challenge. An international, multidisciplinary consensus conference was held on November 15, 2010, by the University of Washington's Rehabilitation Research and Training Center for Multiple Sclerosis (MS RRTC), with funding from the Consortium of Multiple Sclerosis Centers (CMSC) and the National Institute on Disability and Rehabilitation Research (NIDRR), to discuss the concept of self-management for people with MS. The specific goals of the consensus conference were as follows: 1) review the current research on self-management and related issues in chronic disability and specifically in MS; 2) review optimal research methodologies, outcome measurement tools, program planning frameworks, and dissemination strategies for self-management research; and 3) establish recommendations on the next steps necessary to develop, adapt, and test self-management interventions for people with MS. The consensus conference and this document are the initial steps toward achieving the stated goals. Participants in the consensus conference concluded that it is necessary to: 1) define an empirically based conceptual model of self-management for people with MS; 2) establish reliable and valid self-management outcome measures; 3) use best practices to validate models of self-management interventions; and 4) plan dissemination and knowledge translation of interventions once their effectiveness is established.
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Affiliation(s)
- Robert Fraser
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA (RF, DE, DA, AV, KLJ, GHK); and Department of Rehabilitation Counseling, Western Washington University, Bellingham, WA, USA (EJ)
| | - Dawn Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA (RF, DE, DA, AV, KLJ, GHK); and Department of Rehabilitation Counseling, Western Washington University, Bellingham, WA, USA (EJ)
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA (RF, DE, DA, AV, KLJ, GHK); and Department of Rehabilitation Counseling, Western Washington University, Bellingham, WA, USA (EJ)
| | - Aimee Verrall
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA (RF, DE, DA, AV, KLJ, GHK); and Department of Rehabilitation Counseling, Western Washington University, Bellingham, WA, USA (EJ)
| | - Kurt L Johnson
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA (RF, DE, DA, AV, KLJ, GHK); and Department of Rehabilitation Counseling, Western Washington University, Bellingham, WA, USA (EJ)
| | - Erica Johnson
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA (RF, DE, DA, AV, KLJ, GHK); and Department of Rehabilitation Counseling, Western Washington University, Bellingham, WA, USA (EJ)
| | - George H Kraft
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA (RF, DE, DA, AV, KLJ, GHK); and Department of Rehabilitation Counseling, Western Washington University, Bellingham, WA, USA (EJ)
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Glaser A, Levitt G, Morris P, Tapp J, Gibson F. Enhanced quality and productivity of long-term aftercare of cancer in young people. Arch Dis Child 2013; 98:818-24. [PMID: 23966026 DOI: 10.1136/archdischild-2013-304348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Long-term morbidity associated with survival from childhood cancer is well defined. Traditional models of hospital-based long-term aftercare are not sustainable and may not be necessary for all. A programme to support development and implementation of redesigned care pathways is reported. METHOD Application of service improvement methodologies to identify the case for change, to evidence development of, and test, new aftercare pathways. RESULTS Four models of aftercare were identified; traditional cancer centre-delivered medical follow-up, shared care with local hospitals or primary care, specialist nurse-led supported management and self-management. Key components required for successful implementation of risk-stratified care included; comprehensive information transfer with treatment summaries and care plans, provision of care coordinators, effective transition across services, remote monitoring systems, educating professionals, maintaining patient choice. CONCLUSIONS Adoption of risk-stratified evidence-based aftercare pathways, generated through application of service improvement methodologies, can result in the delivery of enhanced quality and productivity.
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Affiliation(s)
- Adam Glaser
- Department of Paediatric and Adolescent Oncology, Leeds Teaching Hospitals NHS Trust, , Leeds, UK
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Oliveira VC, Ferreira PH, Maher CG, Pinto RZ, Refshauge KM, Ferreira ML. Effectiveness of self-management of low back pain: systematic review with meta-analysis. Arthritis Care Res (Hoboken) 2013; 64:1739-48. [PMID: 22623349 DOI: 10.1002/acr.21737] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the effectiveness of self-management for nonspecific low back pain (LBP). METHODS We performed a systematic review searching the Medline, Embase, CINAHL, PsycINFO, LILACS, PEDro, AMED, SPORTDiscus, and Cochrane databases from earliest record to April 2011. Randomized controlled trials evaluating self-management for nonspecific LBP and assessing pain and disability were included. The PEDro scale was used to assess the methodologic quality of included trials. Data were pooled where studies were sufficiently homogenous. Analyses were conducted separately for short- (less than 6 months after randomization) and long-term (at least 12 months after randomization) followup. Six criteria for self-management were used to assess the content of the intervention. RESULTS The search identified 2,325 titles, of which 13 original trials were included. Moderate-quality evidence showed that self-management is effective for improving pain and disability for people with LBP. The weighted mean difference at short-term followup for pain was -3.2 points on a 0-100 scale (95% confidence interval [95% CI] -5.1, -1.3) and for disability was -2.3 points (95% CI -3.7, -1.0). The long-term effects were -4.8 (95% CI -7.1, -2.5) for pain and -2.1 (95% CI -3.6, -0.6) for disability. CONCLUSION There is moderate-quality evidence that self-management has small effects on pain and disability in people with LBP. These results challenge the endorsement of self-management in treatment guidelines.
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