Holistic needs assessment and care plans for women with gynaecological cancer: do they improve cancer-specific health-related quality of life? A randomised controlled trial using mixed methods

Evaluation of the Nurse-Led Symptom Management Program for Patients With Gynecologic Cancer Undergoing Chemotherapy

BACKGROUND

Patients with cancer experience symptoms concurrently. Nurses need to make multisymptom management and educate patients about self-management strategies.

OBJECTIVE

The aim of this study was to evaluate the effect of a nurse-led symptom management program (NL-SMP), developed based on the Symptom Management Model, quality of life (QoL), and symptom severity of women with gynecological cancer undergoing chemotherapy.

METHODS

This randomized controlled study sample consisted of 41 women receiving chemotherapy at an outpatient clinic in Istanbul, Turkey, between November 2018 and December 2019. European Organisation for Research and Treatment of Cancer Quality-of-Life Scale, Edmonton Symptom Assessment Scale, and Modified Brief Sexual Symptom Checklist-Women were used to collect data. Women were randomly assigned to 2 groups: intervention (n = 21) and control (n = 20). The intervention group attended the NL-SMP in addition to usual care. Data were collected at the first (time 1), third (time 2), and last chemotherapy cycle (time 3). Repeated measures analysis of variance, Cochran-Q, and t tests were used to analyze the data.

RESULTS

In the intervention group, the QoL was significantly higher; symptom severity was lower than that of the control group at time 2 and time 3. At time 3, more women in the control group reported at least 1 sexual difficulty and were not satisfied with their sexual function, whereas there was no change for women in the intervention group.

CONCLUSION

The NL-SMP, which consisted of systematic symptom assessment, prioritization of symptoms, providing symptom, and patient-specific education, decreased deterioration in the QoL and symptom severity of women.

IMPLICATIONS FOR PRACTICE

Conducting multisymptom assessments, prioritizing symptoms, providing symptom- and patient-specific education, and supporting symptom self-management throughout treatment can lead to effective symptom management.

Holistic needs assessment in outpatient cancer care: a randomised controlled trial

DESIGN

Analyst blinded, parallel, multi-centre, randomised controlled trial (RCT).

PARTICIPANTS

People with confirmed diagnoses of cancer (head and neck, skin or colorectal) attending follow-up consultation 3 months post-treatment between 2015 and 2020.

INTERVENTION

Holistic needs assessment (HNA) or care as usual during consultation.

OBJECTIVE

To establish whether incorporating HNA into consultations would increase patient participation, shared decision making and postconsultation self-efficacy.

OUTCOME MEASURES

Patient participation in the consultations examined was measured using (a) dialogue ratio (DR) and (b) the proportion of consultation initiated by patient. Shared decision making was measured with CollaboRATE and self-efficacy with Lorig Scale. Consultations were audio recorded and timed.

RANDOMISATION

Block randomisation.

BLINDING

Audio recording analyst was blinded to study group.

RESULTS

147 patients were randomised: 74 control versus 73 intervention.

OUTCOME

No statistically significant differences were found between groups for DR, patient initiative, self-efficacy or shared decision making. Consultations were on average 1 min 46 s longer in the HNA group (respectively, 17 m 25 s vs 15 min 39 s).

CONCLUSION

HNA did not change the amount of conversation initiated by the patient or the level of dialogue within the consultation. HNA did not change patient sense of collaboration or feelings of self-efficacy afterwards. HNA group raised more concerns and proportionally more emotional concerns, although their consultations took longer than treatment as usual.

IMPLICATIONS FOR PRACTICE

This is the first RCT to test HNA in medically led outpatient settings. Results showed no difference in the way the consultations were structured or received. There is wider evidence to support the roll out of HNA as part of a proactive, multidisciplinary process, but this study did not support medical colleagues facilitating it.

TRIAL REGISTRATION NUMBER

NCT02274701.

Amplifying the Patient Voice: A Survey of Practitioners' Use of Patient-reported Outcome Measures Across Radiotherapy Providers in England

AIMS

The NHS England Radiotherapy Service Specification calls for routine use of patient-reported outcome measures (PROMs). However, barriers exist at patient, healthcare professional and service levels. The aim of the present study was to determine the current use of PROMs within radiotherapy services in England. The current attitudes, barriers and enablers to the implementation of PROMs in radiotherapy practice were evaluated and practical recommendations to inform future implementation were developed.

MATERIALS AND METHODS

A mixed-methods approach was adopted to obtain quantitative and qualitative data. An online questionnaire was developed and disseminated to all radiotherapy operational delivery network managers across England. The questionnaire consisted of 12 open and closed questions relating to PROMs use, with the option to provide free-text responses. Inductive thematic analysis was conducted on free-text comments, whereas descriptive statistics were used to analyse quantitative data.

RESULTS

In total, 182 responses were received from 40 of the 50 radiotherapy providers, resulting in a response rate of 84%. The current use of PROMs was analysed, including rationale for use, tools used, format of PROMs collection and timing within the radiotherapy pathway. Most respondents indicated that PROMs were used in the context of clinical trials only. Through thematic analysis, four identical key themes were identified relating to both barriers and enablers to PROMs use; these included IT infrastructure, time, human/financial resources and training/education. A fifth theme, standardisation, was identified as a key enabler to PROMs use.

CONCLUSIONS

Our findings show that outside of clinical trials, PROMs are not routinely used in radiotherapy services due to barriers identified at professional and service levels. Here we provide recommendations to mitigate the barriers identified and implement PROMs in radiotherapy, including training for healthcare professionals and standardisation of PROMs tools and storage. This study provides a key first step in driving PROMs implementation within radiotherapy services across England.

Identifying Language Features Associated With Needs of Ovarian Cancer Patients and Caregivers Using Social Media

BACKGROUND

Online health communities (OHCs) can be a source for clinicians to learn the needs of cancer patients and caregivers. Ovarian cancer (OvCa) patients and caregivers deal with a wide range of unmet needs, many of which are expressed in OHCs. An automated need classification model could help clinicians more easily understand and prioritize information available in the OHCs.

OBJECTIVE

The aim of this study was to use initial OHC postings to develop an automated model for the classification of OvCa patient and caregiver needs.

METHODS

We collected data from the OvCa OHC and analyzed the initial postings of patients and caregivers (n = 853). Two annotators coded each posting with 12 types of needs. Then, we applied the machine learning approach with bag-of-words features to build a model to classify needs. F1 score, an indicator of model accuracy, was used to evaluate the model.

RESULTS

The most reported needs were information, social, psychological/emotional, and physical. Thirty-nine percent of postings described information and social needs in the same posting. Our model reported a high level of accuracy for classifying those top needs. Psychological terms were important for classifying psychological/emotional and social needs. Medical terms were important for physical and information needs.

CONCLUSIONS

We demonstrate the potential of using OHCs to supplement traditional needs assessment. Further research would incorporate additional information (eg, trajectory, stage) for more sophisticated models.

IMPLICATIONS FOR PRACTICE

This study shows the potential of automated classification to leverage OHCs for needs assessment. Our approach can be applied to different types of cancer and enhanced by using domain-specific information.

"DORLAN" Health Education in solving the physical and sexual problems of the gynecological cancer patients during chemotherapy

Gynecological cancer is one of the cancer types, which is deadly cancer among women. Chemotherapy is one of the medical treatment options to kill cancer cells. This study aimed to identify the effect of "DORLAN" Health Education on physical and sexual problems of gynecological cancer patients. Quasi-experimental pre-post-test with control group was used in this study. A sample of 94 women who were undergoing chemotherapy. Data collection was performed using demographic data questionnaires, a FACT-G questionnaire, a Sexual Satisfaction Scale for Women (SSS-W) questionnaire, and a Multidimensional Scale of Perceived Social Support (MSPSS) questionnaire. The results of this study showed that the "DORLAN" Health Education Package significantly influenced the physical and sexual problems of gynecological cancer patients. "DORLAN" Health Education Package has a significant influence to solve the physical and sexual problems of women under chemotherapy treatment.

A proposed tailored investigational algorithm for women treated for gynaecological cancer with long-term gastrointestinal consequences

BACKGROUND AND AIM

Long-term changes in gastrointestinal function impacting quality of life after treatment for cancer are common. Peer reviewed guidance to investigate and manage GI dysfunction following cancer treatment has been published. This study reviewed gastrointestinal symptoms of women previously treated for gynaecological cancer and considered whether suggested algorithms could be amended to optimise management for this cohort.

METHODS

Demographic and clinical data recorded for patients attending a specialist consequences of cancer treatment gastroenterology service prospectively are reported using median and range. The Wilcoxon signed rank test analysed changes in symptoms between initial assessment to discharge from the service.

RESULTS

Between April 2013 and March 2016, 220 women, with a median age of 57 years (range 24-83 years), treated for gynaecological cancer (cervical (50%)), endometrial (28%), ovarian (15%), vaginal or vulval (7%) attended. Twelve gastrointestinal symptoms were statistically significantly reduced by time of discharge from the specialist gastroenterology clinic including bowel frequency ≥ 4/day (88%), type 6 or 7 stool consistency (36%), urgency (31%) and incontinence (21%). General quality of life improved from a median score of 4 at first assessment to a median of 6 at discharge (p < 0.001). A median of four (range, 1-9) diagnoses were made.

CONCLUSION

Women with gastrointestinal symptoms after cancer treatment benefit from a systematic management approach. After excluding disease recurrence, a proposed investigational algorithm and the oncology team includes FBC, U&Es, LFTs, thyroid function test, vitamin B12, vitamin D, a hydrogen methane breath test and a SeHCAT scan. If rectal bleeding is present, iron studies, flexible sigmoidoscopy or colonoscopy should be performed. Patients with normal investigations or symptoms not responding to treatment require gastroenterology input.

Delphi survey to inform patient-reported symptom monitoring after ovarian cancer treatment

BACKGROUND

Increasing numbers of ovarian cancer patients are living longer and requiring regular follow-up to detect disease recurrence. New models of follow-up care are needed to meet the growing number and needs of this patient group. The potential for patient-reported outcome measures (PROMs) to capture key symptoms and online technology to facilitate long-term follow-up has been suggested.

OBJECTIVES

Prior to a pilot study exploring the potential for electronic patient-reported symptom monitoring, the content of an online intervention was developed via Delphi methodology.

DESIGN AND SETTING

A Delphi process was conducted aiming to obtain consensus amongst the clinicians and patients from 4 hospitals on the key aspects to monitor during follow-up after ovarian cancer treatment, and how to monitor them in an online intervention. A two round Delphi was conducted. Consensus was defined as at least 70% agreement.

RESULTS

Out of 43 participants, 30 (18 patients, 12 healthcare professionals) completed round 1 and 19 (11 patients, 8 healthcare professionals) completed round 2. Consensus was reached on the key symptoms to monitor, and the importance of monitoring both duration and frequency of symptoms. Opportunity for review of psychological wellbeing and holistic needs were considered important by both groups. The frequency of online questionnaire completion, timeframe for patients to reflect on (e.g. during the past X weeks), and the choice of PROMs items to monitor symptoms did not reach the consensus threshold.

CONCLUSION

It is crucial that any intervention and the selection of PROMs is fully described to ensure transparency about the development and decisions taken. In this work, a set of key symptoms and areas to monitor were agreed, which has informed the design of an online intervention and a subsequent pilot study is now underway. The proposed model of remote follow-up using electronic PROMs could be adapted and explored in other cancer sites.

Meeting psychosocial needs to improve health: a prospective cohort study

Background

Cancer impacts on patients and their families across a range of different domains. For that reason, optimal cancer care has moved away from a disease-centric focus to a more holistic approach in order to proactively support people with their individual needs and concerns. While international policy clearly advocates this agenda, implementation into routine care is limited. Therefore, relevant interventions that measurably improve patient outcomes are essential to understand if this ideal is to become routine multidisciplinary practice. The aim of this study was to analyse the impact of a proactive, holistic, community-based intervention on health-related quality of life in a cohort of people diagnosed with cancer. Secondary aim was to explore the relationship between changes in health status and: cancer type, cancer stage, number of concerns expressed and change in severity of concerns pre and post intervention.

Method

Prospective observational cohort study. A convenience sample of 437 individuals were referred to the service ‘Improving the Cancer Journey (ICJ) in the UK. Each completed the Euroqol EQ-5D-3 L and visual analogue scale (VAS) and a Holistic Needs Assessment (HNA) during initial visit to the service and again at follow-up review, median 84 days later. Change between scores was tested with paired t-tests and relationships between variables with multiple regression models with heteroscedasticity-consistent standard errors.

Results

Participants were White British with median age between 50 and 64 years. Cancer type and stage were varied. EQ-5D utility scores improved at follow-up by 0.121 [0.0891–0.153], p < .001, and VAS scores improved by 7.81 [5.88–9.74], p < .001. The strongest predictor of change was a decrease in severity of concerns. Cancer stage ‘palliative care’ contributed to a reduction in health status.

Conclusion

This study is the first to show that a holistic community intervention dedicated to supporting the individual concerns of participants had both a statistically significant and clinically meaningful impact on participants’ health-related quality of life. The mean change in EQ-5D scores was more than the ‘minimally important clinical difference’ described in the literature. This is important because while quality of life has multiple determinants, this study has shown for the first time that it is possible to capture a clinically meaningful improvement as a function of reducing someone’s personally identified concerns.

Clinical nurses' awareness and caring experiences for patients with cervical cancer: A qualitative study

To determine the degree to which nurses are aware of cervical cancer and to describe nurses' experiences of caring for patients with cervical cancer. To promote quality of nursing care of cervical cancer, we need to explore their perceptions and nursing experience in doing cervical-cancer care. This study was a qualitative descriptive design. Interviews were conducted with 14 registered nurses. The interviews were audiotaped, transcribed and analyzed. Content analysis was performed. Fourteen nurses who had been working at wards and cancer education centers were recruited in this study. Nine key themes emerged from three categories such as nurses' awareness of cervical cancer, awareness of cervical cancer patient and caring experience. Nurses expressed fear of cervical cancer and helplessness in the face of a life-threatening prognosis. Nurses stated that they might have prejudice about cervical cancer, since it is caused by a sexually transmitted disease. They also recalled that patients with cervical cancer were more sensitive and demanding. Our findings provide a comprehensive and in-depth perspective in understanding the experience of caring for cervical cancer patients. Clinical nurses showed complex emotional reactions to cervical cancer, and expressed prejudice against the sex life of cervical-cancer patients. More education is required to ensure that clinical nurses can provide a nurse-led intervention with patients by managing nurses' fear, prejudice, and the care burden.

The impact of gynaecological cancer treatment on physical activity levels: a systematic review of observational studies

BACKGROUND

The natural history of physical activity levels during and following gynaecological cancer treatment is not well understood. This is required in order to establish the time at which physical activity levels are lowest in order to target cancer rehabilitation or exercise interventions in gynaecological cancer population accordingly.

OBJECTIVES

To conduct a systematic review to evaluate the impact of gynaecological cancer treatments on physical activity levels and to summarise the pattern of changes in physical activity levels over time among patients with gynaecological cancer.

METHODS

A comprehensive literature search was performed via MEDLINE (1946-2018), CINAHL (1982-2018), EMBASE (1947-2018), Ovid Emcare (1947-2018), PsycINFO (1806-2018) and the Cochrane Library (1991-2018). Studies were eligible for inclusion if they had assessed changes in physical activity levels during and after gynaecological cancer treatment. The methodological quality of the eligible studies was assessed by two independent reviewers using the Joanna Briggs Institute Critical Appraisal Tools.

RESULTS

In total, six studies (three cohort studies and three cross-sectional studies) with 1607 participants were included. All studies used patient-reported physical activity measures. Two of the three cohort studies measured patient-recalled physical activity levels before diagnosis (baseline), and length of follow-up varied across all studies. The majority of participants were treated surgically±adjuvant therapy. Physical activity levels decreased at 6 months following surgery when compared with pre-treatment levels. Approximately 91% of participants did not meet physical activity guidelines 2 years following diagnosis, and 58% reported being less physically active 3 years after diagnosis, compared with the pre-diagnosis levels.

CONCLUSIONS

Despite the paucity of evidence and limitations in the current body of literature, this review demonstrated that compared to pre-diagnosis, levels of physical activity remain low in gynaecological cancer survivors up to 3 years after diagnosis. More research is warranted to better characterise the pattern of change of physical activity levels across the disease trajectory and identify changes in physical activity patterns by cancer treatments and gynaecological tumour streams in order to target interventions accordingly.

Using patient-reported religious/spiritual concerns to identify patients who accept chaplain interventions in an outpatient oncology setting

PURPOSE

The goals of this study were to (1) describe the prevalence and correlates of patient-reported religious/spiritual (R/S) needs in outpatient oncology patients and (2) estimate the associations of R/S concerns with acceptance of an R/S intervention offered by phone.

METHODS

This was a retrospective analysis of data collected from distress screenings and spiritual care interventions at an outpatient cancer center from March 1, 2017 to May 9, 2017. Patients (n = 1249) used a tablet to self-report the following R/S concerns: spiritual or religious concern, isolation, struggle to find hope/meaning in life, concern for family, fear of death, shame/guilt, and doubts about faith. Patients were also screened for anxiety, depression, and distress. A chaplain contacted patients that reported one or more R/S concerns to offer R/S interventions via telephone or in person.

RESULTS

Approximately one third (29.9%) of surveyed patients indicated at least one R/S need. Younger age, female gender, anxiety, depression, and distress were associated with indication of specific R/S concerns. Fear of death (OR 1.64 [1.02, 2.66], p = 0.043), struggle to find meaning/hope in life (OR 2.47 [1.39, 4.39], p = 0.002), and anxiety (p = 1.003) were associated with increased odds of intervention acceptance.

CONCLUSION

Effective screening practices are needed for chaplains to prioritize patients most in need. This exploratory study suggests that screening for struggle to find meaning/hope in life, fear of death, and anxiety will help chaplains identify patients who have R/S concerns and will likely accept R/S interventions. Developing effective telehealth practices like this is an important direction for the field.