Potential inequities in availability of care from breast care nurses: a qualitative study reporting the experiences and perspectives of women with metastatic breast cancer in Australia

Effects of the supportive care needs of patients with cancer on their comfort levels

BACKGROUND

Providing supportive care to patients with cancer and improving their comfort levels can promote their adjustment to the disease, compliance with treatment and improve their quality of life.

AIM

The aim of this cross-sectional, descriptive study was to identify the effects of the supportive care needs of cancer patients on their comfort levels.

METHODS

The study was performed in the oncology department of a university hospital. A total of 153 cancer patients undergoing chemotherapy constituted the sample. The data collection procedure included the Supportive Care Needs Survey (SCNS) and the General Comfort Questionnaire (GCQ).

RESULTS

The SCNS scores of the patients were low (Mean±SD: 75.13±27.93). The socio-cultural dimension of the GCQ was the most adversely influenced area of comfort. There was a negative relationship between needs and comfort levels (rs=-0.69, p<0.01). Lower scores of comfort were associated with higher scores of SCNS (ß=-0.487; ß=-0.316; ß=-0.958, respectively).

CONCLUSIONS

Cancer patients undergoing chemotherapy were supported in meeting their physical and psychological needs and performing their activities of daily living and care during their hospital stay. Patients with higher support needs had lower comfort levels.

Experiences, difficulties and coping methods of female nurses caring for breast cancer surgery patients: A qualitative study

AIM

The present study aims to qualitatively explore the experiences, problems, and coping methods of nurses caring for mastectomy patients.

METHODS

The study employs an exploratory-descriptive design with the participation of 14 nurses serving in a surgical oncology clinic. We gathered the data through semi-structured, face-to-face interviews and analyzed the transcriptions of audio recordings using the thematic analysis method. We then extracted relevant codes and subthemes to achieve the main themes. The main themes are presented in three relevant contexts.

RESULTS

Participating nurses' experiences are addressed through the themes of 'emotional difficulties,' 'physical difficulties,' and 'positive awareness.' In addition, their coping methods are considered within the themes of 'coping methods' and 'motivation.' The final context is identified as needs, where the themes of 'organizational needs' and 'psychosocial needs' are explored. Our findings highlighted that although participating nurses usually confront physical and emotional challenges, they exert much effort to develop both positive awareness and engage in behavioral changes. Interestingly, we observed that participants remain ineffective in dealing with and have difficulties employing relevant solutions for professional issues.

CONCLUSION

Overall, even though participating nurses need to deal with the burden of physical and emotional challenges when caring for patients, their coping strategies with these difficulties often remain insufficient. Thus, our humble recommendation may lie in satisfying the organizational and psychosocial needs of surgical nurses to promote their coping skills when fulfilling their demanding tasks with mastectomy patients.

Making the unbearable, bearable: Qualitative examination of patient, family and nurses' perspectives on the role and value of specialist metastatic breast care nurses

PURPOSE

To examine the role and value of specialist metastatic breast care nurses in Australia from the perspective of metastatic breast care nurses, patients, and family members. Metastatic breast cancer (mBC) is treatable yet incurable, with distinct supportive care needs, yet many of these needs are unmet.

METHOD

Diverse sampling methods were used to recruit 10 people with mBC, 5 family members and 10 metastatic breast care nurses. Semi-structured interviews were conducted online or by telephone during August-December 2020, and analysed thematically.

RESULTS

The role of the specialist nurse was strongly valued within and across participant groups, with close alignment regarding what was highly valued. Three themes were identified. First, nurses played a vital role in giving voice and visibility to patients with mBC in a healthcare system in which they often felt invisible. Second, nurses combined their clinical and psychosocial skills with a sense of authentic engagement to create a safe space for those with mBC to discuss their feelings, experiences, and topics, especially those that were unlikely to be discussed in their other social and clinical interactions. Finally, nurses supported patients in living as well as possible while managing symptoms, ongoing treatment, and attendant psychosocial impacts of an incurable and life-limiting condition.

CONCLUSIONS

This study underscores the central importance of metastatic breast care nurses in enhancing patient well-being, bridging gaps in care, and offering much-needed support. By addressing patients' emotional, clinical, and social needs, these specialist nurses contribute to a more holistic and compassionate approach to managing mBC.

Current Management and Future Perspectives in Metastatic HER2-Positive Breast Cancer

OBJECTIVE

Metastatic HER2-positive breast cancer remains a significant clinical challenge with a poor prognosis. The introduction of anti-HER2 therapies has significantly improved survival in early and advanced stages. However, patients with metastatic HER2-positive breast cancer eventually experience progression due to de novo or acquired resistance. This review article comprehensively analyzes the current management of metastatic HER2-positive breast cancer, addressing the complexities in determining the optimal HER2-targeted therapy sequence.

DATA SOURCES

Discussion of selected peer-reviewed articles and expert opinion.

CONCLUSIONS

We explore the actual standard of care and the emerging therapeutic options that hold promise for further improving patient care and survival in this aggressive breast cancer subtype. This article highlights vital toxicities linked to anti-HER2 therapies, emphasizing their recognition across treatments as interstitial lung disease, diarrhea, or left ventricular dysfunction.

IMPLICATIONS FOR NURSING PRACTICES

Oncology nurses have a key role to play in detecting potential adverse effects of anti-HER2 therapies. The development of new drugs, as antibody-drug conjugates, with a distinct toxicity profile makes it necessary for us to be updated on the management of these new toxicities.

Exploring the experiences of women living with metastatic breast cancer [MBC]: A systematic review of qualitative evidence

PURPOSE

Metastatic breast cancer [MBC] is the leading cause of cancer death in women globally with no cure. Women diagnosed with MBC endure a catastrophic upheaval to multiple aspects of their life and a radically transformed future landscape. Evidence suggests that the provision of care for women living with metastatic breast cancer is inadequate, socially isolating and stigmatising. To date, this topic has received little research attention. To increase understanding of the experiences of women living with MBC, a synthesis of current evidence is required. This paper presents a review of qualitative evidence on women's experiences of MBC.

METHODS

A qualitative evidence synthesis [QES] was conducted to synthesise primary qualitative research on the experiences of women living with MBC. Searches were performed of electronic databases Medline, Medline Ovid, PsycINFO, Psych articles, PubMED, CINAHL Complete, Scopus and grey literature databases. The methodological quality of the included studies was appraised using a modified version of the Critical Appraisal Skills Programme [CASP]. Title, abstract, and full-text screening were undertaken. A 'best fit' framework approach using the ARC [Adversity, Restoration, Compatibility] framework was used to guide data extraction and synthesis. Confidence in the findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation, Confidence in the Evidence from Reviews of Qualitative research [GRADE-CERQual].

RESULTS

28 papers from 21 research studies containing 478 women's experiences of living with MBC were deemed suitable for inclusion in this qualitative evidence synthesis. Findings are presented in a new conceptual framework RAAW [adapted from ARC] for women living with MBC under themes: Reality, Adversity, Adjustment and Wellbeing. Findings revealed that a diagnosis of MBC impacted every aspect of women's lives; this is different to a diagnosis of early breast cancer. An overarching theme of lack of support extended across various facets of their lives. A lack of psychological, emotional, and psychosocial support was evident, with a critical finding that models of care were not fit for purpose. Deficits included a lack of information, knowledge, inclusion in shared decision-making and MDT support, specifically the need for palliative care/oncology support access. Some women living with MBC wanted to be identified as having a chronic illness not a life-limiting illness. Culture and socioeconomic standing influenced the availability of various types of support. The impact of treatment and symptoms had an adverse effect on women's quality of life and affected their ability to adjust.

CONCLUSION

This review synthesised the qualitative literature on the experiences of women living with MBC. The ARC framework used in the synthesis was adapted to develop a revised conceptual framework titled RAAW to represent the evidence from this review on experiences for women living with MBC; Reality & Adversity: A diagnosis of MBC; Adjustment: Living with MBC; Wellbeing: Awareness, meaning, engagement [RAAW; MBC].

Living with metastatic breast cancer (LIMBER): experiences, quality of life, gaps in information, care and support of patients in the UK

PURPOSE

To determine the experiences, information, support needs and quality of life of women in the UK living with metastatic breast cancer (MBC) to provide content for educational materials.

METHODS

An online survey, hosted for 3 months on a UK MBC charity website, comprised sections covering issues such as communication about MBC treatment and management, helpful and less helpful things that healthcare professionals, family and friends did or said and completion of the Patient Roles and Responsibilities Scale (PRRS).

RESULTS

A total of 143 patients participated; 48/143(33%) presented de novo; 54/143(38%) had been living with MBC > 2 years. PRRS analysis revealed that MBC imposed a serious impact upon most respondents' own caring abilities and social lives. A majority 98/139 (71%) wished they had known more about MBC before their diagnosis; 63/134(47%) indicated that they still did not fully understand their illness; merely 78/139(56%) had access to a specialist nurse and only 69/135(51%) had been offered any additional support. Respondents reported little consideration given to their lifestyle/culture during consultations and inconsistent information, support services, continuity of care or access to clinical trials. They commented upon things health care professionals/friends and family did or said that were useful and cited other behaviours that were especially unhelpful.

CONCLUSIONS

MBC exerted a deleterious impact upon patients' activities of daily living which were exacerbated in part by significant gaps in support, communication and information.

IMPLICATIONS FOR CANCER SURVIVORS

LIMBER results are informing the content of educational materials currently being developed for patients' formal and informal carers.