1
|
Muñoz-Villaverde S, Serrano-Oviedo L, Martínez-García M, Pardo Y, Tares-Montserrat L, Gómez-Romero FJ, Garcimartin P. Spanish version of the short European Health Literacy Survey Questionnaire HLS-Q12: Transcultural adaptation and psychometric properties. PLoS One 2024; 19:e0299736. [PMID: 38421993 PMCID: PMC10903891 DOI: 10.1371/journal.pone.0299736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Health literacy has a direct impact on the health of populations. It is related to education, capacity for self-care, and management of health resources. The Health Literacy Survey Questionnaire HLS-Q12 is one of the reference instruments but has not yet been adapted to Spanish. The aims of the study were to cross-culturally adapt and evaluate the psychometric properties of the Spanish version of the HLS-Q12. METHODS Data was collected from June 2020 to March 2022. The sample consisted of 60 patients who initiated cancer treatment for the first time within a clinical trial. Double direct translation, back-translation, cognitive debriefing with a 10-patient sample, and an expert committee were used for cross-cultural adaptation. For validation of the HLS-Q12, a psychometric analysis was performed to assess feasibility, reliability, sensitivity to change and construct validity with other measures such as health-related quality of life, empowerment, and health needs. RESULTS The HLS-Q12 is equivalent at the semantic, conceptual, and content level to the original version and its psychometric properties demonstrated good internal consistency with a Cronbach's alpha of 0.88 and a McDonald´s omega of 0.91, a high degree of fit for the confirmatory factor analysis, and a statistically significant sensitivity to change (p = 0.025). CONCLUSIONS Based on robust psychometric values, the Spanish version of HLS-Q12 was found to be a good cross-culturally adapted tool for collecting correct information on health literacy in cancer patients regardless of tumour type or stage. Although more studies are needed, this version of HLS-Q12 could be used in research for collecting data on the health literacy needs of Spanish-speaking patients.
Collapse
Affiliation(s)
- Sergio Muñoz-Villaverde
- Oncology Clinical Trials Unit, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Cancer Research Program, Barcelona, Spain
- Catalan Institute of Health, Casc Antic Primary Care Centre, Barcelona Territorial Management, Barcelona, Spain
| | - Leticia Serrano-Oviedo
- Translational Research Unit, University General Hospital of Ciudad Real, Servicio de Saud de Castilla-La Mancha (SESCAM), Spain
| | - María Martínez-García
- Oncology Clinical Trials Unit, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Cancer Research Program, Barcelona, Spain
- Department of Medical Oncology, Hospital del Mar, Parc de Salud Mar, Barcelona, Spain
| | - Yolanda Pardo
- IMIM (Hospital del Mar Medical Research Institute), Health Services Research Group, Barcelona, Spain
- Institute of Health Carlos III, Centre for Biomedical Research Network, Epidemiology and Public Health (CIBERESP), ISCIII, Madrid, Spain
- Department of Psychiatry and Legal Medicine, School of Medicine, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Llüisa Tares-Montserrat
- Oncology Clinical Trials Unit, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Cancer Research Program, Barcelona, Spain
| | - Francisco Javier Gómez-Romero
- Translational Research Unit, University General Hospital of Ciudad Real, Servicio de Saud de Castilla-La Mancha (SESCAM), Spain
- School of Medicine at Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Paloma Garcimartin
- Nursing Directorate, Hospital del Mar, Barcelona, Spain
- Biomedical Network Research Centre for Cardiovascular Diseases, CIBERCV (Carlos III Health Institute), Madrid, Spain
| |
Collapse
|
2
|
Muñoz-Villaverde S, Martínez-García M, Serrano-Oviedo L, Gómez-Romero FJ, Sobrado-Sobrado AM, Cidoncha-Moreno MÁ, Riesgo-Martín J, Pedreira-Robles G, Garcimartin P. Impact of telenurse-led intervention in clinical trials on health literacy, empowerment, and health outcomes in patients with solid tumours: a pilot quasi-experimental study. BMC Nurs 2024; 23:86. [PMID: 38308260 PMCID: PMC10835870 DOI: 10.1186/s12912-023-01641-x] [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: 07/26/2023] [Accepted: 12/05/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, decentralised clinical trials incorporated self-monitoring, self-reporting, and telenursing tools to address health literacy and health empowerment of patients enrolled in clinical trials. We aimed to determine the impact of an educational intervention using telenursing consultations on health literacy, health empowerment, and health-related quality of life in cancer patients enrolled in clinical trials by measuring the level of satisfaction with the care received and assessing the views of healthcare professionals concerning the advanced practice nurse (APN) role in oncology clinical trials. METHODS In this pilot analytical, descriptive, longitudinal, quasi-experimental, and pre-post test study, an educational intervention was conducted by 5 visits with an APN using synchronous teleconsultation in patients starting cancer treatment for the first time in a clinical trial (n = 60), and health professionals working with the APN (n = 31). A descriptive analysis of the samples and questionnaires were utilised along with statistical comparisons. RESULTS After the intervention, patients' health literacy (31.7%), health empowerment (18.3%), and health-related quality of life (33.3%) increased (p < 0.05), with a decrease and trend towards resolution of care needs (p < 0.05). Satisfaction with the quality and care received in terms of perceived convenience, transition, and continuity of care showed positive results in 64.9 ± 20.7, 77.6 ± 19.5, and 72.1 ± 20.4 of respondents, respectively. On the overall assessment of the APN role, healthcare professionals expressed a high level of agreement with the statements related to their work performance. CONCLUSIONS The data indicates that a clinical trial APN-led telenursing educational intervention results in an overall increase in health literacy, an improvement in health empowerment and health-related quality of life, and a decrease in care needs of oncology clinical trials patients. Patients stated that they received a high quality of care and health professionals indicated high levels of acceptance with APNs. Based on these results, we suggest that the APN role should gain more recognition in the Spanish healthcare system and their professional competencies should be aligned with those of other countries.
Collapse
Affiliation(s)
- Sergio Muñoz-Villaverde
- Oncology Clinical Trials Unit, Hospital del Mar, Barcelona, Spain
- Cancer Research Programme, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Casc Antic Primary Care Centre, Catalan Institute of Health, Barcelona Territorial Management, Barcelona, Spain
| | - María Martínez-García
- Oncology Clinical Trials Unit, Hospital del Mar, Barcelona, Spain
- Cancer Research Programme, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Leticia Serrano-Oviedo
- Translational Research Unit, University General Hospital of Ciudad Real, Servicio de Salud de Castilla-La Mancha (SESCAM), Ciudad Real, Spain.
| | - Francisco Javier Gómez-Romero
- Translational Research Unit, University General Hospital of Ciudad Real, Servicio de Salud de Castilla-La Mancha (SESCAM), Ciudad Real, Spain
- Faculty of Medicine of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain
| | | | | | - Juan Riesgo-Martín
- Casc Antic Primary Care Centre, Catalan Institute of Health, Barcelona Territorial Management, Barcelona, Spain
| | - Guillermo Pedreira-Robles
- ESIMar (Mar Nursing School), Universitat Pompeu Fabra Affiliated, Parc de Salut Mar, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Paloma Garcimartin
- Nursing department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Research Group in Nursing Care, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Biomedical Network Research Centre for Cardiovascular Diseases, CIBERCV (Carlos III Health Institute), Madrid, Spain
| |
Collapse
|
3
|
Cosgrove D, Connolly M, Monnery D. Holistic care needs in an inpatient oncology unit: patients versus professionals. BMJ Support Palliat Care 2023:spcare-2023-004617. [PMID: 38123958 DOI: 10.1136/spcare-2023-004617] [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: 09/21/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Macmillan Cancer Support advocates that a Holistic Needs Assessment (HNA) is carried out at diagnosis and re-evaluated at significant key milestones throughout the patient journey. This now includes acute admission. However, evidence describing the use of HNAs and prevalence of unmet holistic needs in the acute oncology setting is lacking. This project aims to identify the prevalence of unmet holistic needs of patients in an acute oncology setting, and discern the differences in perception of needs between patients and healthcare professionals (HCPs). METHODS Patient and HCP surveys were conducted at 2 time points over a 10-month period. Surveys were co-designed with patient representatives based on the Macmillan Cancer Support 'concerns checklist' and used a 5-point Likert scale, rating the importance of each domain to the patient and HCP and the degree to which they felt the clinical team were aware of their needs. RESULTS In areas where there was good concordance between patient and HCPs ratings of prevalence, patients still perceived that HCPs were mostly unaware of these needs. Furthermore, HCPs overvalued the importance of advanced care planning and cardiopulmonary resuscitation discussions for patients. CONCLUSIONS There are discrepancies between patient and HCP perceptions of unmet holistic needs in the acute oncology setting.
Collapse
Affiliation(s)
| | - Maya Connolly
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Daniel Monnery
- Palliative Medicine, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
- University of Liverpool School of Life Sciences, Liverpool, UK
| |
Collapse
|
4
|
Le Boutillier C, Jeyasingh-Jacob J, Jones L, King A, Archer S, Urch C. Improving personalised care and support planning for people living with treatable-but-not-curable cancer. BMJ Open Qual 2023; 12:e002322. [PMID: 37666580 PMCID: PMC10481844 DOI: 10.1136/bmjoq-2023-002322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023] Open
Abstract
People living with treatable-but-not-curable (TbnC) cancer encounter cancer-related needs. While the NHS long-term plan commits to offering a Holistic Needs Assessment (HNA) and care plan to all people diagnosed with cancer, the content, delivery and timing of this intervention differs across practice. Understanding how people make sense of their cancer experience can support personalised care. A conceptual framework based on personal narratives of living with and beyond cancer (across different cancer types and all stages of the disease trajectory), identified three interlinked themes: Adversity, Restoration and Compatibility, resulting in the ARC framework.Our aim was to use the ARC framework to underpin the HNA to improve the experience of personalised care and support planning for people living with TbnC cancer. We used clinical work experience to operationalise the ARC framework and develop the intervention, called the ARC HNA, and service-level structure, called the ARC clinic. We sought expert input on the proposed content and structure from patients and clinicians through involvement and engagement activities. Delivered alongside standard care, the ARC HNA was piloted with patients on the TbnC cancer (myeloma and metastatic breast, prostate or lung) pathway, who were 6-24 months into their treatment. Iterations were made to the content, delivery and timing of the intervention based on user feedback.Fifty-one patients received the intervention. An average of 12 new concerns were identified per patient, and 96% of patients achieved at least one of their goals. Patients valued the space for reflection and follow-up, and clinicians valued the collaborative approach to meeting patients' supportive care needs. Compared with routine initial HNA and care plan completion rates of 13%, ARC clinic achieved 90% with all care plans shared with general practitioners. The ARC clinic adopts a novel and proactive approach to delivering HNAs and care plans in a meaningful and personalised way.
Collapse
Affiliation(s)
- Clair Le Boutillier
- Division of Methodologies, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Julian Jeyasingh-Jacob
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Surgery, Cardiovascular and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Lizzie Jones
- Department of Surgery, Cardiovascular and Cancer, Imperial College Healthcare NHS Trust, London, UK
- Maggie's West London, London, UK
| | - Alex King
- Department of Surgery, Cardiovascular and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Stephanie Archer
- Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Catherine Urch
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Surgery, Cardiovascular and Cancer, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
5
|
Snowden A, Young J, Roberge D, Schipani S, Murray E, Richard C, Lussier MT, White C. Holistic needs assessment in outpatient cancer care: a randomised controlled trial. BMJ Open 2023; 13:e066829. [PMID: 37142317 PMCID: PMC10163480 DOI: 10.1136/bmjopen-2022-066829] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Austyn Snowden
- Edinburgh Napier University, School of Nursing Midwifery and Social Care, Edinburgh, UK
| | - Jenny Young
- Edinburgh Napier University, School of Nursing Midwifery and Social Care, Edinburgh, UK
| | - Denis Roberge
- Département de médecine de famille et de médecine d'urgence, University of Quebec in Montreal, Montreal, Quebec, Canada
| | - Stefano Schipani
- Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Esther Murray
- Psychology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Claude Richard
- MEDICODE, University of Quebec in Montreal, Montreal, Quebec, Canada
| | - Marie-Therese Lussier
- Faculté de médecine - Département de médecine de famille et de médecine d'urgence, University of Montreal, Montreal, Quebec, Canada
| | - Craig White
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
6
|
Mortensen A, Wessel I, Rogers SN, Tolver A, Jarden M. Needs assessment in patients surgically treated for head and neck cancer-a randomized controlled trial. Support Care Cancer 2022; 30:4201-4218. [PMID: 35083545 DOI: 10.1007/s00520-021-06759-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the effect and feasibility of a head and neck cancer-specific needs assessment tool integrated into nursing rehabilitation consultations early in the post-surgical period on quality of life, symptom burden, and referrals for multidisciplinary follow-up. METHODS Ninety-two surgically treated patients with head and neck cancer were enrolled in a two-arm randomized controlled trial. All participants received nursing rehabilitation consultations prior to discharge, and two weeks and two months post-operative. The intervention group had their needs assessed using Patient Concerns Inventory, while standard care used a systematic questioning approach. Primary outcome was quality of life. Secondary outcomes were symptom burden and referrals for multidisciplinary rehabilitation follow-up. RESULTS No significant differences were found in quality of life or symptom burden between groups. However, 35% more patients in the intervention group were referred for rehabilitation. The attrition rate was similar in both groups, with a dropout rate of six in each group. No patients declined using the Patient Concerns Inventory. CONCLUSION The intervention showed no improvement in QoL or symptom burden compared to standard care. However, the results suggest that important needs were identified and addressed. Especially emotional and existential needs, which were accommodated through referrals and professional advice. Nursing rehabilitation consultations using the Patient Concerns Inventory are feasible and may ensure that patient preferences and priorities are incorporated in their care. TRIAL REGISTRATION ClinicalTrials.com (NCT03443258). Date of registration: May 31st, 2018.
Collapse
Affiliation(s)
- Annelise Mortensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Simon N Rogers
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, L39 4QP and Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, Great Britain, UK
| | - Anders Tolver
- Data Science Lab, Department of Mathematical Sciences, University of Copenhagen, Universitetsparken 5, 2200, Copenhagen N, Denmark
| | - Mary Jarden
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University and Department of Hematology, Center for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| |
Collapse
|
7
|
Sun K, Goodfellow H, Konstantara E, Hill A, Lennard D, Lloyd-Dehler E, Mughal M, Pritchard-Jones K, Robson C, Murray E. The multidisciplinary, theory-based co-design of a new digital health intervention supporting the care of oesophageal cancer patients. Digit Health 2021; 7:20552076211038410. [PMID: 34873450 PMCID: PMC8642779 DOI: 10.1177/20552076211038410] [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: 05/03/2020] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Oesophageal cancer patients have complex care needs. Cancer clinical nurse
specialists play a key role in coordinating their care but often have heavy
workloads. Digital health interventions can improve patient care but there
are few examples for oesophageal cancer. This paper aims to describe the
multidisciplinary co-design process of a digital health intervention to
improve the experience of care and reduce unmet needs among patients with
oesophageal cancer. Methods A theory-based, multi-disciplinary, co-design approach was used to inform the
developmental process of the digital health intervention. Key user needs
were elicited using mixed methodology from systematic reviews, focus groups
and interviews and holistic need assessments. Overarching decisions were
discussed among a core team of patients, carers, health care professionals
including oncologists and cancer clinical nurse specialists, researchers and
digital health providers. A series of workshops incorporating a summary of
findings of key user needs resulted in the development of a minimum viable
product. This was further refined after a pilot study based on feedback from
end users. Results The final digital health intervention consists of a mobile app feature for
patients and carers connected to a dashboard with supporting additional
features for clinical nurse specialist. It contains a one-way messaging
function for clinical nurse specialists to communicate with patients,
functions for patients to record weight and holistic need assessment results
which could be viewed by their clinical nurse specialists as well as a
library of informative articles. Conclusions The multidisciplinary co-design of a digital health intervention providing
support for oesophageal cancer patients and health care professionals has
been described. Future studies to establish its impact on patient outcomes
are planned.
Collapse
Affiliation(s)
- Kristi Sun
- Research Department of Primary Care and Population Health, University College London, UK
| | - Henry Goodfellow
- Research Department of Primary Care and Population Health, University College London, UK
| | - Emmanouela Konstantara
- Research Department of Primary Care and Population Health, University College London, UK
| | | | - Debby Lennard
- Research Department of Primary Care and Population Health, University College London, UK
| | - Elizabeth Lloyd-Dehler
- Research Department of Primary Care and Population Health, University College London, UK
| | | | - Kathy Pritchard-Jones
- North Central and East London Cancer Alliance, University College London Hospitals NHS Foundation Trust, UK
| | - Chris Robson
- Research Department of Primary Care and Population Health, University College London, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, UK
| |
Collapse
|
8
|
The nurse-patient interaction during rehabilitation consultations in patients surgically treated for head and neck cancer- a qualitative study. Eur J Oncol Nurs 2021; 53:101985. [PMID: 34275744 DOI: 10.1016/j.ejon.2021.101985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Patients treated surgically for head and neck cancer may experience detrimental early and late effects of their treatment and are in need of rehabilitation post treatment to alleviate symptoms and effects. This study aimed to explore nurse-patient interactions during rehabilitation consultations assessing needs of patients in order to understand how nurses and patients experienced the consultation, the extent to which patients experienced being involved in the needs assessment and how patients experienced the information delivered. METHODS Findings in this study drew on three data sources: 15 observations of nurse-patient interactions during rehabilitation consultations; 15 individual patient interviews and a focus group interview with nurses. Observations and individual patient interviews took place at three different time points during the patient trajectory. The method and analysis applied Interpretive Description and Systematic Text Condensation. Analysis was performed across all three data sources and three time points. RESULTS Four interrelated themes were identified, showing that conducting rehabilitation nursing consultations and actively involving patients is a complex process. The themes revealed the complexity: expectations for nurse-patient interaction differ; challenges of building rapport; barriers to adequately identifying rehabilitation needs; and factors inhibiting communication of advice and recommendations. Uncovering emotional needs were especially challenging. Patient further experienced an information overload, especially just prior to discharge. CONCLUSION Nurse-patient interaction in the rehabilitation consultation is complex and involves many different interrelated aspects that require the nurse to have the necessary interpersonal and professional skills to support the patient to enhance their involvement in the encounter.
Collapse
|
9
|
Dahill A, Al-Nakishbandi H, Cunningham K, Humphris G, Lowe D, Rogers S. Loneliness and quality of life after head and neck cancer. Br J Oral Maxillofac Surg 2020; 58:959-965. [DOI: 10.1016/j.bjoms.2020.04.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/28/2020] [Indexed: 02/09/2023]
|
10
|
Hawkins C, Kirby M, Genn H, Close H. Legal needs of adults with life-limiting illness: what are they and how are they managed? A qualitative multiagency stakeholder exercise. INTEGRATED HEALTHCARE JOURNAL 2020. [DOI: 10.1136/ihj-2019-000029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectiveLittle is known about legal needs in the context of life-limiting illness, particularly the need for advice concerning legal arrangements, rights and entitlements. This UK-based multiagency stakeholder engagement exercise scoped legal needs associated with life-limiting illness and identified support structures, gaps and opportunities for practice improvement.Method and analysisSnowball sampling generated a stakeholder group from a wide range of regional and national organisations involved in care of people with life-limiting illness, spanning health, social care, legal support, advice, charities, prison services as well as patient and carer representatives. A coproduced survey of three open questions generated qualitative data, interpreted by thematic analysis.ResultsStakeholders reported a broad spectrum of problems and needs raising legal issues, with no consistency of definition. A classification is proposed, identifying matters concerning rights and entitlements of patients/carers in day-to-day life and decisions around care, both immediate and in the future, as well as professional responsibilities in delivering personalised care. The support structures identified were predominantly online literature, although there was some availability of remote and face-to-face services. Limited awareness of the issues, variable service configuration, fragmentation of care and inequitable access were identified as barriers to support. Stakeholders recognised the need for education and closer multiagency working.Conclusions‘Legal needs’ incorporate wide-ranging issues, but there is inconsistency in perceptions among stakeholders. Practice is variable, risking unmet need. Opportunities for improvement include more formal integration of social welfare legal services in the health context, generating clearer pathways for assessment and management.
Collapse
|
11
|
The patient needs assessment in cancer care: identifying barriers and facilitators to implementation in the UK and Canada. Support Care Cancer 2020; 29:805-812. [PMID: 32500207 PMCID: PMC7767902 DOI: 10.1007/s00520-020-05542-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/19/2020] [Indexed: 11/05/2022]
Abstract
Purpose Personalised information and support can be provided to cancer survivors using a structured approach. Needs assessment tools such as the Holistic Needs Assessment (HNA) in the UK and the Comprehensive Problem and Symptom Screening (COMPASS) questionnaire in Canada are recommended for use in practice; however, they are not widely embedded into practice. The study aimed to determine the extent to which nurses working in cancer care in the UK and Manitoba value NA and identify any barriers and facilitators they experience. Method Oncology nurses involved in the care of cancer patients in the UK (n = 110) and Manitoba (n = 221) were emailed a link to an online survey by lead cancer nurses in the participating institutions. A snowball technique was used to increase participation across the UK resulting in 306 oncology nurses completing the survey in the UK and 116 in Canada. Results Participants expressed concerns that these assessments were becoming bureaucratic “tick-box exercises” which did not meet patients’ needs. Barriers to completion were time, staff shortages, lack of confidence, privacy, and resources. Facilitators were privacy for confidential discussions, training, confidence in knowledge and skills, and referral to resources. Conclusion Many busy oncology nurses completed this survey demonstrating the importance they attach to HNAs and COMPASS. The challenges faced with implementing these assessments into everyday practice require training, time, support services, and an appropriate environment. It is vital that the HNA and COMPASS are conducted at optimum times for patients to fully utilise time and resources.
Collapse
|
12
|
Rosenlund L, Degsell E, Jakola AS. Moving from clinician-defined to patient-reported outcome measures for survivors of high-grade glioma. Patient Relat Outcome Meas 2019; 10:267-276. [PMID: 31692481 PMCID: PMC6711557 DOI: 10.2147/prom.s179313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Persons with high-grade glioma face both neurological and cancer-related symptoms from the tumor itself and its treatment affecting their daily lives. Survival alone is not an adequate outcome, the quality of the survivorship experience needs to be regarded with equal importance. Patient-reported outcome (PRO) measures can be used to evaluate treatment effects and symptom management interventions. PURPOSE The aim of this review was to identify the use, challenges, and potential of PRO measures in survivors of high-grade glioma. METHODS A narrative expert opinion review was performed on the subject. In addition to our own experiences we searched PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and PsycINFO for brain tumor-specific PRO measures used in the population of adult patients with high-grade glioma, both original articles and reviews were included. RESULTS There are several PRO measures that have been validated for patients with primary brain tumors including high-grade glioma. PRO measures are used both in clinical trials to evaluate the effect of treatment on health-related quality of life, and in daily clinical practice for holistic needs assessment and symptom management. Common PRO measures used for patients with high-grade glioma are European Organization for Research and Treatment of Cancer general instrument for patients with cancer together with brain tumor module, Functional Assessment of Cancer Therapy-Brain, and MD Anderson Symptom Inventory for Brain Tumor. Neurologic and cognitive disorders often occur in patients with high-grade glioma, which affects patients' ability to self-report over time, making it more challenging in this population. PRO as a primary outcome seems underutilized. CONCLUSION For clinical research, PRO measures need to be used together with other clinical outcome measures rather than replacing traditional outcome measures. Moving to more use of PRO measures in survivorship care has potential to improve patient-caregiver-healthcare team communication, symptom management, and quality of care. Implementing PROs in survivorship care should also involve caregivers and a response based on the results.
Collapse
Affiliation(s)
- Lena Rosenlund
- Regional Cancer Centre Stockholm, Stockholm, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Eskil Degsell
- Regional Cancer Centre Stockholm, Stockholm, Sweden
- Malignant Brain Tumor Pathway, Quality and Patient Safety Department, Karolinska University Hospital, Stockholm, Sweden
- The Swedish Brain Tumor Association, Stockholm, Sweden
| | - Asgeir Store Jakola
- Department of Clinical Neurosciences, Institute of Physiology and Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
| |
Collapse
|
13
|
Johnston L, Young J, Campbell K. The implementation and impact of Holistic Needs Assessments for people affected by cancer: A systematic review and thematic synthesis of the literature. Eur J Cancer Care (Engl) 2019; 28:e13087. [DOI: 10.1111/ecc.13087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/14/2019] [Accepted: 04/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Lucy Johnston
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
| | - Jenny Young
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
| | | |
Collapse
|
14
|
Diffin J, Ewing G, Harvey G, Grande G. Facilitating successful implementation of a person-centred intervention to support family carers within palliative care: a qualitative study of the Carer Support Needs Assessment Tool (CSNAT) intervention. BMC Palliat Care 2018; 17:129. [PMID: 30572859 PMCID: PMC6302509 DOI: 10.1186/s12904-018-0382-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An understanding of how to implement person-centred interventions in palliative and end of life care is lacking, particularly for supporting family carers. To address this gap, we investigated components related to successful implementation of the Carer Support Needs Assessment Tool (CSNAT) intervention, a person-centred process of carer assessment and support, using Promoting Action on Research Implementation in Health Services (PARIHS) as a theoretical framework. This study identifies how the PARIHS component of 'facilitation' and its interplay with the components of 'context' and 'evidence' affect implementation success. METHODS MRC Framework Phase IV study to evaluate implementation of the CSNAT intervention at scale, over six months, in 36 UK palliative care services. 38 practitioners acting as internal facilitators in 35/36 services were interviewed. Field notes were collected during teleconference support sessions between the external and internal facilitators. RESULTS Successful implementation was associated with internal facilitators' 'leverage' including their positioning within services, authority to change practice, and having a team of supportive co-facilitators. Effective facilitation processes included a collaborative approach, ongoing communication, and proactive problem solving to address implementation barriers. Facilitators needed to communicate the evidence and provide legitimacy for changing practice. Contextual constraints on facilitation included having to adjust recording systems to support implementation, organisational changes, a patient-focused culture and lack of managerial support. CONCLUSIONS The CSNAT intervention requires attention to both facilitation processes and conducive organisational structures for successful implementation. These findings are likely to be applicable to any person-centred process of assessment and support within palliative care.
Collapse
Affiliation(s)
- J Diffin
- School of Nursing and Midwifery, Research Fellow, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK. .,Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
| | - G Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - G Harvey
- Health Management Group, Alliance Manchester Business School, University of Manchester, Manchester, UK.,Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - G Grande
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| |
Collapse
|
15
|
Hope-Stone L, Ablett J, Salmon P. Reflections on a Health Psychology Service for Patients with Uveal Melanoma: The Challenge of Psychological Screening and Intervention When Distress is 'Normal'. J Clin Psychol Med Settings 2018; 26:421-429. [PMID: 30465122 PMCID: PMC6851395 DOI: 10.1007/s10880-018-9595-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We appraise the role of screening for distress as part of health psychology assessment of patients newly diagnosed with cancer. We reviewed records of consecutive patients who accepted a health psychologist’s assessment over 4 years, examining convergence and divergence of the result of screening (whether patients reached threshold as ‘cases’) with the psychologist’s clinical judgment of need for intervention. Of 261 patients, 88 (33.7%) were ‘cases’. Of these, need for psychological intervention was identified in 70 (79.5%). Of the 173 (66.3%) ‘non-cases’, need was identified in 59 (34.1%). Examination of cases where the psychologist’s judgment diverged from screening showed that ‘caseness’ can arise from distress that patients can manage themselves and, conversely, that psychological needs arise in the absence of overt distress. Formal screening may not identify need for psychological intervention. The psychologist’s role is to make expert judgments of patients’ current and future needs. Dialogue with patients should be the vehicle for assessment.
Collapse
Affiliation(s)
- Laura Hope-Stone
- Liverpool Ocular Oncology Centre & Clinical Health Psychology Service-Cancer, Royal Liverpool and Broadgreen University Hospital, NHS Trust, Prescot St, Liverpool, L7 8XP, UK. .,Institute of Psychology, Health & Society, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - Janice Ablett
- Liverpool Ocular Oncology Centre & Clinical Health Psychology Service-Cancer, Royal Liverpool and Broadgreen University Hospital, NHS Trust, Prescot St, Liverpool, L7 8XP, UK.,Institute of Psychology, Health & Society, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Peter Salmon
- Institute of Psychology, Health & Society, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| |
Collapse
|
16
|
Abstract
A district nurse is an expert generalist practitioner who uses advanced clinical skills and knowledge to fulfil an ever-evolving role. The district nurse is accountable for the care planning, coordination and management of people with multi-faceted and intricate health care needs. In addition, an interprofessional approach to health and social care is required to enable the district nurse to co-ordinate care and enable patients to be cared for and remain within their homes. As the demand on primary and community services increases, care is further enriched by working in partnership with families, carers and voluntary service providers. The nurse patient relationship is the founding component for person-centred, holistic care. Through holistic assessment and shared decision making, co-produced care planning permits people to fundamentally take ownership of their health and enhances formal care provision. This case study reflects the role of the district nurse in Northern Ireland, through comprehensive assessment in clinical practice and highlights how a therapeutic relationship, being centred on the patient and shared decision-making impact positively on the care process.
Collapse
Affiliation(s)
- Charlene Young
- District nursing student, University of Ulster, Jordanstown, Northern Health and Social Care Trust
| | - Hilary Thompson
- Lecturer in Nursing, District Nursing Option Leader, Ulster University
| |
Collapse
|
17
|
Mitchell KSJ, Delfont S, Bracey ML, Endacott R. Top ten concerns burdening people with cancer: Perceptions of patients with cancer and the nurses caring for them. Eur J Oncol Nurs 2018; 33:102-106. [PMID: 29551171 DOI: 10.1016/j.ejon.2018.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE We examined the concerns that nurses perceive patients to have, whether these are congruent with patients' concerns and whether they vary according to cancer site. We also examined Distress Thermometer scores according to cancer site. METHOD A cross-sectional survey design: (i) secondary analysis of an existing Holistic Needs Assessment (HNA) and Distress Thermometer (DT) dataset was used, (ii) a survey of specialist nurse teams to identify their perceptions of patient concerns. Data collected between January 2015 and June 2016 from the HNA database from one NHS Trust in England (n = 1233 patients). Specialist nurse teams for breast, colorectal, gynaecology, skin and urology cancers identified the concerns that they perceived their patients would report. RESULTS The HNA showed high internal consistency (Cronbach's alpha 0.86). Across the five cancer sites, nurses identified between 3 and 6 of the top ten concerns (TTC) expressed by patients, with wide variation across cancer sites. Nine of the TTC were significantly associated (p < 0.05) with a specific cancer site. The breast and gynaecological cancer groups both recorded significantly higher median Distress Thermometer scores than the urology, skin and colorectal cancer groups (Kruskall-Wallis χ2 (4, n = 1228) 186.695, p=<.01). CONCLUSIONS One of the aims of the eHNA is to enable service delivery appropriate to patient needs. Our findings suggest that this will only be achieved if eHNA is examined, and services developed, by individual cancer site. The misconception of patient needs by specialist nurses underscores the importance of review of information provided by patients during consultations.
Collapse
Affiliation(s)
- Keith S J Mitchell
- Royal Devon & Exeter NHS Foundation Trust, Barrack Rd, Exeter, Devon, EX2 5DW, United Kingdom.
| | - Sarah Delfont
- FORCE Cancer Charity, Barrack Rd, Exeter, Devon, EX2 5DW, United Kingdom.
| | - Maria Lucinda Bracey
- Royal Devon & Exeter NHS Foundation Trust, Barrack Rd, Exeter, Devon, EX2 5DW, United Kingdom.
| | - Ruth Endacott
- Plymouth University/Royal Devon and Exeter Hospital Clinical School, University of Plymouth, Faculty of Health and Human Sciences, Plymouth, PL4 8AA, United Kingdom.
| |
Collapse
|
18
|
Matheson L, Watson EK, Nayoan J, Wagland R, Glaser A, Gavin A, Wright P, Rivas C. A qualitative metasynthesis exploring the impact of prostate cancer and its management on younger, unpartnered and gay men. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28382745 DOI: 10.1111/ecc.12676] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2017] [Indexed: 11/29/2022]
Abstract
Prostate cancer (PCa) can negatively impact on men's sexual, urinary and emotional functioning, affecting quality of life. Most men with PCa are older (≥65 years), married and heterosexual and little is known about the impact on men who are younger, unpartnered or gay. We aimed to synthesise existing qualitative research on these three groups of men. A systematic metasynthesis was undertaken that included data on the unique impacts of PCa on younger (<65 years) (n = 7 papers), unpartnered (n = 17 papers) or gay or bisexual men (n = 11 papers) using a modified meta-ethnographic approach. The three overarching constructs illustrated the magnified disruption to men's biographies, that included: marginalisation, isolation and stigma-relating to men's sense of being "out of sync"; the burden of emotional and embodied vulnerabilities and the assault on identity-illustrating the multiple threats to men's work, sexual and social identities; shifting into different communities of practice-such as the shift from being part of a sexually active community to celibacy. These findings suggest that PCa can have a particular impact on the quality of life of younger, unpartnered and gay men. This has implications for the provision of tailored support and information to these potentially marginalised groups.
Collapse
Affiliation(s)
- L Matheson
- Department of Applied Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - E K Watson
- Department of Applied Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - J Nayoan
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - R Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - A Glaser
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - A Gavin
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - P Wright
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - C Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
19
|
Snowden A, Young J, Fleming M. Protocol for a mixed methods longitudinal enquiry into the impact of a community based supportive service for people affected by cancer. BMC Cancer 2016; 16:720. [PMID: 27599721 PMCID: PMC5012037 DOI: 10.1186/s12885-016-2757-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/31/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Globally, cancer rates are increasing. In Scotland, it is estimated that 2 in 5 people will develop cancer in their lifetime. Therefore, this is crucial time to provide personalised care and support to individuals affected by cancer. In response to this a community based supportive cancer service was launched in Glasgow, Scotland. The aim of this service is to proactively provide those affected by cancer with an assessment of their needs and personalised support where needed. To our knowledge, there is no other service like this in the United Kingdom. METHODS The aim of this study is to understand if and how the service impacts upon the experiences and outcomes of people living with and affected by cancer. The study uses a sequential mixed methods design across a 5 year time point. Data gathering includes questionnaires, interviews, observations and reflective diaries. Participants include people affected by cancer who have used the service, a comparative sample who have not used the service, individuals who deliver the service and wider stakeholders. Outcomes include measures of patient activation, quality of life, health status, and social support. Data collection occurs at baseline, 2.5 years and 4 years with data from observations and reflective diaries supplemented throughout. DISCUSSION This study evaluates an innovative community based cancer service. It focuses on impact and process issues relevant to a) the individuals in receipt of the service, b) the service providers, and c) the wider culture. As the programme evolves overtime, the research has been designed to draw out learning from the programme in order to support future commissioning both within Scotland and across the UK.
Collapse
Affiliation(s)
- Austyn Snowden
- Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN Scotland, UK
| | - Jenny Young
- Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN Scotland, UK
| | - Mick Fleming
- Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN Scotland, UK
| |
Collapse
|