The palliative care needs and experiences of people with advanced head and neck cancer: A scoping review

BACKGROUND

The palliative care needs of people with advanced head and neck cancer pose unique complexities due to the impact the illness has on eating, speaking, appearance and breathing. Examining these needs would help provide guidance about developing relevant models of care and identify gaps in research knowledge.

AIM

To identify and map out the palliative care needs and experiences for people with advanced head and neck cancer.

DESIGN

A scoping literature review following the methods described by the Joanna Briggs Institute.

DATA SOURCES

An electronic search of the literature was undertaken in MEDLINE (Ovid), EMBASE and CINAHL covering the years January 1996 to January 2019.

RESULTS

People with advanced head and neck cancer often had palliative care needs but there was variability in the timing and access to relevant services. A high prevalence of interventions, for example hospital admissions were needed even during the last month of life. This was not necessarily negated with early engagement of palliative care. Dissonance between patients and family carers about information needs and decision-making was an additional complexity. Studies tended to be descriptive in nature, and often involved a single centre.

CONCLUSION

This scoping review demonstrates the complexity of care for people with advanced head and neck cancer and the issues related to the current healthcare systems. Focus on appropriate referral criteria, increased integration and coordination of care and robust evaluation of specific care components seems key. Linkage between research and service design delivery across teams, disciplines and care settings seems pertinent.

A Qualitative Study Exploring Patient, Family Carer and Healthcare Professionals' Direct Experiences and Barriers to Providing and Integrating Palliative Care for Advanced Head and Neck Cancer

OBJECTIVES

To report on direct experiences from advanced head and neck cancer patients, family carers and healthcare professionals, and the barriers to integrating specialist palliative care.

METHODS

Using a naturalistic, interpretative approach, within Northwest England, a purposive sample of adult head and neck cancer patients was selected. Their family carers were invited to participate. Healthcare professionals (representing head and neck surgery and specialist nursing; oncology; specialist palliative care; general practice and community nursing) were recruited. All participants underwent face-to-face or telephone interviews. A thematic approach, using a modified version of Colazzi's framework, was used to analyze the data.

RESULTS

Seventeen interviews were conducted (9 patients, 4 joint with family carers and 8 healthcare professionals). Two main barriers were identified by healthcare professionals: "lack of consensus about timing of Specialist Palliative Care engagement" and "high stake decisions with uncertainty about treatment outcome." The main barrier identified by patients and family carers was "lack of preparedness when transitioning from curable to incurable disease." There were 2 overlapping themes from both groups: "uncertainty about meeting psychological needs" and "misconceptions of palliative care."

CONCLUSIONS

Head and neck cancer has a less predictable disease trajectory, where complex decisions are made and treatment outcomes are less certain. Specific focus is needed to define the optimal way to initiate Specialist Palliative Care referrals which may differ from those used for the wider cancer population. Clearer ways to effectively communicate goals of care are required potentially involving collaboration between Specialist Palliative Care and the wider head and neck cancer team.

Healthcare professionals' promotion of physical activity to people living with and beyond head and neck cancer: a cross-sectional survey

PURPOSE

Physical activity (PA) can improve health-related outcomes for head and neck cancer (HaNC) patients, and PA guidance from healthcare professionals' can increase patients' PA levels. However, less than 9% of HaNC patients are physically active. This study explored healthcare professionals' promotion of PA across the National Health Service (NHS) in North West England and North Wales, to HaNC patients.

METHODS

A cross-sectional online survey exploring healthcare professionals' promotion of PA in HaNC. The International Physical Activity Questionnaire-Short Form was used to estimate healthcare professionals' PA levels. Quantitative data were analyzed using descriptive or inferential statistics and qualitative data were analyzed using reflexive thematic analysis. Data were synthesized drawing on the capability-opportunity-motivation-behavior model and theoretical domains framework.

RESULTS

Eighty-one professionals participated. Fifty-three percent self-reported high levels of PA. Seventy-five percent considered PA promotion as part of their role; however, only 39% discussed PA with their patients (reflective motivation and social/professional role and identity). Only 38% felt confident initiating PA discussions and 76% reported needing further training. Training on the benefits of PA for HaNC patients and how to encourage health-related behavior change were identified as beneficial (psychological capability and knowledge).

CONCLUSION

Healthcare professionals are influential in enabling patients to adopt health-related behavior change; however, PA promotion was not routine practice for professionals involved in the care of HaNC patients. Training should be provided to professionals on PA promotion, with a focus on behavior change techniques. Future research should explore how behavior change techniques can be implemented into clinical practice to improve health-related outcomes in HaNC.

Physical activity promotion and participation for people living with and beyond head and neck cancer: A mixed methods study

PURPOSE

Head and neck cancer (HaNC) can be debilitating, resulting in high symptom burden. Physical activity (PA) can improve quality of life; however, less than 9% of HaNC patients are physically active. This study explored barriers to, and facilitators of, PA promotion and participation for HaNC patients.

METHODS

Semi-structured interviews with patients, family members and healthcare professionals were conducted. A questionnaire was used to measure patients' self-reported self-efficacy (The General Self-Efficacy Scale) and patients' and healthcare professionals' self-reported PA (The International PA Questionnaire - Short Form). Qualitative data were analysed using reflexive thematic analysis and quantitative data were analysed descriptively. Data were synthesised drawing on the Capability-Opportunity-Motivation-Behaviour model and the Theoretical Domains Framework.

RESULTS

Twenty-eight patients, 10 family members and 18 healthcare professionals participated. Most patients self-reported moderate-to-high levels of PA and self-efficacy. Professionals self-reported high levels of PA. Patients were unaware of the benefits of PA for managing side effects and improving quality of life. Family members and professionals were fearful of patients causing themselves harm by being physically active (reflective motivation and beliefs about consequences). Some professionals did not consider it within their role to promote PA to HaNC patients. Many professionals stated they required training in PA promotion, and patients and family members stated they required information and guidance (psychological capability and knowledge).

CONCLUSION

The responsibility of PA promotion is multidisciplinary and educating patients on the benefits and safety of PA may mitigate treatment-related side effects and improve quality of life. Future research should explore if barriers to, and facilitators of, PA behaviour change over a patient's treatment trajectory.

Barriers to and facilitators of physical activity in adults living with and beyond cancer, with special emphasis on head and neck cancer: a systematic review of qualitative and mixed methods studies

PURPOSE

Physical activity can improve health outcomes for cancer patients; however, only 30% of patients are physically active. This review explored barriers to and facilitators of physical activity promotion and participation in patients living with and beyond cancer. Secondary aims were to (1) explore similarities and differences in barriers and facilitators experienced in head and neck cancer versus other cancers, and (2) identify how many studies considered the influence of socioeconomic characteristics on physical activity behaviour.

METHODS

CINAHL Plus, MEDLINE, PsycINFO, Scopus and Cochrane (CDSR) were searched for qualitative and mixed methods evidence. Quality assessment was conducted using the Mixed Methods Appraisal Tool and a Critical Appraisal Skills Programme Tool. Thematic synthesis and frequency of reporting were conducted, and results were structured using the Capability-Opportunity-Motivation-Behaviour model and Theoretical Domains Framework.

RESULTS

Thirty qualitative and six mixed methods studies were included. Socioeconomic characteristics were not frequently assessed across the included studies. Barriers included side effects and comorbidities (physical capability; skills) and lack of knowledge (psychological capability; knowledge). Having a dry mouth or throat and choking concerns were reported in head and neck cancer, but not across other cancers. Facilitators included improving education (psychological capability; knowledge) on the benefits and safety of physical activity.

CONCLUSION

Educating patients and healthcare professionals on the benefits and safety of physical activity may facilitate promotion, uptakeand adherence. Head and neck cancer patients experienced barriers not cited across other cancers, and research exploring physical activity promotion in this patient group is required to improve physical activity engagement.