Satisfaction with nurse-led telephone follow up for low to intermediate risk prostate cancer patients treated with radical radiotherapy. A comparative study

Beliefs, barriers, and promotion practices of Indian nurses' regarding healthy eating for cancer survivors in a tertiary care hospital-A cross sectional survey

Purpose

To describe the beliefs, barriers and promotion practices of Indian nurses' regarding healthy eating (HE) behaviours amongst cancer survivors, and to gain insights into whether their educational qualifications might affect the promotion of HE.

Methods

Data was gathered using a validated questionnaire, 388 of the approached 400 nurses who worked at a tertiary care hospital in India gave informed consent to participate in the study. The Mann-Whitney U test and the Chi square analysis (for continuous and categorical variables respectively) were performed to carry out sub-group comparisons based on the qualification of the nurses i.e., Bachelor of Science in Nursing (BSc) and General Nursing and Midwifery (GNM).

Results

The nurses believed that dieticians/nutritionists were primarily responsible for educating the cancer survivors regarding HE. HE was promoted by nurses' relatively equally across multiple treatment stages ("during" treatment 24.4%, "post" treatment 23.1%; and "pre" treatment 22.3%). Nurses' believed HE practices had numerous benefits, with improved health-related quality of life (HRQoL) (75.7%), and mental health (73.9%) being the most frequent responses. The most frequently cited barriers by the nurses in promoting HE were lack of time (22.2%), and lack of adequate support structure (19.9%). Sub-group comparisons generally revealed no significant difference between the BSc and GNM nurses in their perceptions regarding HE promotion to cancer survivors. Exceptions were how the GNM group had significantly greater beliefs regarding whether HE can "reduce risk of cancer occurrence" (p = 0.004) and "whether or not I promote HE is entirely up to me" (p = 0.002).

Conclusion

The nurses in India believe in the promotion of HE practices among cancer survivors across various stages of cancer treatments. However, they do face a range of barriers in their attempt to promote HE. Overcoming these barriers might facilitate effective promotion of HE among cancer survivors and help improve survivorship outcomes.

Implications for cancer survivors

Indian nurses employed in the two tertiary care hospitals wish to promote HE among cancer survivors, but require further knowledge and support services for more effective promotion of HE.

Nurse-led renal cell carcinoma clinic: a single center review

BACKGROUND

In 2015 our centre introduced a nurse-led renal cell cancer follow-up protocol and clinic for patients who have undergone partial or radical nephrectomy for organ-confined kidney tumours. The main aims of this clinic were to improve healthcare efficiency and standardize follow-up processes.

OBJECTIVES

The primary objective was to assess the effectiveness of a nurse-led renal cell cancer follow up clinic in regard to surveillance protocol compliance and the timely identification and appropriate management of recurrences. A secondary objective was to evaluate this locally developed follow up protocol against the current European Association of Urology (EAU) guidelines surveillance protocol.

PATIENT AND METHODS

All patients who underwent a partial or radical nephrectomy between 2015 and 2021 at a single Western Australia institution for a primary renal malignancy were included. Data was collected from local clinical information systems and protocol adherence, recurrence characteristics and management were assessed. The current EAU guidelines were applied to the cohort to assess differences in risk-stratification and theoretical outcomes between the protocols.

RESULTS

After a mean follow up period of 31.2 months (range 0-77 months), 75.5% (185/245) of patients had all follow up imaging and reviews within 1 month of the timeframe scheduled on the protocol. 17.1% (42/245) had a delay in their follow up of more than a month at some stage, 5.7% (14/245) did not attend for follow up but had documented attempts to facilitate their compliance, and 0.4% (1/245) were lost to follow up with no evidence of attempted contact. 15.5% (38/245) of patients had recurrence of malignancy detected during follow up and these were all discussed in a multi-disciplinary team (MDT) meeting. The recurrence rate was 2.5% (3/119) for low risk, 17.7% (14/79) for intermediate risk, and 44.7% (21/47) for high risk patients when they were re-stratified according to EAU risk categories. No recurrences were detected through ultrasound (USS) or chest x-ray (CXR) in this cohort and our protocol tended to place patients in higher risk-stratification groups as compared to current EAU guidelines.

CONCLUSION

Nurse-led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and Computerized tomography (CT) should be considered the imaging modality of choice for this purpose. The EAU surveillance protocol appears superior to our protocol, and we have therefore transitioned to the EAU guideline protocol going forward.

Supportive care interventions for men with urological cancers: a scoping review

PURPOSE

To identify supportive care interventions for men with urological cancers.

METHODS

Experimental studies conducted among men with any urological cancer were eligible for inclusion. Academic Search Complete, CINAHL Plus with Full Text, MEDLINE, APA PsycArticles, APA PsycInfo, Social Sciences Full Text (H.W. Wilson), SocINDEX with Full Text, ERIC, Google Scholar and ClinicalTrials.gov were searched on 6 December 2022. No database limits were applied. The included studies were methodologically appraised. A narrative synthesis of the results was conducted.

RESULTS

Thirty studies were included with 10 categories of interventions identified. Over 300 outcomes were measured, and more than 100 instruments were used. Multicomponent interventions generally led to positive changes in physiological outcomes like body mass index, as well as exercise tolerance and quality of life. This change, however, was not sustained in the long term. Cognitive-behavioural interventions significantly improved psychological symptoms but seldom physical symptoms. Telephone and web-based interventions showed great promise in improving outcomes like depression, positive affect, negative affect, perceived stress, spiritual wellbeing and fatigue. Findings from physical activity/exercise-based interventions were promising for both, physical and psychological outcomes. Rehabilitative interventions were associated with significant improvements in quality of life, urinary symptoms and psychological symptoms, albeit in the short term. Mixed results were reported for nurse-led interventions, family-based interventions and nutritional interventions.

CONCLUSION

All but one study focused exclusively on prostate cancer. The included studies were significantly heterogeneous. Multicomponent, cognitive-behavioural, telephone and web-based, physical activity/exercise-based and rehabilitative interventions showed great promise in improving various outcomes. This improvement, however, was often short-lived.

Nurse-Led Telephone Follow-Up Intervention for Titrating and Tapering Opioids in Chronic Pain Patients - A Feasibility Study

Background and Purpose

Opioids in chronic non-cancer pain are debated, but remain a part of the pain treatment for selected patients. Research is scarce on the relieving and adverse effects of opioids, and how to deliver opioid treatment in this patient group. This study's purpose was to assess the feasibility of a nurse-led telephone follow-up intervention for titrating or tapering opioids, including a pilot study of the intervention outcomes.

Patients and Methods

The feasibility assessment and process evaluation were performed according to the UK Medical Research Council (MRC) framework for evaluating complex interventions. A pilot study of the intervention outcomes was also performed. With a retrospective, descriptive, and longitudinal approach, we analyzed reports from 32 patients who titrated or tapered opioids. Information on demography, sleep satisfaction, health status, pain intensity/bothersomeness, opioid doses, and side effects was derived from the Oslo Pain Registry. Descriptive statistics, t-tests, and chi-square tests were used to analyze registry data.

Results

The study findings indicate that the intervention is feasible. Areas of impact were lack of a sound theory basis, unclear allocation criteria, and inconsistent and non-validated measurement tools. Mechanisms of change were interprofessional collaboration, nurses' knowledge and competencies, predictability, and availability. Statistical analyses showed no between-groups differences in demographical-, clinical-, and pain characteristics, except those who titrated opioids were significantly older than patients tapering opioids (P=0.010). All patients reported poor health and side effects at baseline. Those who tapered opioids had a significant reduction in opioid use (P=0.004). Titrating opioids was associated with a significant increase in side effects (P=0.038).

Conclusion

Considering the limitations and the strengths of the intervention, the present study indicates that the nurse-led telephone follow-up program is a feasible intervention. With the right adjustments and improvements, the intervention is eligible for a larger efficacy study.

Loss to follow-up associated factors in patients with chronic pulmonary aspergillosis and its impact on the disease prognosis

Objective

Pulmonary aspergillosis is a rare but challenging pulmonary disease. The conditions of patients with chronic pulmonary aspergillosis (CPA) can be even more complicated. The mortality rate of CPA remains high, and the prognostic factors are not well established due to a high proportion of loss to follow-up. In this study, we aim to explore factors associated with loss to follow-up in CPA patients and their impact on the disease prognosis after withdrawing anti-fungal treatments.

Methods

Patients with confirmed CPA, who were admitted to the Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University from March 2017 to November 2019, were enrolled in this prospective study. The enrolled patients were followed up for 6 months after discharge. For loss to follow-up patients, the reasons for loss to follow-up and their prognosis after withdrawing anti-fungal treatments during loss to follow-up were recorded by telephone communication. Multivariate logistic regression analysis was performed to determine factors associated with loss to follow-up.

Results

The 199 out of 298 screened patients were included in the study. Except for 67 cases with regular follow-up, the rest 132 cases were lost to follow-up. Factors, including age > 60 years (OR = 2.036, P = 0.03), monthly income ≤ $583 (OR = 5.568, P = 0.0001), education ≤ 6 years (OR = 7.474, P = 0.0001), and non-local residence (OR = 5.893, P = 0.0001) were associated with the loss to follow-up according to multivariate logistic regression analysis. The most common reasons for loss to follow-up were economic factors and clinic visit distance. The overall case fatality rate (CFR) within 180 days in patients with regular follow-up and patients who stopped anti-fungal treatment during the loss to follow-up was 0% and 19.65%, respectively.

Conclusion

The proportion of loss to follow-up in CPA patients remained high. Age (>60 years), poor financial status, low education, and non-local residence were the key factors associated with the loss to follow-up in this study. Our study reveals the need to optimize the follow-up procedures and improve the patients understanding about the benefits and limitations of follow-up to reduce the CFR.

Remote consultations: experiences of UK patients with prostate cancer during the COVID-19 pandemic

Aim: Explore UK prostate cancer patients' experiences and preferences for in-person and remote consultations. Materials & methods: In January-March 2021, patients completed a survey of consultation format preferences. Results: Of 971 patients, most preferred in-person consultations when receiving diagnosis and results (92.3 and 66.5%, respectively) and discussing first and further treatment options (92.0 and 84.0%, respectively). Fewer patients considered follow-up (40.9%) or side effect consultations (47.7%) should be in person. Patients with longer travel preferred telephone consultations for receiving test results post-treatment. Patients over 55 preferred in-person consultations for discussing first treatment. Conclusion: To optimize prostate cancer care in the wake of COVID-19, we recommend patients have the option of consultation format, although key decisions should be made in person.

Non-metastatic castration-resistant prostate cancer: the evolving treatment landscape and role of nurse specialists

Prostate cancer is the most common type of cancer in men in the UK. Within 2 years of diagnosis, one-third of patients with non-metastatic castration-resistant prostate cancer (nmCRPC) will develop metastatic disease, which is associated with significantly greater morbidity and mortality compared to disease without metastases. The approval of second-generation androgen receptor inhibitors such as darolutamide has transformed the nmCRPC treatment landscape because they lead to prolonged metastasis-free survival and better maintenance of quality of life compared with placebo. Early identification of patients with nmCRPC who are suitable for treatment is imperative because most of these patients are asymptomatic. Clinical nurse specialists (CNSs) play a critical, supportive role in the management of disease and treatment follow-up. This product-focused article discusses the use of darolutamide in nmCRPC and the vital role that CNSs play in the management and care of patients with prostate cancer.

Indian nurses' beliefs on physical activity promotion practices for cancer survivors in a tertiary care hospital-a cross-sectional survey

Purpose

To describe the physical activity (PA) promotion practices, beliefs, and barriers of Indian nurses working with cancer survivors, and to gain preliminary insights into how their educational qualification might affect PA promotion practices.

Methods

A validated questionnaire was used to obtain the data (N = 388). Sub-group comparisons were performed based on nursing qualification i.e., Bachelor of Science in Nursing (BSc) and General Nursing and Midwifery (GNM) using Mann-Whitney U test and chi square analysis for continuous and categorical variables, respectively.

Results

The nurses believed that oncologists (47%) followed by physiotherapists (28.9%) were primarily responsible for providing information regarding PA to cancer survivors. The most common period in which the nurses' promoted PA was post treatment (31.7%), although very few nurses (13.3%) promoted PA across more than one of the three treatment periods. Nurses felt that PA had many benefits for cancer survivors; improved mental health (87.7%) and HRQoL (81.1%). Lack of knowledge (42.2%) and lack of time (41.6%) were the most frequently cited barriers. The comparisons based on educational qualification did not typically reveal many significant differences.

Conclusion

Indian nurses both BSc and GNM qualified, wish to promote PA to cancer survivors despite numerous barriers, across various stages of treatment and believe PA is beneficial to the survivors in the process of recovery. Overcoming these barriers might aid in better promotion of PA to cancer survivors.

Implication for cancer survivors

Nurses working in a tertiary care hospital in India are willing to promote PA amongst cancer survivors but require more training and support in this area of practice.

The Impact of the COVID-19 Pandemic on Genitourinary Cancer Care: Re-envisioning the Future

CONTEXT

The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid changes in medical practice. Many of these changes may add value to care, creating opportunities going forward.

OBJECTIVE

To provide an evidence-informed, expert-derived review of genitourinary cancer care moving forward following the initial COVID-19 pandemic.

EVIDENCE ACQUISITION

A collaborative narrative review was conducted using literature published through May 2020 (PubMed), which comprised three main topics: reduced in-person interactions arguing for increasing virtual and image-based care, optimisation of the delivery of care, and the effect of COVID-19 in health care facilities on decision-making by patients and their families.

EVIDENCE SYNTHESIS

Patterns of care will evolve following the COVID-19 pandemic. Telemedicine, virtual care, and telemonitoring will increase and could offer broader access to multidisciplinary expertise without increasing costs. Comprehensive and integrative telehealth solutions will be necessary, and should consider patients' mental health and access differences due to socioeconomic status. Investigations and treatments will need to maximise efficiency and minimise health care interactions. Solutions such as one stop clinics, day case surgery, hypofractionated radiotherapy, and oral or less frequent drug dosing will be preferred. The pandemic necessitated a triage of those patients whose treatment should be expedited, delayed, or avoided, and may persist with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in circulation. Patients whose demographic characteristics are at the highest risk of complications from COVID-19 may re-evaluate the benefit of intervention for less aggressive cancers. Clinical research will need to accommodate virtual care and trial participation. Research dissemination and medical education will increasingly utilise virtual platforms, limiting in-person professional engagement; ensure data dissemination; and aim to enhance patient engagement.

CONCLUSIONS

The COVID-19 pandemic will have lasting effects on the delivery of health care. These changes offer opportunities to improve access, delivery, and the value of care for patients with genitourinary cancers but raise concerns that physicians and health administrators must consider in order to ensure equitable access to care.

PATIENT SUMMARY

The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the care provided to many patients with genitourinary cancers. This has necessitated a transition to telemedicine, changes in threshold or delays in many treatments, and an opportunity to reimagine patient care to maintain safety and improve value moving forward.

An exploration of the Role of the Prostate Cancer Specialist Nurse from Two International Perspectives

OBJECTIVE

A diagnosis of prostate cancer is a major life-changing event that brings social, psychological, physical, financial, and spiritual challenges. In both the United Kingdom (UK) and Australia, prostate cancer specialist nurses (PCSNs) have a unique role in the care of men and their families. Prostate cancer specialist nursing roles are described from the UK and Australian perspective.

DATA SOURCES

Government regulations, peer-reviewed journal articles, nursing society and government websites.

CONCLUSION

Specialist nursing roles have developed within different frameworks and in response to very different political drivers in the UK and in Australia. An evidence base has developed demonstrating that PCSNs offer positive outcomes for men and their families. Despite some differences in the scope of international roles, there are common aspects. Both health care settings have challenges in terms of education, role definition, and capacity. Yet both PCSN roles have delivered innovative models of specialist care in terms of service delivery and patient support and education.

IMPLICATIONS FOR NURSING PRACTICE

PCSNs have the potential to significantly decrease the burden on the public health system and influence change. For men with prostate cancer and their families, PCSNs can improve care through holistic nursing models focussing on what is important to individuals: support, education, management of side effects, rehabilitation, and by delivering and improving access to high-quality care.

Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic?

Context

Coronavirus disease 2019 (COVID-19) pandemic has caused increased interest in the application of telehealth to provide care without exposing patients and physicians to the risk of contagion. The urological literature on the topic is sparse.

Objective

To perform a systematic review of the literature and evaluate all the available studies on urological applications of telehealth.

Evidence acquisition

After registration on PROSPERO, we searched PubMed and Scopus databases to collect any kind of studies evaluating any telehealth interventions in any urological conditions. The National Toxicology Program/Office of Health Assessment and Translation Risk of Bias Rating Tool for Human and Animal Studies was used to estimate the risk of bias. A narrative synthesis was performed.

Evidence synthesis

We identified 45 studies (11 concerning prostate cancer [PCa], three hematuria management, six urinary stones, 14 urinary incontinence [UI], five urinary tract infections [UTIs], and six other conditions), including 12 randomized controlled trials. The available literature indicates that telemedicine has been implemented successfully in several common clinical scenarios, including the decision-making process following a diagnosis of nonmetastatic PCa, follow-up care of patients with localized PCa after curative treatments, initial diagnosis of hematuria, management diagnosis and follow-up care of uncomplicated urinary stones and uncomplicated UTIs, and initial evaluation, behavioral therapies, and pelvic floor muscle training in UI patients, as well as follow-up care after surgical treatments of stress urinary incontinence or pelvic organ prolapse. The methodological quality of most of the reports was good.

Conclusions

Telehealth has been implemented successfully in selected patients with PCa, UI, pelvic organ prolapse, uncomplicated urinary stones, and UTIs. Many urological conditions are suitable for telehealth, but more studies are needed on other highly prevalent urological malignant and benign conditions. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine. More robust data on long-term efficacy, safety, and health economics are necessary.

Patient summary

The diffusion of coronavirus disease 2019 (COVID-19) infections has recently increased the interest in telehealth, which is the adoption of telecommunication to deliver any health care activity. The available literature indicates that telemedicine has been adopted successfully in selected patients with several common clinical urological conditions, including prostate cancer, uncomplicated urinary stones, uncomplicated urinary infections, urinary incontinence, or pelvic organ prolapse. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine, but more robust data on long-term efficacy, safety, and costs are necessary.

A nurse practitioner model for the assessment of suspected prostate cancer referrals is safe, cost and time efficient

Purpose

To evaluate the outcomes from a Urology Nurse Practitioner (UNP)-led service for the initial assessment and diagnostic decision making and for suspected prostate cancer referrals.

Methods

Using a modified Delphi analysis approach, a panel of Urological Prostate Cancer specialists were asked to review the UNP management plans of a convenience sample of 60 randomly selected patient cases – between June 2012 and June 2015. The panel was required to establish consensus or identify divergence of clinical practice, based on five key statements. In addition, cost analysis, waiting time and patient satisfaction evaluation were made regarding the nurse-led service.

Results

In 87% (52/60 cases), consensus was reached by the panel that the UNP management plan was entirely appropriate and in only two cases was there discordance, where the panel felt that the management plan by the UNP was inappropriate with errors potentially and significantly affecting the patient. Over the 3 years, a modest cost saving of £11,500.38 was realised, which due to increased referrals has now realised in 1 year (2017/18) a saving of £11,335.50. Compared to the previous physician-led service, waiting times for patient appointment fell by 52% over the 3-year period; 57/63 (90%) patients reported being satisfied with seeing a UNP instead of a doctor for their first appointment; 60/63 (95%) reported that, following the initial hospital visit with the UNP, they had a clear understanding of what the next steps were in their assessment. Overall, 54/63 (86%) were ‘very satisfied’ with the UNP-led service.

Conclusion

Our study demonstrates that a UNP approach to the assessment and management of suspected prostate cancer referrals provides an effective approach to care in an ever-demanding healthcare arena.

Through a supported training programme, urology nurses can deliver a high standard of service.

Influences on health-care practitioners' promotion of physical activity to their patients with prostate cancer: a qualitative study

INTRODUCTION Physical activity is beneficial for the physical and psychological health of patients with prostate cancer (PCa). Health-care practitioners are ideally positioned to promote physical activity to their patients. AIM To identify factors that influenced health care practitioners to either promote or not promote physical activity to their patients with PCa. METHODS Individual interviews were conducted with 16 Auckland-based health-care practitioners, including specialists (oncologists and urologists), physiotherapists and complementary and alternative (acupuncturists) health-care practitioners. Data were analysed using an inductive thematic approach. RESULTS Treatment-related factors (ie counteracting side-effects of hormone suppression treatment), longer life expectancy and risk factors for other conditions appeared to influence the promotion of physical activity to patients. Time constraints of consultations and complex medical issues were barriers to the promotion of physical activity. CONCLUSIONS This study found that a variety of health-care practitioners are providing some degree of physical activity advice to their patients with PCa. Collaborative practice among health-care practitioners to verbally reinforce the benefits of physical activity, coupled with referral to experts in physical activity promotion/rehabilitation (such as physiotherapists), should be encouraged for best practice care.

Nurse-led renal cancer follow-up is safe and associated with high patient satisfaction-an audit from the East of England

Background

With more people diagnosed and dying from renal cancers in England than ever before, treatment and follow-up post-surgery is of paramount importance. We have instituted a nurse-led follow-up service for renal cancers as a way to improve efficiency and make better use of clinic time. This is our first attempt to audit our service.

Objectives

One of the main objectives of this project was to measure compliance of a nurse-led renal surveillance clinic against an established institutional follow-up protocol which was based on current European Association of Urology guidelines. We also aimed to assess patient satisfaction with nurse-led care.

Patients and Methods

A total of 89 patients with low/intermediate-risk kidney cancers who were on the nurse-led renal surveillance database following nephrectomy or partial nephrectomy were placed on a database. This was then audited for adherence to the clinic protocol. These same patients were subsequently sent patient satisfaction questionnaires.

Results

The audit revealed high levels of compliance against the renal clinic protocol as well as positive feedback from the patient satisfaction questionnaire. Ninety-five percent said they felt either at ease or very at ease speaking to the nurse specialist. No one was dissatisfied with their consultations with 86% being very satisfied and 14% fairly satisfied. This was reinforced further by 100% of patients feeling that they could discuss all aspects of their condition with the Uro-oncology Clinical Nurse Specialist (UOCNS). Ninety-seven percent felt that they had adequate time with the nurse.

Conclusion

Nurse-led follow-up, in our setting, was noted to be safe and effective and was associated with high levels of patient satisfaction. This study adds to the growing body of work on the efficacy of nurse-led care.

Nurse-led active surveillance for prostate cancer is safe, effective and associated with high rates of patient satisfaction-results of an audit in the East of England

Introduction

Active surveillance (AS) is an option in the management of men with low-stage, low-risk prostate cancer. These patients, who often require prolonged follow-up, can put a strain on outpatient resources. Nurses are ideally placed to develop advanced roles to help meet this increased demand—a model we have utilised since 2014. We set about to comprehensively evaluate our nurse-led AS (NLAS) programme.

Patients and methods

An audit of patient notes was carried out to assess compliance with trust and national guidelines. A questionnaire was designed to capture patients’ experiences of NLAS. This was piloted and then distributed to all patients in our NLAS programme. A second questionnaire was designed to assess the views of stakeholders within the department.

Results

Compliance with various aspects of local guidelines ranged from 88.8% to 100%. 143 patients are currently in the programme with a mean duration of AS of 37.03 months. 104 questionnaires were returned. Most of the patients were aware of the role of the nurse prior to their visit, and all were happy to meet with a nurse. All of the patients indicated their confidence in the nurse monitoring their prostate-specific antigen. Among those requiring further investigations, 85.3% were happy with the information they received prior to their tests. Overall, 96.2% were either very satisfied or satisfied with NLAS. All stakeholders held positive views about NLAS.

Conclusions

NLAS is safe and effective. Patients and stakeholders alike held positive views of the programme.

Telepsychiatry as an Economically Better Model for Reaching the Unreached: A Retrospective Report from South India

AIM

In a resource-poor country such as India, telepsychiatry could be an economical method to expand health-care services. This study was planned to compare the costing and feasibility of three different service delivery models. The end user was a state-funded long-stay Rehabilitation Center (RC) for the homeless.

METHODOLOGY

Model A comprised patients going to a tertiary care center for clinical care, Model B was community outreach service, and Model C comprised telepsychiatry services. The costing included expenses incurred by the health system to complete a single consultation for a patient on an outpatient basis. It specifically excluded the cost borne by the care-receiver. No patients were interviewed for the study.

RESULTS

The RC had 736 inmates, of which 341 had mental illness of very long duration. On comparing the costing, Model A costed 6047.5 INR (100$), Model B costed 577.1 INR (9.1$), and Model C costed 137.2 INR (2.2$). Model C was found fifty times more economical when compared to Model A and four times more economical when compared to Model B.

CONCLUSION

Telepsychiatry services connecting tertiary center and a primary health-care center have potential to be an economical model of service delivery compared to other traditional ones. This resource needs to be tapped in a better fashion to reach the unreached.

[French national survey on incoming phone calls in oncology departments]

INTRODUCTION

Oral therapies have shifted the follow-up of patients with cancer from hospital to home. As a consequence, the number of incoming calls has increased. To understand the source, reasons, management and burden of calls, we underwent a French national survey. The objective was to describe the way calls are managed in oncology departments.

METHODS

The study was a prospective survey in a representative sample of French oncology specialists using oral therapies.

RESULTS

Among 51 participating onco/radiotherapy departments, 86 % of specialists were oncologists or hematologists and 14 % radiation oncologists. Eighty percent were from public centers and 20 % from private ones. The median number of calls/week was 110. Sixty-six percent of calls were from patients and families and 23 % from general practitioners. Upon calls reception by the secretaries, half of them corresponded to a medical question. Sixty-five percent of centers did not have an established specific procedure and 70 % of responders did not specifically train their teams to address the management of calls. Sixty-five percent of the specialists spent more than 30min/day. Most of them considered it disturbing medical activities. Sixty-six percent of patients calls were related to adverse effects of treatments. Twenty-two percent of specialists declared at least one severe adverse effect linked to misinterpretation of a call.

DISCUSSION

With the increase of oral therapies, incoming phone calls represent an important burden of work. To improve calls management, adaptations of organizations are needed.

Acceptability of telephone support as perceived by patients with cancer: A systematic review

Telephone-based interventions can increase accessibility to healthcare and are increasingly used as a convenient method of providing support. We conducted a systematic review of published literature reporting adult patients' perceptions of the acceptability of, and satisfaction with, telephone-based interventions during or post-treatment for cancer. Systematic searches identified 4,855 articles. Forty-eight articles describing 50 studies were included in the review. Three intervention categories were identified post hoc: (1) telephone follow-up in lieu of routine hospital follow-up, (2) telephone interventions for treatment side-effect monitoring and toxicity management supplementary to usual care, and (3) supplementary psycho-educational telephone interventions. Across studies, some consistent findings emerged. Positive perceptions emphasised the convenience of telephone interventions and increased accessibility to care. Conflicting perceptions of the quality of the support received, the impact of telecare on the patient-healthcare professional relationship and the need for such interventions emerged. In conclusion, the evidence base relating to patients' perceptions of telephone-based interventions is increasing. Interpretation of findings is currently limited by methodological limitations in the primary research. The instruments chosen to assess patient satisfaction quantitatively do not always reflect the patient-centred priorities that emerge from qualitative data. Subsequent research would benefit from well-designed qualitative studies and patient-centred outcome measures to ensure that the individuality of participants' positive and negative experiences is captured.

Use of the Distress Thermometer in a cancer helpline context: Can it detect changes in distress, is it acceptable to nurses and callers, and do high scores lead to internal referrals?

PURPOSE

To improve understanding about; (1) the validity of the Distress Thermometer (DT) as a measure of changes in distress after a cancer helpline call, (2) the impact of a helpline call on callers' distress, (3) caller and helpline nurses' comfort with use of the DT, and (4) the extent to which DT scores over the critical threshold, are associated with referral to internal support services for follow-up psychosocial care.

METHODS

Callers (people diagnosed with cancer and their family/friends: N = 100) completed a questionnaire that included DT ratings (three time-points), the Depression Anxiety and Stress Scale-21 (DASS-21) and measures of comfort with the DT tool. Nurses recorded referrals to internal services and their comfort in using the DT in each call.

RESULTS

The DT correlated with the DASS-21 depression (r = 0.45, p < 0.001), anxiety (r = 0.56, p < 0.001) and stress (r = 0.64, p < 0.001) subscales demonstrating validity. Callers' self-rated distress was significantly lower after the call, regardless of gender or caller type (F(2, 97) = 63.67, p < 0.01, partial eta squared = 0.57). Over 74% of people diagnosed with cancer, 80% family/friends and 89.3% of nurses felt comfortable with DT use. Only 16% of participants were referred on to follow-up internal support services despite 90% of people with cancer and 75% of family/friends' DT scores' suggesting they required follow-up care.

CONCLUSIONS

The DT is a valid and acceptable tool for use by cancer helplines. Improved documentation of referrals is required to better understand referral patterns.

Current nutrition promotion, beliefs and barriers among cancer nurses in Australia and New Zealand

Rationale. Many cancer patients and survivors do not meet nutritional and physical activity guidelines, thus healthier eating and greater levels of physical activity could have considerable benefits for these individuals. While research has investigated cancer survivors’ perspective on their challenges in meeting the nutrition and physical guidelines, little research has examined how health professionals may assist their patients meet these guidelines. Cancer nurses are ideally placed to promote healthy behaviours to their patients, especially if access to dieticians or dietary resources is limited. However, little is known about cancer nurses’ healthy eating promotion practices to their patients. The primary aim of this study was to examine current healthy eating promotion practices, beliefs and barriers of cancer nurses in Australia and New Zealand. A secondary aim was to gain insight into whether these practices, beliefs and barriers were influenced by the nurses’ hospital or years of work experience.

Patients and Methods. An online questionnaire was used to obtain data. Sub-group cancer nurse comparisons were performed on hospital location (metropolitan vs regional and rural) and years of experience (<25 or ≥25 years) using ANOVA and chi square analysis for continuous and categorical data respectively.

Results. A total of 123 Australasian cancer nurses responded to the survey. Cancer nurses believed they were often the major provider of nutritional advice to their cancer patients (32.5%), a value marginally less than dieticians (35.9%) but substantially higher than oncologists (3.3%). The majority promoted healthy eating prior (62.6%), during (74.8%) and post treatment (64.2%). Most cancer nurses felt that healthy eating had positive effects on the cancer patients’ quality of life (85.4%), weight management (82.9%), mental health (80.5%), activities of daily living (79.7%) and risk of other chronic diseases (79.7%), although only 75.5% agreed or strongly agreed that this is due to a strong evidence base. Lack of time (25.8%), adequate support structures (17.3%) nutrition expertise (12.2%) were cited by the cancer nurses as the most common barriers to promoting healthy eating to their patients. Comparisons based on their hospital location and years of experience, revealed very few significant differences, indicating that cancer nurses’ healthy eating promotion practices, beliefs and barriers were largely unaffected by hospital location or years of experience.

Conclusion. Australasian cancer nurses have favourable attitudes towards promoting healthy eating to their cancer patients across multiple treatment stages and believe that healthy eating has many benefits for their patients. Unfortunately, several barriers to healthy eating promotion were reported. If these barriers can be overcome, nurses may be able to work more effectively with dieticians to improve the outcomes for cancer patients.

Establishing nurse-led active surveillance for men with localised prostate cancer: development and formative evaluation of a model of care in the ProtecT trial

OBJECTIVES

To develop a nurse-led, urologist-supported model of care for men managed by active surveillance or active monitoring (AS/AM) for localised prostate cancer and provide a formative evaluation of its acceptability to patients, clinicians and nurses. Nurse-led care, comprising an explicit nurse-led protocol with support from urologists, was developed as part of the AM arm of the Prostate testing for cancer and Treatment (ProtecT) trial.

DESIGN

Interviews and questionnaire surveys of clinicians, nurses and patients assessed acceptability.

SETTING

Nurse-led clinics were established in 9 centres in the ProtecT trial and compared with 3 non-ProtecT urology centres elsewhere in UK.

PARTICIPANTS

Within ProtecT, 22 men receiving AM nurse-led care were interviewed about experiences of care; 11 urologists and 23 research nurses delivering ProtecT trial care completed a questionnaire about its acceptability; 20 men managed in urology clinics elsewhere in the UK were interviewed about models of AS/AM care; 12 urologists and three specialist nurses working in these clinics were also interviewed about management of AS/AM.

RESULTS

Nurse-led care was commended by ProtecT trial participants, who valued the flexibility, accessibility and continuity of the service and felt confident about the quality of care. ProtecT consultant urologists and nurses also rated it highly, identifying continuity of care and resource savings as key attributes. Clinicians and patients outside the ProtecT trial believed that nurse-led care could relieve pressure on urology clinics without compromising patient care.

CONCLUSIONS

The ProtecT AM nurse-led model of care was acceptable to men with localised prostate cancer and clinical specialists in urology. The protocol is available for implementation; we aim to evaluate its impact on routine clinical practice.

TRIAL REGISTRATION NUMBERS

NCT02044172; ISRCTN20141297.

Developing an Evidence-Based, Nurse-Led Psychoeducational Intervention With Peer Support in Gynecologic Oncology

BACKGROUND

The physical and psychosocial impact of radiotherapy for gynecologic cancer requires complex interventions to address treatment-related, psychosocial, and psychosexual and survivorship needs. A multidisciplinary approach is required to address these needs, but standard practice is varied and lacks a sound evidence base.

OBJECTIVE

The aim of this study was to describe the process of development and pilot testing of a novel evidence-based, complex psychoeducational intervention aiming to improve psychosocial outcomes for gynecologic-oncology patients treated curatively with radiotherapy.

METHODS

The intervention combines tailored nursing consultations with telephone peer support pretreatment, midtreatment, end of treatment, and posttreatment. The UK Medical Research Council framework for developing complex interventions was used to produce an evidence-based, feasible, and acceptable intervention.

RESULTS

Intervention manuals and study materials were informed by literature reviews of best-available evidence, relevant theory, and iterative consumer and expert consultations. The nurse manual specified content for consultations providing self-care information, coaching tailored to individual needs, and multidisciplinary care coordination. The peer manual described phone consultations aimed at providing psychosocial support and encouraging adherence to self-care strategies. Three peers and 1 nurse underwent rigorous skills and knowledge-based intervention delivery training. The intervention was pilot tested with 6 patients. Qualitative feedback led to minor design and content changes.

CONCLUSIONS

The intervention was found to be feasible, relevant, and acceptable to participants and clinicians and is currently being tested in a national randomized controlled trial (PeNTAGOn).

IMPLICATIONS FOR PRACTICE

The Medical Research Council framework is useful in developing nursing interventions. The specific methods and strategies described are useful for designing future complex studies targeting patient supportive care.

Development and evaluation of evidence-informed clinical nursing protocols for remote assessment, triage and support of cancer treatment-induced symptoms

The study objective was to develop and evaluate a template for evidence-informed symptom protocols for use by nurses over the telephone for the assessment, triage, and management of patients experiencing cancer treatment-related symptoms. Guided by the CAN-IMPLEMENT© methodology, symptom protocols were developed by, conducting a systematic review of the literature to identify clinical practice guidelines and systematic reviews, appraising their quality, reaching consensus on the protocol template, and evaluating the two symptom protocols for acceptability and usability. After excluding one guideline due to poor overall quality, the symptom protocols were developed using 12 clinical practice guidelines (8 for diarrhea and 4 for fever). AGREE Instrument (Appraisal of Guidelines for Research and Evaluation) rigour domain subscale ratings ranged from 8% to 86% (median 60.1 diarrhea; 40.5 fever). Included guidelines were used to inform the protocols along with the Edmonton Symptom Assessment System questionnaire to assess symptom severity. Acceptability and usability testing of the symptom populated template with 12 practicing oncology nurses revealed high readability (n = 12), just the right amount of information (n = 10), appropriate terms (n = 10), fit with clinical work flow (n = 8), and being self-evident for how to complete (n = 5). Five nurses made suggestions and 11 rated patient self-management strategies the highest for usefulness. This new template for symptom protocols can be populated with symptom-specific evidence that nurses can use when assessing, triaging, documenting, and guiding patients to manage their-cancer treatment-related symptoms.

Human chorionic gonadotropin β induces migration and invasion via activating ERK1/2 and MMP-2 in human prostate cancer DU145 cells

We previously demonstrated that human chorionic gonadotropin β (hCGβ) induced migration and invasion in human prostate cancer cells. However, the involved molecular mechanisms are unclear. Here, we established a stable prostate cancer cell line overexpressing hCGβ and tested hCGβ-triggered signaling pathways causing cell migration and invasion. ELISA showed that the hCGβ amount secreted into medium increased with culture time after the hCGβ-transfected cells were incubated for 3, 6, 9, 12 and 24 h. More, hCGβ standards promoted MAPK (ERK1/2) phosphorylation and increased MMP-2 expression and activity in both dose- and time-dependent manners in hCGβ non-transfected cells. In addition, hCGβ promoted ERK1/2 phosphorylation and increased MMP-2 expression and activity significantly in hCGβ transfected DU145 cells. Whereas ERK1/2 blocker PD98059 (25 µM) significantly downregulated phosphorylated ERK1/2 and MMP-2. Particularly, hCGβ promoted cell migration and invasion, yet the PD98059 diminished the hCGβ-induced cell motility under those conditions. These results indicated that hCGβ induced cell motility via promoting ERK1/2 phosphorylation and MMP-2 upregulation in human prostate cancer DU145 cells.