Bridging the information and support gap: evaluation of a hospital-based cancer support nurse service

Cancer care coordination: building a platform for the development of care coordinator roles and ongoing evaluation

Continuity of care is integral to the quality and safety of care provided to people with cancer and their carers. Further evidence is required to examine the contribution Nurse Cancer Care Coordinator (NCCC) roles make in improving the continuity. The aim of the present study was to clarify the assumptions underpinning the NCCC roles and provide a basis for ongoing evaluation. The project comprised a literature review and a qualitative study to develop program logic. The participants who were purposively sampled included policy makers, practitioners, patient advocates, and researchers. Both the literature and participant reports found that NCCC roles are diverse and responsive to contextual influences to coordinate care at the individual (patient), organisational, and systems levels. The application of the program logic for the development of NCCC roles was explored. The conceptualisation of NCCC roles was also examined in relation to Boundary Spanning and Relational Coordination theory. Further research is required to examine how NCCCs contribute to improving equity, safety, quality and coordination of care. The project has implications for research, policy and practice, and makes explicit existing assumptions to provide a platform for further development and evaluation of these roles.

Evaluation of a hospital-based cancer information and support centre

BACKGROUND

Although information seeking is encouraged by health care professionals as a positive coping strategy evidence suggests information needs of those affected by cancer are not always fully met. In response to the need for novel models of information provision and educational support for people affected by cancer, a hospital-based cancer information and support centre (CISC) was introduced into a tertiary cancer hospital. Professional support is provided by a cancer support nurse (CSN) with the clinical experience of working with cancer patients, whilst peer support is provided by volunteers.

MATERIALS AND METHODS

A survey was developed to ascertain the perceptions and experiences of consumers (users) of a hospital-based CISC. The aim was to understand what information and support patients and families consider important and helpful in order to develop the service to reflect the needs of its users. During a 12-month period 111 surveys were distributed to users of the centre.

RESULTS

Sixty-nine surveys were returned (62.1%). Nearly all visits were motivated by the need to access (58/84.0%) information, indicating an unmet or changing need. The CSN initiated referrals to support services, both internal and community based, for 21 (53.9%) participants with whom there was contact. Contact with the CISC volunteers also resulted in internal or community-based referrals for 15 (32.6%) of participants. Of note, half of the participants (35/50.7%) reported seeking additional information from the internet as a consequence of having visited the CISC and/or having contact with the CSN or volunteer, in contrast to the six (8.7%) who had reported internet use for information prior to their first visit. Participants indicated a desire for the service to provide additional support to enhance self-care capacity and to do so alongside other people affected by cancer.

CONCLUSIONS

Our study results support the capacity of a hospital-based CISC to provide a highly valued service that can broaden information options and meet changing information and support needs of people affected by cancer in an ongoing capacity. An experienced, qualified CSN in this setting is ideally positioned to screen for unmet information and support needs and deliver tailored education to support both inpatient and ambulatory care services. Information prescriptions have the potential to provide a 'directed information seeking approach' to those who visit a CISC. Through the use of information technology there is scope to develop information and support that expands beyond pamphlets and booklets.

Translating theory into practice: using Action Research to introduce a coordinated approach to emotional care

OBJECTIVE

This paper describes a translational project that explored the feasibility and effect of introducing a coordinated approach to emotional care.

METHODS

The project was undertaken using Action Research on one ward at St John of God Hospital Subiaco, Western Australia. A senior Registered Nurse was appointed to provide the leadership and direction to staff regarding emotional care and an education program for staff was provided. The project was evaluated using both quantitative and qualitative data.

RESULTS

Data demonstrated an increase in the patient's evaluation of emotional care, although levels were found to fluctuate throughout the project. Factors such as the emotional distress of the staff were hypothesised as impacting on the delivery of emotional care.

CONCLUSION

The approach used in this project was found to be a useful method of improving emotional care. However, the data collected in this study revealed the complexity of emotional care delivery and the possible impact of a number of factors within the environment.

PRACTICE IMPLICATIONS

Emotional care delivery can be improved by using a coordinated research-based educational approach led by a clinical champion. However, the impact of other factors within the hospital environment needs to be considered and more research is required.

Medical information delivered to patients: discrepancies concerning roles as perceived by physicians and nurses set against patient satisfaction

OBJECTIVE

To assess and to compare roles as perceived by physicians and nurses regarding medical information delivered to patients and to set this against patients' opinions on the quality of the medical information delivered to them.

METHODS

A questionnaire administered to 302 physicians (MDs) and 533 nurses (NUs), and an inpatient satisfaction survey administered to 1246 patients the day before discharge, as a part of a quality improvement program on patient information in a university hospital.

RESULTS

MDs and NUs reported that diagnosis and prognosis announcements were made by MDs alone. Concerning explanations about diagnosis, information on investigations, and benefits and risks of treatment, NUs considered that they provided information in addition to MDs, while MDs considered that it was generally they alone who delivered the information. Patients were generally very satisfied with information delivered, but more than 20% were not satisfied with information on benefits and risks of investigations and treatments. The most important problem underlined by NUs was that they lacked knowledge of the medical information delivered to patients by MDs (55%).

CONCLUSION

Perceived roles in the transmission of medical information to patients were very different between MDs and NUs. Patient satisfaction seemed to be greater where professional roles were clear-cut. Physicians did not recognise the primary role of the NUs. Lack of MD-NU collaboration affects the quality of patient care.

PRACTICE IMPLICATIONS

A better definition of the specific roles of MDs and NUs, their training in effective methods of asserting opinions and knowledge and in conducting collaborative ward rounds would be of benefit to patients.

Information and support needs of callers to the Cancer Helpline, The Cancer Council Victoria

The broad aims of the present evaluation were, firstly, to describe the information and support needs of callers to a Cancer Helpline and, secondly, to describe the response of the service to these needs. A further aim was to use these results to develop strategies to improve the service. Anonymous caller information collected over a 6-year period was analysed. The setting of the study was the Cancer Helpline service operated by the Cancer Council Victoria within the state of Victoria, Australia. The caller profile was similar to that described in the literature, with the majority of callers being women, younger than the general cancer population and enquiring most commonly about breast cancer. Patients and their relatives called to obtain information about cancer diagnosis, treatment and management and to obtain psychological and emotional support. Callers received emotional support, were supplied with verbal and written information and were referred to a variety of support services. Some population groups are underrepresented in the data. Changes to the Helpline and other services over the 6-year period are described. The pattern of callers to the Cancer Helpline appears similar to that described in the USA and Europe. Many issues and challenges are common. The paper discusses additional strategies for meeting the information and support needs of those affected by cancer and describes current and suggested research areas.