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Gomula J, Warner M, Blandford A. Women's use of online health and social media resources to make sense of their polycystic ovary syndrome (PCOS) diagnosis: a qualitative study. BMC Womens Health 2024; 24:157. [PMID: 38443902 PMCID: PMC10913566 DOI: 10.1186/s12905-024-02993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND With the growing availability of online health resources and the widespread use of social media to better understand health conditions, people are increasingly making sense of and managing their health conditions using resources beyond their health professionals and personal networks. However, where the condition is complex and poorly understood, this can involve extensive "patient work" to locate, interpret and test the information available. The overall purpose of this study was to investigate how women with polycystic ovary syndrome (PCOS) across two healthcare systems engage with online health resources and social media to better understand this complex and poorly understood lifelong endocrine disorder. METHODS A semi-structured interview study was conducted with women from the US ( N = 8 ) and UK ( N = 7 ) who had been diagnosed with PCOS within the previous five years. Transcribed data was analysed using a reflexive thematic analysis method. RESULTS We highlight the information needs and information-seeking strategies women use to make sense of how PCOS affects them, to gain emotional support, and to help them find an effective treatment. We also show how women with PCOS use online health and social media resources to compare themselves to women they view as "normal" and other women with PCOS, to find their sense of "normal for me" along a spectrum of this disorder. CONCLUSION We draw on previous models of sense-making and finding normal for other complex and sensitive health conditions to capture the nuances of making sense of PCOS. We also discuss implications for the design and use of social media to support people managing PCOS.
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Affiliation(s)
- Julia Gomula
- Computer Science Department, UCL, Gower Street, London, UK
| | - Mark Warner
- Computer Science Department, UCL, Gower Street, London, UK.
| | - Ann Blandford
- Computer Science Department, UCL, Gower Street, London, UK
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2
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Amplifying the Patient Voice: A Survey of Practitioners' Use of Patient-reported Outcome Measures Across Radiotherapy Providers in England. Clin Oncol (R Coll Radiol) 2023; 35:199-208. [PMID: 36443139 DOI: 10.1016/j.clon.2022.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/22/2022] [Accepted: 11/04/2022] [Indexed: 11/28/2022]
Abstract
AIMS The NHS England Radiotherapy Service Specification calls for routine use of patient-reported outcome measures (PROMs). However, barriers exist at patient, healthcare professional and service levels. The aim of the present study was to determine the current use of PROMs within radiotherapy services in England. The current attitudes, barriers and enablers to the implementation of PROMs in radiotherapy practice were evaluated and practical recommendations to inform future implementation were developed. MATERIALS AND METHODS A mixed-methods approach was adopted to obtain quantitative and qualitative data. An online questionnaire was developed and disseminated to all radiotherapy operational delivery network managers across England. The questionnaire consisted of 12 open and closed questions relating to PROMs use, with the option to provide free-text responses. Inductive thematic analysis was conducted on free-text comments, whereas descriptive statistics were used to analyse quantitative data. RESULTS In total, 182 responses were received from 40 of the 50 radiotherapy providers, resulting in a response rate of 84%. The current use of PROMs was analysed, including rationale for use, tools used, format of PROMs collection and timing within the radiotherapy pathway. Most respondents indicated that PROMs were used in the context of clinical trials only. Through thematic analysis, four identical key themes were identified relating to both barriers and enablers to PROMs use; these included IT infrastructure, time, human/financial resources and training/education. A fifth theme, standardisation, was identified as a key enabler to PROMs use. CONCLUSIONS Our findings show that outside of clinical trials, PROMs are not routinely used in radiotherapy services due to barriers identified at professional and service levels. Here we provide recommendations to mitigate the barriers identified and implement PROMs in radiotherapy, including training for healthcare professionals and standardisation of PROMs tools and storage. This study provides a key first step in driving PROMs implementation within radiotherapy services across England.
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Millet N, Moss EL, Munir F, Rogers E, McDermott HJ. A qualitative exploration of physical and psychosocial well-being in the short and long term after treatments for cervical cancer. Eur J Cancer Care (Engl) 2022; 31:e13560. [PMID: 35166375 DOI: 10.1111/ecc.13560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/29/2021] [Accepted: 01/26/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Cervical cancer is predominantly a cancer of younger women, and improvements in oncological outcomes have led to an increase in cervical cancer survivors living with the long-term effects of treatment. Understanding the recovery process after treatment is essential to increase awareness of the short- and long-term needs of survivors. The aim of this study was to qualitatively explore the recovery process and return to daily activity of cervical cancers survivors from a biopsychosocial perspective. METHODS Participants were 21 women treated for cervical cancer between the ages of 18 and 60 years, living in the United Kingdom. Interviews were undertaken face to face and via the telephone using a semi-structured interview schedule. RESULTS Data analysis revealed themes which represented participants' experience and perceptions of treatment as a paradox; emotional needs after treatment; and a journey of adversarial growth. A key finding from this analysis was the nuanced experiences between treatment modalities, with physical changes perceived to be more disruptive following radical treatments, whilst psychological repercussions were significant regardless of treatment type. CONCLUSION This study provides novel insight into the varied recovery experiences of those treated with surgery and/or chemoradiotherapy for cervical cancer, which can be used to improve the survivorship experience.
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Affiliation(s)
- Nessa Millet
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK.,Department of Gynaecological Oncology, University Hospitals of Leicester, Leicester, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Eva Rogers
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Hilary J McDermott
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
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Digital support for living with and beyond gynaecological cancer. Radiography (Lond) 2020; 26:e270-e276. [PMID: 32439292 DOI: 10.1016/j.radi.2020.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/18/2020] [Accepted: 03/28/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Gynae-Radiotherapy places exceptional psychosocial and physical burdens on patients. Technological developments and associated acute toxicity and survival outcomes have improved, however holistic support has not kept pace. Digital technologies have potential to enhance support and patient experience. The project aimed to co-create a prototype of a digital health intervention that could serve the needs of women living with and beyond treatment for gynaecological cancer. METHODS A multi-disciplinary and co-creation approach was adopted. Four workshops were held, comprising of a number of activities to support participants' expression of views and facilitate discussion. Methods included word cloud generation, prompt cards, empathy maps and persona creation, domain storylines and requirements identification. RESULTS Support drops off dramatically once treatment is completed. Patients struggled to adjust to their 'new normal' and felt unprepared for changes post-treatment. Patients felt overwhelmed with leaflets yet wanted instant access to reliable and relevant information in one place, better information on late side effects and improved communication about sexual health and sexuality. Reassurance through a digital intervention was viewed positively and specific ideas for achieving this were suggested through: Sharing experiences; targeted practical advice; peer support and advice/support for significant others. CONCLUSION The co-creation of a prototype generated further discussion and an interactive prototype was developed. Based on workshop findings it is believed that the intervention could provide life-long support for women living with and beyond cancer. IMPLICATIONS FOR PRACTICE Increased focus is needed on the late effects of radiotherapy, specifically in supporting psychosocial wellbeing. Co-creation is a rewarding and fulfilling activity that met numerous aims beyond those of the project. It is recommended that mixed staff-patient groups are developed and adopted in more informal ways for the improvement of services.
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Understanding survivors' needs and outcomes: the role of routinely collected data. Curr Opin Support Palliat Care 2019; 12:254-260. [PMID: 29916842 DOI: 10.1097/spc.0000000000000352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW The number of cancer survivors is growing due to population ageing, earlier detection and more effective therapies. Routinely collected data (RCD), generally cancer registry data, has been used to investigate survivors' needs and outcomes. We reviewed uses of RCD since 2017, identifying novel findings and research directions. RECENT FINDINGS Survival is improving internationally but continues to vary between subgroups. Longitudinal survivor surveys suggest malignancy-specific temporal patterns in unmet needs and health-related quality-of-life (HRQoL). Unmet needs are a risk factor for future depression and depression predicts poorer HRQoL in all domains. Emerging evidence suggests links between posttraumatic stress and poor HRQoL and posttraumatic growth and improved HRQoL. Evidence for a link between cancer-related financial hardship and poor HRQoL is accumulating. Surveys and linkage studies continue to show poorer work outcomes in survivors. Among survivors of childhood and young adult cancers, large linkage studies demonstrate significant risk of late effects, including hospitalization, pregnancy and labour complications, and cardiac death. SUMMARY RCD plays a significant role in understanding survivors' needs and outcomes. New approaches which overlay different types of data - including detailed clinical and treatment data, biomarker data and nonhealth administrative data - have the potential to generate considerable new knowledge.
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Labeled as lucky: contradictions between what women and healthcare professionals experience regarding the need for help after the early stages of gynecological cancer. Support Care Cancer 2019; 28:907-916. [DOI: 10.1007/s00520-019-04882-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/21/2019] [Indexed: 02/07/2023]
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The Dyadic Communicative Resilience Scale (DCRS): scale development, reliability, and validity. Support Care Cancer 2019; 27:4555-4564. [PMID: 30923889 DOI: 10.1007/s00520-019-04763-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE There has yet to be a quantitative measurement of communicative resilience processes as outlined in the Communicative Theory of Resilience (CTR). This study aims to determine the structure, reliability, and validity of the Dyadic Communicative Resilience Scale (DCRS) in cancer patients and partners. METHOD The DCRS was administered to 584 participants, including 312 cancer patients and 272 partners of cancer patients along with the common coping subscale of the dyadic coping inventory, the cancer-related communication problems with couples scale, and the resilience promoting scale. RESULTS Exploratory and confirmatory factor analyses revealed nine dimensions of dyadic communicative resilience within the five resilience processes outlined in the CTR. Structure reliability was shown with Cronbach's alphas between .77 and .88 and good to excellent model fit for the nine factors. Convergent and discriminant validities were demonstrated by significant Pearson correlations with relevant, established coping/resilience measures. CONCLUSIONS The DCRS has a clear nine factor structure and demonstrates good reliability. The measure has good convergent and discriminate validity indicating its utility in future research examining resilience in cancer populations.
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Etkind SN, Lovell N, Nicholson CJ, Higginson IJ, Murtagh FE. Finding a 'new normal' following acute illness: A qualitative study of influences on frail older people's care preferences. Palliat Med 2019; 33:301-311. [PMID: 30526371 PMCID: PMC6376597 DOI: 10.1177/0269216318817706] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND: The frail older population is growing, and many frail older people have episodes of acute illness. Patient preferences are increasingly considered important in the delivery of person-centred care and may change following acute illness. AIM: To explore influences on the care preferences of frail older people with recent acute illness. DESIGN: Qualitative in-depth individual interviews, with thematic analysis. SETTING/PARTICIPANTS: Maximum variation sample of 18 patients and 7 nominated family carers from a prospective cohort study of people aged over 65, scoring ⩾5 on the Clinical Frailty Scale, and with recent acute illness, who were not receiving specialist palliative care. Median patient age was 84 (inter-quartile range 81–87), 53% female. Median frailty score 6 (inter-quartile range 5–7). RESULTS: Key influences on preferences were illness and care context, particularly hospital care; adaptation to changing health; achieving normality and social context. Participants focused on the outcomes of their care; hence, whether care was likely to help them ‘get back to normal’, or alternatively ‘find a new normal’ influenced preferences. For some, acute illness inhibited preference formation. Participants’ social context and the people available to provide support influenced place of care preferences. We combined these findings to model influences on preferences. CONCLUSION: ‘Getting back to normal’ or ‘finding a new normal’ are key focuses for frail older people when considering their preferences. Following acute illness, clinicians should discuss preferences and care planning in terms of an achievable normal, and carefully consider the social context. Longitudinal research is needed to explore the influences on preferences over time.
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Affiliation(s)
- Simon Noah Etkind
- 1 Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Natasha Lovell
- 1 Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Caroline Jane Nicholson
- 1 Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,2 St Christopher's Hospice, London, UK
| | - Irene J Higginson
- 1 Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,3 King's College Hospital NHS Foundation Trust, London, UK
| | - Fliss Em Murtagh
- 1 Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,4 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Bull J, Oster C, Flight I, Wilson C, Koczwara B, Watson DI, Bright T. The role of rehabilitation in patients undergoing oesophagectomy for cancer and pre-malignant disease: A qualitative exploration of the views of patients, carers and healthcare providers. Eur J Cancer Care (Engl) 2019; 28:e12996. [PMID: 30675740 DOI: 10.1111/ecc.12996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 10/23/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Oesophagectomy for cancer is associated with significant morbidity and mortality, and reduced quality of life. Structured rehabilitation potentially offers improved physical and psychological outcomes. We aimed to explore patient, carer and healthcare provider attitudes and preferences towards the role of rehabilitation. METHODS We interviewed 15 patients who had undergone an oesophagectomy, 10 carers and 13 healthcare providers about perceived impacts of treatment; preferred components of a rehabilitation program; barriers/enablers of support provision; and participation in rehabilitation programs. Data were analysed using framework analysis. RESULTS The overarching theme was "Getting back to normal." Diagnosis of disease signified a disruption to the normal trajectory of patients' lives and the post-treatment period was characterised as striving to return to normal. Patients and carers focused on rehabilitation needs post-treatment including dietary support, physiotherapy and healthcare provider support. Healthcare providers described rehabilitation as potentially beneficial from the pre-treatment phase and, along with carers, highlighted the importance of psychological support. Barriers included access to services, cost of service provision and appointment burden. CONCLUSION A need for rehabilitation services was identified by healthcare providers from the point of diagnosis, rather than only after surgery. Implications include improved service provision by healthcare institutions for patients undergoing oesophagectomy.
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Affiliation(s)
- Jeff Bull
- College of Medicine and Public Health, Flinders University Discipline of Surgery, Bedford Park, South Australia, Australia
| | - Candice Oster
- Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Carlene Wilson
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,La Trobe University/Olivia Newton John Cancer Wellness and Research Centre, Austin Hospital, Heidelberg, Victoria, Australia
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - David I Watson
- College of Medicine and Public Health, Flinders University Discipline of Surgery, Bedford Park, South Australia, Australia
| | - Tim Bright
- College of Medicine and Public Health, Flinders University Discipline of Surgery, Bedford Park, South Australia, Australia
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Dengsø KE, Tjørnhøj-Thomsen T, Dalton SO, Christensen BM, Hillingsø J, Thomsen T. Gut disruption impairs rehabilitation in patients curatively operated for pancreaticoduodenal cancer - a qualitative study. BMC Cancer 2018; 18:1017. [PMID: 30348133 PMCID: PMC6196562 DOI: 10.1186/s12885-018-4933-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/10/2018] [Indexed: 11/18/2022] Open
Abstract
Background How patients recover and resume everyday life after curative hepato-pancreato-biliary (HPB) surgery with intestinal reconstruction has, to our knowledge, not previously been investigated. We wanted to explore the patient experience in order to develop our capability to support their rehabilitation and identify interventional gaps in the current post-surgical care of these patients. Therefore, the aim of the present study was to explore patients’ experiences of their gut, digestion, recovery and uptake of everyday life after HPB surgery with intestinal reconstruction. Methods A qualitative explorative study with semi-structured interviews with 12 patients. We analysed data using qualitative content analysis with an inductive approach. Results Two main themes with six sub-themes emerged from the analysis: 1. “Disrupted gut” covering the sub-themes: the weakened body; fighting cachexia; re-aligning to the altered body. 2. “Recovery work” with the sub-themes: the value of municipal rehabilitation programmes; reclaiming the sociality of meals; going back to work. The patients described overarching digestive changes, predominantly diarrhea and nausea. Diarrhea and nausea challenged rehabilitation efforts and limited patients’ participation in social activities. Patients toiled to regain strength and every-day life as it was before surgery. Current municipal rehabilitation programmes facilitated these efforts. Conclusions The patients articulated an overarching experience of gut disruption, predominantly presenting as nausea, diarrhea and difficulty eating. This challenged their recovery work and uptake of every-day life. Specialised follow-up at expert centres might mitigate the sequelae of gut disruption after HPB surgery. We suggest that follow-up programmes systematically monitor the experienced symptoms of gut disruption with HPB-specific PROMS. Furthermore, research into the pathophysiology of cachexia and novel interventions for reducing cachexia and weakness after curative HPB surgery is relevant.
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Affiliation(s)
- Kristine Elberg Dengsø
- Department of Gastrointestinal Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, 2100, Copenhagen, Denmark.
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, 1353, Copenhagen, Denmark
| | | | - Bo Marcel Christensen
- Department of Gastrointestinal Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, 2100, Copenhagen, Denmark
| | - Jens Hillingsø
- Department of Gastrointestinal Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, 2100, Copenhagen, Denmark
| | - Thordis Thomsen
- Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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12
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Phillips E, Montague J, Archer S. "A peculiar time in my life": making sense of illness and recovery with gynaecological cancer. Int J Qual Stud Health Well-being 2018; 12:1364603. [PMID: 28856979 PMCID: PMC5590624 DOI: 10.1080/17482631.2017.1364603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Worldwide there are nearly 1.1 million new cases of gynaecological cancer annually. In England, uterine, ovarian and cervical cancers comprize the third most common type of new cancer in women. Research with gynaecological cancer patients within 6 months of diagnosis is rare, as is data collection that is roughly contemporaneous with treatment. Our aim was to explore the experiences of women who were, at study entry, within 6 weeks of surgery or were undergoing chemotherapy or radiotherapy. METHODS An interpretative phenomenological analysis (IPA) of data from 16 women in five focus groups was conducted in the UK, exploring women's experiences of being diagnosed with and treated for gynaecological cancer. RESULTS Participants conceptualized their experiences temporally, from the shock of diagnosis, through their cancer treatment, to thinking about recovery. They tried to make sense of diagnosis, even with treatment being complete. In the context of the Self-Regulation Model, these women were struggling to interpret a changing and multi-faceted illness identity, and attempting to return to pre-illness levels of health. CONCLUSIONS This study adds to this under-studied time period in cancer survivorship. The results suggest that survivors' goals may change from returning to pre-illness status to reformulating goals as survival time increases.
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Affiliation(s)
| | | | - Stephanie Archer
- b NIHR Imperial Patient Safety Translational Research Centre , Imperial College London, St Mary's Hospital , London , UK
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Sandsund C, Towers R, Thomas K, Tigue R, Lalji A, Fernandes A, Doyle N, Jordan J, Gage H, Shaw C. Holistic needs assessment and care plans for women with gynaecological cancer: do they improve cancer-specific health-related quality of life? A randomised controlled trial using mixed methods. BMJ Support Palliat Care 2017; 10:e16. [PMID: 28847853 PMCID: PMC7286034 DOI: 10.1136/bmjspcare-2016-001207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 01/09/2017] [Accepted: 04/01/2017] [Indexed: 12/20/2022]
Abstract
Objectives Holistic needs assessment (HNA) and care planning are proposed to address unmet needs of people treated for cancer. We tested whether HNA and care planning by an allied health professional improved cancer-specific quality of life for women following curative treatment for stage I–III gynaecological cancer. Methods Consecutive women were invited to participate in a randomised controlled study (HNA and care planning vs usual care) at a UK cancer centre. Data were collected by questionnaire at baseline, 3 and 6 months. The outcomes were 6-month change in European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-C30 (version 3), global score (primary) and, in EORTC subscales, generic quality of life and self-efficacy (secondary). The study was blinded for data management and analysis. Differences in outcomes were compared between groups. Health service utilisation and quality-adjusted life years (QALY) (from Short Form-6) were gathered for a cost-effectiveness analysis. Thematic analysis was used to interpret data from an exit interview. Results 150 women consented (75 per group); 10 undertook interviews. For 124 participants (61 intervention, 63 controls) with complete data, no statistically significant differences were seen between groups in the primary endpoint. The majority of those interviewed reported important personal gains they attributed to the intervention, which reflected trends to improvement seen in EORTC functional and symptom scales. Economic analysis suggests a 62% probability of cost-effectiveness at a £30 000/QALY threshold. Conclusion Care plan development with an allied health professional is cost-effective, acceptable and useful for some women treated for stage I–III gynaecological cancer. We recommend its introduction early in the pathway to support person-centred care.
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Affiliation(s)
- Catherine Sandsund
- Therapies Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Richard Towers
- Lead Nurse Counsellor, Psychological Support Services, The Royal Marsden NHS Foundation Trust, London, UK
| | - Karen Thomas
- Senior Statistician Research Data Management and Statistics Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Ruth Tigue
- Therapies Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Amyn Lalji
- Therapies Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Andreia Fernandes
- Gynaeoncology Unit, Clinical Services Division, The Royal Marsden NHS Foundation Trust, London, UK
| | - Natalie Doyle
- Nurse Consultant in Living With and Beyond Cancer, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jake Jordan
- Surrey Health Economics Centre, School of Economics, University of Surrey, Guildford, UK
| | - Heather Gage
- Surrey Health Economics Centre, School of Economics, University of Surrey, Guildford, UK
| | - Clare Shaw
- Therapies Department, The Royal Marsden NHS Foundation Trust, London, UK
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Raphaelis S, Kobleder A, Mayer H, Senn B. Effectiveness, structure, and content of nurse counseling in gynecologic oncology: a systematic review. BMC Nurs 2017; 16:43. [PMID: 28785169 PMCID: PMC5543445 DOI: 10.1186/s12912-017-0237-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/31/2017] [Indexed: 01/26/2023] Open
Abstract
Background Gynecological pre-cancer and gynecological cancers are considerable diseases in women throughout the world. The disease and treatment lead to numerous biopsychosocial issues. To improve the outcomes of affected women, several counseling interventions have been tested thus far in nursing research. These interventions target different endpoints and are composed of various structural and content components. The purpose of this research was to systematically review the effectiveness of nurse counseling on any patient outcomes tested so far in gynecologic oncology before, during and after treatment and to explore structure and content components. Methods Experimental, quasi-experimental, and pre-experimental studies assessing the effectiveness of nurse counseling in women with gynecological neoplasia were searched for in PubMed®, CINAHL®, PsychINFO®, Cochrane®, and EMBASE®. Reference lists were hand-searched and relevant authors were contacted. Moreover, the evidence level and methodological quality of the included studies were assessed. Afterwards, the effect of nurse counseling on each identified patient outcome was narratively analyzed. To identify the structural and content components of the included interventions, a structured content analysis was performed. Finally, it was determined which components were associated with favorable outcomes within the included studies. Results Seven experimental and three pre-experimental studies, reporting the effects of 11 interventions on a total of 588 participants, were eligible. No study investigated women with pre-cancer. Three studies had a high, five a moderate, and two a low methodological quality. Positive effects were found on quality of life, symptoms, and healthcare utilization. Eight structural components and four content components composed of various sub-components were identified and linked to specific effects. Conclusions The current evidence base is fragmented and inconsistent. More well-designed, large-scale studies including women with pre-cancer are warranted. Most convincing evidence indicates that nurse counseling can improve symptom distress. Components associated with the most trustworthy effects include nurses with an academic education; repeated and individual consultations during and after active treatment; structured, tailored, interdisciplinary orientated, and theoretically based counseling concepts; specific materials; comprehensive symptom management; and utilization of healthcare services. Healthcare providers and researchers can use the findings of this review for the systematic development of nurse counseling in gynecologic oncology. Electronic supplementary material The online version of this article (doi:10.1186/s12912-017-0237-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Silvia Raphaelis
- Department of Nursing Science, University of Vienna, Alser Strasse 23, 1080 Vienna, Austria
| | - Andrea Kobleder
- Institute for Applied Nursing Sciences IPW-FHS, University of Applied Sciences FHS St. Gallen, Rosenbergstrasse 59, 9001 St. Gallen, Switzerland
| | - Hanna Mayer
- Department of Nursing Science, University of Vienna, Alser Strasse 23, 1080 Vienna, Austria
| | - Beate Senn
- Institute for Applied Nursing Sciences IPW-FHS, University of Applied Sciences FHS St. Gallen, Rosenbergstrasse 59, 9001 St. Gallen, Switzerland.,Sydney Nursing School, The University of Sydney, Mallett Street 88, Camperdown, NSW 2050 Australia
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Komatsu H, Yagasaki K, Yamauchi H, Yamauchi T. Patients’ Perspectives on Creating a Personal Safety Net During Chemotherapy. Clin J Oncol Nurs 2016; 20:13-6. [DOI: 10.1188/16.cjon.13-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Katy Weare
- Royal Women's Hospital, Melbourne, Australia
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Robb KA, Davis J. Examining progress in cancer rehabilitation: are we closer to parity of esteem? Eur J Cancer Care (Engl) 2015; 24:601-4. [PMID: 26303585 DOI: 10.1111/ecc.12369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 11/29/2022]
Affiliation(s)
- K A Robb
- Consequences of Cancer and its Treatment Collaborative (CCaT), Macmillan Cancer Support, London, UK
| | - J Davis
- Macmillan Cancer Support, London, UK
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Boulton M, Adams E, Horne A, Durrant L, Rose P, Watson E. A qualitative study of cancer survivors’ responses to information on the long-term and late effects of pelvic radiotherapy 1-11 years post treatment. Eur J Cancer Care (Engl) 2015. [DOI: 10.1111/ecc.12356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. Boulton
- Department of Clinical Health Care; Oxford Brookes University; Oxford UK
| | - E. Adams
- School of Psychology; College of Life Sciences; Birmingham University; Birmingham UK
| | - A. Horne
- Oxford University Hospitals NHS Trust; Department of Radiotherapy; Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford UK
| | - L. Durrant
- Oxford University Hospitals NHS Trust; Department of Radiotherapy; Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford UK
| | - P. Rose
- Department of Primary Health Care Sciences; University of Oxford; Oxford UK
| | - E. Watson
- Department of Clinical Health Care; Oxford Brookes University; Oxford UK
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Abstract
OBJECTIVES To explore the experiences of patients receiving oral anticancer agents. DESIGN A qualitative study using semistructured interviews with a grounded theory approach. SETTING A university hospital in Japan. PARTICIPANTS 14 patients with gastric cancer who managed their cancer with oral anticancer agents. RESULTS Patients with cancer experienced inner conflict between rational belief and emotional resistance to taking medication due to confrontation with cancer, doubt regarding efficacy and concerns over potential harm attached to use of the agent. Although they perceived themselves as being adherent to medication, they reported partial non-adherent behaviours. The patients reassessed their lives through the experience of inner conflict and, ultimately, they recognised their role in medication therapy. CONCLUSIONS Patients with cancer experienced inner conflict, in which considerable emotional resistance to taking their medication affected their occasional non-adherent behaviours. In patient-centred care, it is imperative that healthcare providers understand patients' inner conflict and inconsistency between their subjective view and behaviour to support patient adherence.
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Affiliation(s)
- Kaori Yagasaki
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
| | - Hiroko Komatsu
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
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Cox A, Faithfull S. Aiding a reassertion of self: a qualitative study of the views and experiences of women with ovarian cancer receiving long-term nurse-led telephone follow-up. Support Care Cancer 2015; 23:2357-64. [PMID: 25588575 DOI: 10.1007/s00520-014-2578-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This study explored the views and experiences of women following treatment for ovarian cancer who had received long-term (at least 3 years) nurse-led telephone follow-up. Exploring the long-term experiences of follow-up for women with ovarian cancer provides important information regarding the coping processes of cancer survivors that can inform the development of innovative and patient-centred approaches of cancer follow-up. METHODS This is a qualitative study approach using interpretative phenomenological analysis (IPA). Eleven women were identified by a clinical nurse specialist as having received nurse-led telephone follow-up for a period of at least 3 years. These women were interviewed in person or over the telephone using a semi-structured interview schedule; interviews were audio-recorded and transcriptions were analysed using IPA. RESULTS Nurse-led telephone follow-up was felt to support a reassertion of self and a rejection of patient identity. Three core themes emerged regarding the positive impact of nurse-led telephone follow-up: 'Somebody was looking out for me' highlights the perception of increased psychosocial support; 'It's just reassurance' includes both the deep trust in the expertise of the nurse and the reassurance of the continued blood tests; and 'Time was never an issue' presents the perception of relaxed follow-up appointments with time to talk and the perceived practical benefits of this approach. CONCLUSIONS Nurse-led telephone follow-up was broadly recommended for women following treatment for ovarian cancer, particularly for those later on in the survivorship trajectory when focus may move from biomedical aspects of cure to holistic approaches to well-being. Remote interventions which provide a perception of a consistent and constant source of medical and psychosocial support may support adaption to cancer survivorship by enabling a reassertion of self and a rejection of patient identity.
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Affiliation(s)
- Anna Cox
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK,
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21
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Baker P, Beesley H, Fletcher I, Ablett J, Holcombe C, Salmon P. ‘Getting back to normal’ or ‘a new type of normal’? A qualitative study of patients' responses to the existential threat of cancer. Eur J Cancer Care (Engl) 2014; 25:180-9. [DOI: 10.1111/ecc.12274] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 11/30/2022]
Affiliation(s)
- P. Baker
- Clinical and Health Psychology Section; School of Psychological Sciences; University of Manchester; Manchester UK
| | - H. Beesley
- Royal Liverpool and Broadgreen University Hospital NHS Trust; Liverpool UK
| | - I. Fletcher
- Division of Health Research; University of Lancaster; Lancaster UK
| | - J. Ablett
- Royal Liverpool and Broadgreen University Hospital NHS Trust; Liverpool UK
| | - C. Holcombe
- Royal Liverpool and Broadgreen University Hospital NHS Trust; Liverpool UK
| | - P. Salmon
- Division of Clinical Psychology; University of Liverpool; Liverpool UK
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22
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Sharp L, Deady S, Gallagher P, Molcho M, Pearce A, Alforque Thomas A, Timmons A, Comber H. The magnitude and characteristics of the population of cancer survivors: using population-based estimates of cancer prevalence to inform service planning for survivorship care. BMC Cancer 2014; 14:767. [PMID: 25319534 PMCID: PMC4216835 DOI: 10.1186/1471-2407-14-767] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 09/24/2014] [Indexed: 02/08/2023] Open
Abstract
Background Rising cancer incidence and survival mean that the number of cancer survivors is growing. Accumulating evidence suggests many survivors have long-term medical and supportive care needs, and that these needs vary by survivors’ socio-demographic and clinical characteristics. To illustrate how cancer registry data may be useful in survivorship care service planning, we generated population-based estimates of cancer prevalence in Ireland and described socio-demographic and clinical characteristics of the survivor population. Methods Details of people diagnosed with invasive cancer (ICD10 C00-C96) during 1994–2011, and who were still alive on 31/12/2011, were abstracted from the National Cancer Registry, and tabulated by cancer site, sex, current age, marital status, initial treatment, and time since diagnosis. Associations were investigated using chi-square tests. Results After excluding non-melanoma skin cancers, 17-year cancer prevalence in Ireland was 112,610 (females: 58,054 (52%) males: 54,556 (48%)). The four most prevalent cancers among females were breast (26,066), colorectum (6,598), melanoma (4,593) and uterus (3,505) and among males were prostate (23,966), colorectum (8,207), lymphoma (3,236) and melanoma (2,774). At the end of 2011, 39% of female survivors were aged <60 and 35% were ≥70 compared to 25% and 46% of males (p < 0.001). More than half of survivors of bladder, colorectal and prostate cancer were ≥70. Cancers with the highest percentages of younger (<40) survivors were: testis (50%); leukaemia (females: 28%; males: 22%); cervix (20%); and lymphoma (females: 19%; males: 20%). Fewer female (57%) than male (64%) survivors were married but the percentage single was similar (17-18%). More female (25%) than male survivors (18%; p < 0.001) were ≥10 years from diagnosis. Overall, 69% of survivors had undergone cancer-directed surgery, and 39%, 32% and 18% had received radiotherapy, chemotherapy and hormone therapy, respectively. These frequencies were higher among females than males (surgery: 82%, 54%; radiotherapy: 42%, 35%; chemotherapy: 40%, 22%; hormone therapy: 23%, 13%). Conclusions These results reveal the socio-demographic and clinical heterogeneity of the survivor population, and highlight groups which may have specific medical and supportive care needs. These types of population-based estimates may help decision-makers, planners and service providers to develop follow-up and after-care services to effectively meet survivors’ needs.
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Affiliation(s)
- Linda Sharp
- National Cancer Registry, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland.
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Debruyne P, Knott V, Weller D. Themes for our journal: 2014-2016. Eur J Cancer Care (Engl) 2014; 23:285-7. [DOI: 10.1111/ecc.12202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P.R. Debruyne
- General Hospital Groeninge; Kortrijk Belgium
- Centre for Positive Ageing; University of Greenwich; London UK
| | - V.E. Knott
- Menzies School of Health Research; Brisbane Australia
| | - D. Weller
- General Practice; University of Edinburgh
- Cancer and Primary Care Research International Network (Ca-PRI); Edinburgh UK
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Leslie P, Sandsund C, Roe J. Researching the rehabilitation needs of patients with life-limiting disease: Challenges and opportunities. PROGRESS IN PALLIATIVE CARE 2014. [DOI: 10.1179/1743291x14y.0000000087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Predeger EJ, O'Malley M, Hendrix T, Parker NM. Oncology rehabilitation outcomes over time: a mixed-methods approach. Oncol Nurs Forum 2014; 41:E56-63. [PMID: 24578086 DOI: 10.1188/14.onf.e56-e63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate an oncology rehabilitation program over time. DESIGN A cross-sectional, retrospective program evaluation using a mixed-methods approach. SETTING An outpatient oncology rehabilitation program housed in an urban, hospital-based comprehensive cancer center in Alaska. SAMPLE 102 cancer survivors who had completed a 10-week oncology rehabilitation program (mean time since completion was 2.5 years). METHODS Participants completed a mailed, 28-item retrospective survey to collect perceived activity level recalled at various points in time as well as program perceptions. Open-ended questions elicited narrative comments about motivators and barriers. The Medical Outcomes Study (MOS) SF-36® was completed before and after the program. MAIN RESEARCH VARIABLES Health-related quality of life, perceived health status, activity level, motivators, barriers, and program perceptions. FINDINGS A small increase in level of activity from precancer to the current time (postrehabilitation) (z = -3.1, p < 0.01) was reported. Most and least helpful motivators emerged from the narrative data, resulting in the shared interpretation of "I have my life back." CONCLUSIONS Program motivators were effective in helping cancer survivors maintain some increased activity and retain positive perceptions well after the completion of the program. IMPLICATIONS FOR NURSING Survivors who complete a rehabilitation program retain a sense of restoration and caring, and some engage in physical activity over time. Adapting the program based on insights into the survivor perspective may assist oncology rehabilitation clinicians to promote optimum physical activity and sustain healthful change.
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