Prospective evaluation of a colorectal cancer nurse follow-up clinic

Registered Nurses' Perspectives of the Impact of a Post-registration Education Qualification on Patient Care and Clinical Practice in Cancer Care: a Qualitative Study

Student evaluation of teaching is routinely completed as modules and programmes of study at higher education institutions conclude. The evaluations are often focused on the educational value and experience. For programmes with healthcare professionals as students, the impact of the learning on patient care and clinical practice is not routinely captured in these student evaluations. These insights are crucial as the definitive impact of learning for many educational programmes of study for healthcare professionals is to enhance patient outcomes. The aim of this qualitative research study was to capture the impact of a post-registration Specialist Practice in cancer pathway for registered nurses in the context of Northern Ireland following completion of the programme. Eleven participants engaged in interviews in 2021 who had completed the education programme from 2013 to 2021. Two themes inductively emerged from the data which provided insights into the specific impact of the education programme on patient care and clinical practice. Theme one identified patient outcomes improved, and was related to five sub themes; development of nurse's clinical knowledge; enhanced awareness of the holistic impact of cancer; greater understanding of patient services available; development of clinical networks; and greater decision-making ability. Theme two related to the impact of the qualification on clinical practice through an increase in their professional credibility within the multidisciplinary team in cancer services. The debate on how to capture the impact of education on patient care and clinical practice in cancer care, should consider how to routinely capture this data.

Nurse's Roles in Colorectal Cancer Prevention: A Narrative Review

The objective of this paper is to investigate the different roles of nurses as members of healthcare teams at the primary, secondary, and tertiary levels of colorectal cancer prevention. The research team conducted a narrative review of studies involving the role of nurses at different levels of colorectal cancer prevention, which included a variety of quantitative, qualitative, and mixed-method studies. We searched PubMed, Scopus, Web of Science, Cochrane Reviews, Magiran, the Scientific Information Database (SID), Noormags, and the Islamic Science Citation (ISC) databases from ab initio until 2021. A total of 117 studies were reviewed. Nurses' roles were classified into three levels of prevention. At the primary level, the most important role related to educating people to prevent cancer and reduce risk factors. At the secondary level, the roles consisted of genetic counseling, stool testing, sigmoidoscopy and colonoscopy, biopsy and screening test follow-ups, and chemotherapy intervention, while at the tertiary level, their roles were made up of pre-and post-operative care to prevent further complications, rehabilitation, and palliative care. Nurses at various levels of prevention care also act as educators, coordinators, performers of screening tests, follow-up, and provision of palliative and end-of-life care. If these roles are not fulfilled at some levels of colorectal cancer, it is generally due to the lack of knowledge and competence of nurses or the lack of instruction and legal support for them. Nurses need sufficient clinical knowledge and experience to perform these roles at all levels.

Economic Evaluation of Long-Term Survivorship Care for Cancer Patients in OECD Countries: A Systematic Review for Decision-Makers

Long-term cancer survivorship care is a crucial component of an efficient healthcare system. For numerous reasons, there has been an increase in the number of cancer survivors; therefore, healthcare decision-makers are tasked with balancing a finite budget with a strong demand for services. Decision-makers require clear and pragmatic interpretation of results to inform resource allocation decisions. For these reasons, the impact and importance of economic evidence are increasing. The aim of the current study was to conduct a systematic review of economic evaluations of long-term cancer survivorship care in Organization for Economic Co-operation and Development (OECD) member countries and to assess the usefulness of economic evidence for decision-makers. A systematic review of electronic databases, including MEDLINE, PubMed, PsycINFO and others, was conducted. The reporting quality of the included studies was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Each included study’s usefulness for decision-makers was assessed using an adapted version of a previously published approach. Overall, 3597 studies were screened, and of the 235 studies assessed for eligibility, 34 satisfied the pre-determined inclusion criteria. We found that the majority of the included studies had limited value for informing healthcare decision-making and conclude that this represents an ongoing issue in the field. We recommend that authors explicitly include a policy statement as part of their presentation of results.

Evaluation of the role of the clinical Nurse Specialist in cancer care: an integrative literature review

INTRODUCTION

Although there is growing evidence the Clinical Nurse Specialist role makes a difference to patient care, the full value of this service may not be always appreciated with current models not meeting the needs of those with cancer. The primary aim of this integrative literature review was to evaluate outcomes associated with the role of the Clinical Nurse Specialist in cancer care. The secondary aim was to identify the components of the Clinical Nurse Specialist role in cancer care from the included papers in the literature review.

METHODS

An integrative literature review using a systematic approach was adopted. Literature searches were undertaken in four databases and supplemented with a search in the grey literature and reference lists of included papers. Searches were limited to January 2009-July 2019 and those written in the English language. Three reviewers independently completed the searches and reviewed the papers before reaching a consensus.

RESULTS

Fourteen eligible research papers were identified. Evaluations were predominately positive with the role contributing to improving patient outcomes with regards psychological support, information provision, symptom management, service coordination and patient satisfaction.

CONCLUSION

The findings of this literature review firmly establish the Clinical Nurse Specialist as a valuable member of the multidisciplinary team in enhancing cancer care services.

The cost-effectiveness of follow-up strategies after cancer treatment: a systematic literature review

INTRODUCTION

The cost of treatment and follow-up of cancer patients in the UK is substantial. In a budget-constrained system such as the NHS, it is necessary to consider the cost-effectiveness of the range of management strategies at different points on cancer patients' care pathways to ensure that they provide adequate value for money.

SOURCES OF DATA

We conducted a systematic literature review to explore the cost-effectiveness of follow-up strategies of patients previously treated for cancer with the aim of informing UK policy. All papers that were considered to be economic evaluations in the subject areas described above were extracted.

AREAS OF AGREEMENT

The existing literature suggests that intensive follow-up of patients with colorectal disease is likely to be cost-effective, but the opposite holds for breast cancer.

AREAS OF CONTROVERSY

Interventions and strategies for follow-up in cancer patients were variable across type of cancer and setting. Drawing general conclusions about the cost-effectiveness of these interventions/strategies is difficult.

GROWING POINTS

The search identified 2036 references but applying inclusion/exclusion criteria a total of 44 articles were included in the analysis. Breast cancer was the most common (n = 11) cancer type followed by colorectal (n = 10) cancer. In general, there were relatively few studies of cost-effectiveness of follow-up that could influence UK guidance. Where there was evidence, in the most part, NICE guidance broadly reflected this evidence.

AREAS TIMELY TO DEVELOP RESEARCH

In terms of future research around the timing, frequency and composition of follow-ups, this is dependent on the type of cancer being considered. Nevertheless, across most cancers, the possibility of remote follow-up (or testing) by health professionals other than hospital consultants in other settings appears to warrant further work.

The costs, resource use and cost-effectiveness of Clinical Nurse Specialist-led interventions for patients with palliative care needs: A systematic review of international evidence

BACKGROUND

Patients with palliative care needs do not access specialist palliative care services according to their needs. Clinical Nurse Specialists working across a variety of fields are playing an increasingly important role in the care of such patients, but there is limited knowledge of the extent to which their interventions are cost-effective.

OBJECTIVES

To present results from a systematic review of the international evidence on the costs, resource use and cost-effectiveness of Clinical Nurse Specialist-led interventions for patients with palliative care needs, defined as seriously ill patients and those with advanced disease or frailty who are unlikely to be cured, recover or stabilize.

DESIGN

Systematic review following PRISMA methodology.

DATA SOURCES

Medline, Embase, CINAHL and Cochrane Library up to 2015. Studies focusing on the outcomes of Clinical Nurse Specialist interventions for patients with palliative care needs, and including at least one economic outcome, were considered. The quality of studies was assessed using tools from the Joanna Briggs Institute.

RESULTS

A total of 79 papers were included: 37 randomized controlled trials, 22 quasi-experimental studies, 7 service evaluations and other studies, and 13 economic analyses. The studies included a wide variety of interventions including clinical, support and education, as well as care coordination activities. The quality of the studies varied greatly.

CONCLUSION

Clinical Nurse Specialist interventions may be effective in reducing specific resource use such as hospitalizations/re-hospitalizations/admissions, length of stay and health care costs. There is mixed evidence regarding their cost-effectiveness. Future studies should ensure that Clinical Nurse Specialists' roles and activities are clearly described and evaluated.

Intensive surveillance following curative treatment of colorectal cancer allows effective treatment of recurrence even if limited to 4 years

BACKGROUND

Current evidence suggests a survival benefit to post-operative surveillance following curative colorectal cancer resection; however, there is still no consensus on the optimal duration and form.

OBJECTIVES

The objective is to prospectively audit outcomes of an intensive colorectal cancer follow-up scheme for time to recurrence and survival.

METHODS

We used a surveillance protocol designed to incorporate regular clinical, biochemical, radiological and endoscopic measures at pre-defined intervals.

SETTING

The setting was a Department of Colorectal Surgery in a Tertiary Academic Centre. Follow-up was led by specially trained colorectal nurses in conjunction with surgeons.

PATIENTS

Consecutive patients who had undergone curative treatment for colorectal cancer were included in this study.

MAIN OUTCOMES

Outcomes were measured in terms of overall survival and disease recurrence.

RESULTS

There were 436 patients entered into follow-up, all treated with curative intent. Mean age 65.9 years (SD 12.9 years) and 240 male (55.0 %). Ninety-four patients (21.5 %) with stage I disease, 119 (27.3 %) stage IIa, 30 (6.9 %) stage IIb, 18 (4.1 %) stage IIIa, 78 (17.9 %) stage IIIb, 45 (10.4 %) stage IIIc and 52 (11.9 %) stage IV. Overall median survival was 37.5 months for all patients, (range 0.0-207.8 months). Ninety-two (21.1 %) cancer-related deaths were recorded during the course of the study. The overall 5-year actuarial cancer-related survival was 81.7 %. There was a 40.3 % 5-year actuarial survival was recorded in patients with 39 a recurrence, 57.7 % in patients treated with further curative 40 intent and 27.7 % in patients who received palliative treatment 41 (P < 0.001). Ninety-seven percent of recurrences were detected within 4 years of curative treatment.

CONCLUSIONS

This follow-up protocol confers an 81 % overall 5-year actuarial survival. Our study suggests that surveillance after curative resection can be limited to 4 years, which would lead to detection of over 97 % of all recurrences.

Enhanced recovery and nurse-led telephone follow-up post surgery

AIM

Nurse-led telephone follow-up was undertaken for patients after major colorectal surgery on the enhanced recovery programme following their discharge, with the aim of ensuring they were provided with adequate advice and information to enable their recovery at home.

METHODOLOGY

A total of 200 patients were prospectively called within 4 weeks of discharge home from hospital by the enhanced recovery nurse.

RESULTS

Diet was generally tolerated and mobility was continued at home. Many of the patients had seen a health professional since their discharge home for issues such as wound care or stoma review. Readmission rates were low and most concerns that patients reported were addressed during the telephone call.

DISCUSSION

It is reassuring that the majority of patients were coping well and many of the concerns reported were simply addressed over the telephone with advice. After the first 100 patients were telephoned, improvements were made to the discharge advice provided to the second 100 patients. The responses suggest that there were less community nurse visits in the second half of the patient cohort and this may be associated with changes made to discharge advice.

CONCLUSION

Patients continue to recover well once discharged home following colorectal surgery on the enhanced recovery pathway. Nurse-led telephone follow-up may be a suitable method for short-term follow-up and, potentially, it is also suitable for long-term follow-up of select groups of cancer patients.