Core communication components along the cancer care process: the perspective of breast cancer patients

This study sought to assess the impact of health care professional (HCP) communication on breast cancer patients across the acute care process as perceived by patients. Methodological approach was based on eight focus groups conducted with a sample of patients (n ¼ 37) drawn from 15 Spanish Regions; thematic analysis was undertaken using the National Cancer Institute (NCI) framework of HCP communication as the theoretical basis. Relevant results of this study were the identification of four main communication components: (1) reassurance in coping with uncertainty after symptom detection and prompt access until confirmed diagnosis; (2) fostering involvement before delivering treatments, by anticipating information on practical and emotional illness-related issues; (3) guidance on the different therapeutic options, through use of clinical scenarios; and, (4) eliciting the feeling of emotional exhaustion after ending treatments and addressing the management of potential treatment-related effects. These communication-related components highlighted the need for a comprehensive approach in this area of cancer car

The role experience of advanced practice nurses in oncology: An interpretative phenomenological study.

Aim(s): To understand the experiences of advanced practice nurses working in cancer care. Design: Phenomenological qualitative study. Methods: Three focus groups were held to collect qualitative data. Participants were recruited through theoretical non-probabilistic sampling of maximum variation, based on 12 profiles. Data saturation was achieved with a final sample of 21 oncology advanced practice nurses who were performing advanced clinical practice roles in the four centers from December 2021 to March 2022. An interpretative phenomenological analysis was performed following Guba and Lincoln's criteria of trustworthiness. The centers' ethics committee approved the study, and all participants gave written informed consent. Data analysis was undertaken with NVivo 12 software. Results: Three broad themes emerged from the data analysis: the role performed, facilitators and barriers in the development of the role and nurses' lived experience of the role. Conclusion: Advanced practice nurses are aware that they do not perform their role to its full potential, and they describe different facilitators and barriers. Despite the difficulties, they present a positive attitude as well as a capacity for leadership, which has allowed them to consolidate the advanced practice nursing role in unfavourable environments. Implications for the profession: These results will enable institutions to establish strategies at different levels in the implementation and development of advanced practice nursing roles. Reporting method: Reporting complied with COREQ criteria for qualitative research. Patient or public contributions: No patient or public contribution

Evaluación de la calidad de vida, la utilización de los recursos sanitarios y las necesidades de información sanitaria en pacientes supervivientes de cáncer de mama, próstata y colorrectal. Estudio de metodología mixta de cohortes retrospectivo y cualitativo

[spa] INTRODUCCIÓN: El creciente número de largos supervivientes de cáncer, especialmente en tumores de elevada frecuencia como el cáncer de mama, próstata y colorectal, junto al aumento de la incidencia, debido al envejecimiento de la población, supone un elemento de presión y un reto para la atención oncológica, tanto desde la perspectiva de la organización sanitaria como del conocimiento sobre las necesidades específicas de estos pacientes. HIPÓTESIS: 1) Los supervivientes adultos de 5 y 10 tras el diagnóstico de cáncer de mama, próstata y colorectal desarrollan problemas de salud a largo plazo e impactan en su calidad de vida. 2) Los largos supervivientes de cáncer de mama, próstata y colorectal utilizan los servicios sanitarios principalmente a causa de problemas de salud derivados del cáncer y su tratamiento. 3) Las supervivientes de cáncer de mama reciben información y asesoramiento adecuados sobre el cuidado de la salud tras la finalización del tratamiento. OBJETIVOS PRINCIPALES: 1) Conocer el estado de salud y la calidad de vida de los supervivientes adultos de 5 y 10 años tras el diagnóstico de cáncer de mama, próstata y colorectal. 2) Identificar el tipo de utilización de los recursos sanitarios que realizan. 3) Identificar la viabilidad y las dificultades de la comunicación entre las pacientes de cáncer de mama y los profesionales sanitarios en todo el proceso oncológico. 4) Estudiar si la comunicación e información sobre el cuidado de la salud en las superviventes de cáncer de mama influencian la capacidad del autocuidado y la experiencia personal. OBJETIVOS SECUNDARIOS: 1) Identificar cambios de comportamiento con relación a los hábitos de vida saludable. 2) Conocer el tipo de tratamiento farmacológico y de terapias complementarias que siguen los supervivientes. 3) Identificar factores que pueden influir para lograr una comunicación efectiva. 4) Conocer la percepción de la asistencia recibida. Metodología: Dos estudios, de metodología retrospectiva y multicéntrico y cualitativa. RESULTADOS: Los largos supervivientes de cáncer de mama, próstata y colorectal, que no han tenido recurrencia ni segundas neoplasias, han sido diagnosticados en estadios precoces, presentan morbilidad reducida de baja complejidad y tienen buena calidad de vida. Más del 80% de los pacientes frecuentan la atención primaria debido a morbilidades relacionadas con la edad, consultan en este nivel de forma oportunista sobre las secuelas del tratamiento o del tumor. El seguimiento oncológico se realiza en los servicios oncológicos. Otras necesidades, emocionales, de la sexualidad y los estilos de vida saludable, vinculadas al proceso oncológico emergen fuera del radar de atención establecido. La fragmentación y disparidad observada entre la atención actual y las necesidades de este perfil de supervivientes cuestiona el tipo de seguimiento uniforme actual a todos los largos supervivientes. Otro factor relevante es la escasa y variable información que reciben los pacientes al finalizar los tratamientos sobre los riesgos de salud y el propio cuidado a desarrollar, observándose asimetría entre la información proporcionada y las necesidades manifestadas por las pacientes. CONCLUSIONES: Los resultados sugieren un perfil de pacientes sobre el que se podría desarrollar un nuevo enfoque para su seguimiento; contribuyen al conocimiento sobre sobre las necesidades específicas y la segmentación de los largos supervivientes en nuestro contexto sanitario. La etapa de finalización del tratamiento es una etapa de elevada vulnerabilidad, los pacientes requieren asesoramiento sobre los riesgos de salud a medio y largo plazo, relacionados con el tratamiento y tipo de cáncer, y el cuidado a desarrollar. El contexto comunicativo entre pacientes y profesionales se inicia desde el primer síntoma y en todo el proceso asistencial, incluyendo la etapa de supervivencia; está condicionado por la organización de los servicios sanitarios y las habilidades de comunicación e información de los profesionales.[eng] INTRODUCTION: The growing number of long‐term cancer survivors poses a new challenge to health care systems. The purpose of this thesis was to ascertain the health status, the use of health care services and the information needs of long‐term survivors of breast, prostate and colorectal cancer. Methods: retrospective multicenter cohort study and qualitative research. HYPOTHESIS: 1) Adult survivors of 5 and 10 after the diagnosis of breast, prostate and colorectal cancer develop long‐term health problems and impact on their quality of life. 2) The long‐term survivors of breast, prostate and colorectal cancer use health care services due to health problems cancer and its treatment‐related. 3) The breast cancer survivors receive adequate information and advice on their self‐care after the end of treatment. RESULTS: No significant differences were observed between 5‐year and 10‐year survivors. More than 80% survivors were undergoing drug treatment for morbidity related to advanced age. Quality of life was good in most patients, and cancer‐related morbidity was low and of little complexity. For the most part survivors reported using primary care services oh chronic diseases and opportunistic treatment of sequelae related to the cancer treatment. Oncological follow‐up was centralized at the hospital. Four main communication components were identified: 1) reassurance in coping with uncertainty after symptom detection and prompt access until confirmed diagnosis; 2) fostering involvement before delivering treatments, by anticipating information on practical and emotional illness‐related issues. 3) guidance on the different therapeutic options, through use of clinical scenarios; 4) eliciting the feeling of emotional exhaustion after ending treatments and addressing the management of potential treatment‐related effects. CONCLUSIONS: Survivors of breast, prostate and colorectal cancer with tumoral detection at an early stage and without recurrence or second neoplasms experienced little morbidity and enjoy good quality of life. The communication‐related components highlighted the need for a comprehensive approach in this area of cancer care and specifically for cancer survivors. These studies propose exploration of a follow‐up model in the Spanish health system in which primary care plays a more important role than is customary in cancer survivors in Spain

Una bola de nieve está creciendo en los servicios sanitarios: los pacientes supervivientes de cáncer The growing snowball in health services: long-term cancer survivors

Una de las consecuencias del progreso en el diagnóstico y el tratamiento del cáncer es el aumento de la supervivencia observado en las últimas décadas en Europa y en España. El número de nuevos casos de cáncer continúa aumentando principalmente debido al envejecimiento de la población, por lo que es previsible que el número de personas que viven años tras un diagnóstico de cáncer continúe creciendo. Este hecho supone un elemento de presión a los sistemas sanitarios, que muestran sus limitaciones para atenderlos con el modelo actual de seguimiento. Deben plantearse nuevos escenarios asistenciales, tanto desde la perspectiva de la gestión sanitaria como de la clínica. A pesar de no haber suficiente evidencia científica sobre cómo sistematizar el seguimiento de los casos, se están impulsando diversas estrategias, sobre todo en otros países, para lograr una mayor adecuación en la provisión de servicios a estos pacientes. En España tales experiencias son muy escasas, pero dada la situación emergente, que bien puede ser comparada a un efecto en bola de nieve, se requiere la revisión y la reformulación del modelo actual para ofrecer una respuesta más efectiva y ajustada a la realidad. El propósito de este artículo es identificar las prioridades de atención de estos pacientes desde el punto de vista sanitario, revisar los modelos organizativos que se ensayan en otros países y proponer un marco de referencia, basado en la integración de niveles asistenciales, incluyendo atención primaria de la salud, que es la Cenicienta en este problema, como aproximación a un modelo que permita evaluar las mejores opciones asistenciales para estos pacientes en nuestro entorno sanitario.<br>One of the consequences of diagnostic and therapeutic progress in cancer is the increased survival observed in the last few decades in Spain and elsewhere in Europe. New cancer cases are increasing steadily due to population aging, among other factors. Consequently, the number of long-term survivors can be expected to increase in the years to come. This increase will tax healthcare systems, which are already showing the limitations of the present model of follow-up. New scenarios should be assessed and proposed from both the management and clinical perspectives. Although there is insufficient scientific evidence to indicate the most effective way to organize the follow-up of these patients, several approaches are being proposed in other countries to improve the fit between health services provision and the specific needs of these patients. In Spain, these experiences are scarce. However, given the situation, which could be described as a snowball effect, the current model should be reviewed and new approaches discussed in order to provide a more effective response to this situation. This article aims to identify the priorities for cancer survivors from the healthcare point of view, to review organizational approaches in other countries, and to propose a framework, based on the integration of the different levels of health care, including primary care - the Cinderella of this situation - in order to assess various healthcare options for these patients in the Spanish healthcare context

Patients' and professionals' experiences with advanced practice nursing in cancer care: qualitative study

Purpose: The growing complexity of cancer treatments requires changes in how care is organized and who provides it. The incorporation of advanced practice nursing roles within multidisciplinary teams can improve care in cancer patients. This study aims to understand the lived experience of cancer patients and multidisciplinary professionals in relation to the care provided by the advanced practice nurse. Methods: Phenomenological qualitative study. Data were collected through in-depth interviews and a field diary. Participants were recruited through convenience sampling; until theoretical data saturation was achieved. An interpretative phenomenological analysis was performed, following Guba and Lincoln's criteria for trustworthiness. Results: Interviews were performed with 18 professionals and 11 patients, from highcomplexity public hospitals between March-December 2021. The main themes that emerged were: advanced practice nurse role and competencies, Benefits provided by the APN, and Relevant aspects of nursing care. Conclusion: Advanced practice nurses play a fundamental role in cancer care, making positive contributions to the patient experience and to the multidisciplinary team's work. Elucidating the contribution of advanced practice nurses in oncology will facilitate the definition of their specific competencies and, in turn, the implementation of training and management strategies to consolidate this figure in specialized centers

Health status and health resource use among long-term survivors of breast, colorectal and prostate cancer

Introduction: The growing number of long-term cancer survivors poses a new challenge to health care systems. In Spain, follow-up is usually carried out in oncology services, but knowledge of cancer survivors’ health care needs in this context is limited. The purpose of this study was to ascertain the health status of long-term survivors of breast, prostate, and colorectal cancer and to characterize their use of health care services. Methods: Retrospective multicenter cohort study. We collected data from patients’ clinical histories and through telephone interviews, using a specially designed questionnaire that included the SF-36v2 Quality of Life and Nottingham Health Profile scales. Results: The questionnaire was completed by 51.2% (n= 583) of the potential sample. No significant differences were observed between 5-year and 10-year survivors. Overall, more than 80% of respondents were undergoing drug treatment for morbidity related to advanced age. Quality of life was good in most patients, and cancer-related morbidity was low and of little complexity. For the most part, participants reported using primary care services for care of chronic diseases and opportunistic treatment of sequelae related to the cancer treatment. Oncological follow-up was centralized at the hospital. Conclusions: Survivors of breast, prostate and colorectal cancer with tumoral detection at an early stage and without recurrences or second neoplasms experienced little morbidity and enjoyed good quality of life. This study proposes exploration of a follow-up model in the Spanish health system in which primary care plays a more important role than is customary in cancer survivors in Spain

Self-assessment of a breast care nursing model within a Breast Unit: learning process and keys to improving breast care

Aim and objectives: To assess the adherence of a nursing care model in a multidisciplinary breast cancer unit in a tertiary hospital to the recommended competencies and quality indicators.Background: Aligning the competencies of the breast care nurse with international recommendations for this role helps better fulfil patient needs, increases satisfaction and ensures continuity of care.Design: Cohort study.Methods: Breast care nursing was assessed in all patients treated at the Functional Breast Unit from 1 July 2016 to 30 June 2017. Patients were followed for 1 year. Sociodemographic, clinical and pathological data, treatments performed and nursing interventions were collected. The strobe checklist has been used to report this study. Results: We analysed nursing interventions carried out in 382 patients attended over 1 year in a multidisciplinary breast cancer unit. All patients with early disease had contact with the nurse at different times during their primary treatment. Only 58% of patients with advanced disease had contact with the nurse during their first year of illness. Moreover, first contact with the nurse was delayed by more than a week from diagnosis, the interval recommended by international guidelines.Conclusion: The nursing care model meets the core competencies defined for the breast care nurse in patients with early breast cancer, but the first visit should be organised earlier, and follow-up should extend beyond the completion of primary treatment.Relevance to clinical practice: This study evaluated the breast care nurse model in one breast cancer unit according to international guidelines. Nursing care adhered to most guideline requirements in patients with early breast cancer, but not in those with advanced disease. New models of care need to be developed for women with advanced breast cancer in order to achieve true patient-centred care