A systematic review of the supportive care needs of people living with and beyond cancer of the colon and/or rectum

Purpose: Gaining a clear understanding of the health needs and concerns of people with cancer of the colon and/or rectum can help identify ways to offer a comprehensive care package. Our aim was to systematically assess the relevant literature and synthesise current available evidence. Methods Asystematic review was conducted according to the PRISMA Statement guidelines. Five electronic databases were searched to identify studies employing qualitative and/or quantitative methods. Pre-specified selection criteria were applied to all retrieved records. Findings were integrated in a narrative synthesis. Results: Of 3709 references initially retrieved, 54 unique studies were retained. A total of 136 individual needs were identified and classified into eight domains. Just over half of the needs (70; 51%) concerned information/education or health system/patient-clinician communication issues. Emotional support and reassurance when trying to deal with fear of cancer recurrence featured as themost prominent need regardless of clinical stage or phase of treatment. Information about diet/nutrition and about long-term self-management of symptoms and complications at home; tackling issues relating to the quality and mode of delivery of health-related information; help with controlling fatigue; and on-going contact with a trustworthy health professional also featured assalient needs. Available research evidence is of moderate-to-good quality. Conclusions: Investing time to sensitively inquire about the supportive care needs of this patient population is key, whilst evaluating and re-shaping clinical interactions based on patients' priorities is equally essential. The diverse needs identified require a multi-professional and multi-agency approach to ensure unmet needs are addressed or measures offered

What’s dignity got to do with it? Patient experience of the dignity care intervention: a qualitative evaluation study

The delivery of palliative care in the community setting has been recognized as a valued and challenging aspect of nursing care. To this end, care pathways have been shown to support nurses in a variety of settings to deliver individualized patient care. This study provides a qualitative evaluation of an end-of-life intervention known as the Dignity Care Intervention (DCI) based on patients’ perspectives. The DCI consists of four sections: a manual, the Patient Dignity Inventory, reflective questions, and evidence-based care actions. A qualitative design underpinned by the philosophy of Merlau-Ponty was employed for the evaluation of the DCI. Data collection included individual interviews with participants (n = 25). Interview data were analyzed using framework thematic analysis. Four theme categories were identified: “experience of DCI,” “responding to my illness concerns,” “how illness affects me as a person,” and “how illness concerns affect my relationships.” The DCI was found to enable patients to discuss openly important issues with community nurses that they might not otherwise have raised. Participants conveyed satisfaction with the support they received through the DCI. The use of care pathways detailing interventions to manage clinical problems and ensure systematic integration of the best available evidence into care delivery can improve end-of-life care

Sexual health care provision in cancer nursing care:a systematic review on the state of evidence and deriving international competencies chart for cancer nurses

Background: Sexual health care should be an integral part of holistic, person-centred care for patients with cancer. Nurses can have a pivotal role, but nurse-led care in this context has been historically challenging. Objectives: To update the state of scientific knowledge pertinent to nurses’ competencies in delivering sexual health care to patients with cancer; better understand moderating factors; and evaluate interventions developed/tested to enhance nurses’ competencies. Design: Systematic literature review in line with published PRISMA Statement guidelines. Data sources: Electronic bibliographic databases; journal content lists; reference lists of included studies; author/expert contact. Review methods: Nine electronic databases were searched (June 2008-October 2018) to identify studies employing diverse research methods. We applied pre-specified eligibility criteria to all retrieved records and integrated findings in a narrative synthesis. Results: Of 2,614 returned articles, we included 31 unique studies. Five articles reported on two randomised controlled trials and three single-arm, before-and-after trials. Current evidence suggests that nurses’ knowledge and skill in providing sexual health care still varies widely across different settings, phases and cancers. A plethora of intra-personal, inter-personal, societal and organisational factors may hinder nurse-led care in this context. Nurses’ perceived professional confidence was repeatedly examined as influencing provision of care in this context; unfortunately, it was found lacking and complicated by unhelpful views and beliefs about SHC. Despite the magnitude of the problem, the few trials that tested, sexual health-targeted continuing professional development programmes for nurses, were of low-to-moderate methodological quality, while the associated high risk of methodological bias downgraded the evidence on the interventions’ effectiveness. Conclusion: Our systematic review replicates previous findings and highlights a continuing problem: nurse-led provision of sexual health care in cancer care remains sub-optimal and challenging, due mainly to nurses’ assumptions and prejudices towards sexuality, lack of professional confidence in dealing with sensitive issues, and a complex health care system environment. To realistically deal with this problem, we propose a flexible, two-level chart to promote development of basic competence among all nurses caring for patients with cancer (entry-level), and facilitate subsequent transition to a more specialised, self-pursued role for a subset of nurses (champion-level). The chart itself can be relevant to an international audience, while it might be transferable to other long-term conditions. Accordingly, we propose additional rigorous research to test multi-component educational programmes, customised to meet entry-level and champion-level requirements to realise continuous nursing provision of sexual health care in cancer care

Feasibility and acceptability of the use of patient-reported outcome measures (PROMs) in the delivery of nurse-led supportive care to people with colorectal cancer

Purpose Logistical issues pertinent to the use of patient-reported outcome measures (PROMs) by colorectal cancer nurse specialists (CNS) to identify the needs of people with colorectal cancer (CRC) in acute care remain unknown. We explored the feasibility and acceptability of PROMs-driven, CNS-led consultations to enhance delivery of supportive care to people with CRC completing adjuvant chemotherapy. Methods A systematic literature review and focus groups with patients and CNS (Phase 1) were followed by a repeated-measures, exploratory study (Phase 2), whereby pre-consultation PROM data were collected during three consecutive, monthly consultations, and used by the CNS to enable delivery of personalised supportive care. Results Based on Phase 1 data, the Supportive Care Needs Survey was selected for use in Phase 2. Fourteen patients were recruited (recruitment rate: 56%); thirteen (93%) completed all study assessments. Forty in-clinic patient-clinician consultations took place. At baseline, 219 unmet needs were reported in total, with a notable 21% (T2) and 32% (T3) over-time reduction. Physical/daily living and psychological domain scores declined from T1 to T3, yet not statistically significantly. In exit interviews, patients described how using the PROM helped them shortlist and prioritise their needs. CNS stressed how the PROM helped them tease out more issues with patients than they would normally. Conclusions Nurse-led, PROMs-driven needs assessments with patients with CRC appear to be feasible and acceptable in clinical practice, possibly associated with a sizeable reduction in the frequency of unmet needs, and smaller decreases in physical/daily living and psychosocial needs in the immediate post-chemotherapy period

Using patient-reported outcome measures to deliver enhanced supportive care to people with lung cancer : feasibility and acceptability of a nurse-led consultation model

Purpose: Developing new supportive/palliative care services for lung cancer should encompass effective ways to promptly identify and address patients’ healthcare needs. We examined whether an in-clinic, nurse-led consultation model, which was driven by use of a patient-reported outcomes (PRO) measure, was feasible and acceptable in the identification of unmet needs in patients with lung cancer. Methods: A two-part, repeated-measures, mixed-methods study was conducted. Part 1 employed literature reviews and stakeholder focus group interviews to inform selection of a population-appropriate needs assessment PRO measure. In Part 2, lung cancer nurse specialists (CNS) conducted three consecutive monthly consultations with patients. Recruitment/retention data, PRO data, and exit interview data were analysed. Results: The Sheffield Profile for Assessment and Referral to Care was the PRO measure selected based on Part 1 data. Twenty patients (response rate: 26%) participated in Part 2; 13 (65%) participated in all three consultations/assessments. The PRO measure helped patients to structure their thinking and prompted them to discuss previously underreported and/or sensitive issues, including such topics as family concerns, or death and dying. Lung CNS highlighted how PRO-measures-driven consultations differed from previous ones, in that their scope was broadened to allow nurses to offer personalised care. Small-to-moderate reductions in all domains of need were noted over time. Conclusions: Nurse-led PRO-measures-driven consultations are acceptable and conditionally feasible to holistically identify and effectively manage patient needs in modern lung cancer care. PRO data should be systematically collected and audited to assist in the provision of supportive care to people with lung cancer