Symptom Burden and Palliative Referral Disparities in an Ambulatory South Texas Cancer Center

Background: The American Society of Clinical Oncology's recommendation for “dedicated palliative care services, early in the disease course, concurrent with active treatment” for cancer patients is a challenge for cancer centers to accommodate. Despite demonstrated benefits of concurrent care, disparities among socioeconomic and ethnic groups in access to supportive care services have been described. The aim of this project was to evaluate: (a) how insurance coverage and ethnicity impact patient symptom burden and, (b) how those factors influence palliative access for patients at a South Texas NCI-designated cancer center.Methods: During a 5-month prospective period, 604 patients from five ambulatory oncology clinics completed the 10 question Edmonton Symptom Assessment Scale (ESAS) surveys during their clinic visit. Patient demographics, ESAS scores, palliative referral decisions, and time to palliative encounters were collected. We compared symptom burden and time to consult based on ethnicity and insurance status (insured = Group A; under-insured and safety net = Group B).Results: The mean ESAS score for all patients at the initial visit was 19.9 (SD = 18.1). Safety net patients were significantly more likely to be Hispanic, younger in age, and have an underlying GI malignancy in comparison to insured patients; however, the symptom severity was similar between groups with over 40% of individuals reporting at least one severe symptom. Twenty-one referrals were made to palliative care. On average, Group B had 33.3 days longer wait times until their first potential visit (p < 0.01) when compared to Group A. Time to actual visit was on average 57.6 days longer for patients in Group B compared to patients in Group A (p = 0.01), averaging at 73.8 days for safety net patients.Conclusions: This project highlights the high symptom burden of oncology patients and disparities in access to services based on insurance coverage. This investigation revealed a 4-fold increase in the time to the first scheduled palliative care visit based on whether patients were insured vs. under-insured. While this study is limited by a small sample size, data suggest that under-insured oncology patients may have significant barriers to palliative care services, which may influence their cancer care quality

Engaging patients with radiation related skin discomfort in self-care

Background: Patients receiving radiation to the breast can suffer painful, moist desquamation of the axilla and inframammary fold. Intensity of skin reactions will vary with each individual and be dependent on the total dose of radiation, treatment volume, daily fraction size, energy and type of radiation, as well as other personal factors (Gosselin, 2010). Treatment-related skin reactions make it difficult for women to wear clothing and undergarments comfortably and to perform daily activities. InterDry AG is a textile dressing with an antimicrobial complex that wicks away excess moisture and reduces friction, itching, and burning. Despite showing highly beneficial properties, there is no current published evidence indicating the utility of InterDry Ag for radiation skin reactions. Purpose: This project evaluated the potential utility of InterDry Ag dressing to relieve discomfort of skin reactions for breast cancer patients undergoing radiation treatment. Methods: A descriptive design was employed to better understand the effectiveness of InterDry Ag dressing in reducing side effects of radiation treatment of the breast for women. Twenty eligible participants consented to participate. A radiation oncology nurse evaluated its effect every five days, utilizing a skin assessment questionnaire developed by the nursing team from clinical observations. Results: A personalized skin care regimen was developed with each patient’s feedback. A trusting relationship was developed between the nurse and patient by building rapport that indicated nursing care support. Some women began sharing their emotional stressors with nurses, as well as the physical pain they were experiencing due to the skin reactions. This observation resulted in provision of additional resources for women and engaging them in self-care using a patient-centred approach

South Asian immigrant women’s experiences of being respected within cancer treatment settings

The purpose of this focused ethnographic inquiry was to examine South Asian immigrant women’s experiences and perceptions of respect within health professional–client relationships in the context of a Canadian outpatient treatment clinic. Characteristics of respect described by 11 women interviewed were the meaning of respect, health professional’s way of being, their way of attending to the person, and their way of talking. Language, cultural values and beliefs, along with underlying societal, individual and institutional factors that coexist with health professionals’ ability to create respect were some of the dimensions that influenced how immigrant women experienced respect. Health professionals’ capacity to acknowledge South Asian immigrant women as individuals helped to formulate/construct respect for their individual identities. The need to be respected for ‘my social identity’ as an immigrant woman with cancer was woven throughout women’s stories, illustrated by their personal experiences and perspectives

Expériences des immigrantes d’Asie du Sud en matière de respect dans les milieux de traitement du cancer

Le but de cette enquête ethnographique ciblée était d’examiner les expériences et perceptions de respect chez les immigrantes d’Asie du Sud dans le cadre des relations professionnels de la santé-clients et ce, dans le contexte d’une clinique canadienne de soins externes. Les caractéristiques du respect telles que décrites par les 11 femmes interviewées étaient la signification du respect, la façon d’être des professionnels de la santé, la façon dont ils s’occupent de la personne et la façon dont ils s’expriment oralement. La langue, les valeurs culturelles et les croyances ainsi que les facteurs sous-jacents d’ordre social, individuel et institutionnel qui coexistent avec l’aptitude des professionnels de la santé à créer le respect, constituaient quelquesunes des dimensions qui influençaient l’expérience du respect chez ces immigrantes. La capacité des professionnels de la santé à voir dans les immigrantes d’Asie du Sud des individus favorisait la formulation/construction du respect pour leur identité individuelle. Le besoin que l’on respecte « mon identité sociale » en tant qu’immigrante atteinte de cancer imprégnait les récits des femmes et ressortait de leurs expériences et perspectives personnelles

Rapport d’évaluation des services d’infirmières pivots pour le programme de soutien au cancer du sein

Le projet d’amélioration de la qualité présenté ici avait pour but d’évaluer l’efficacité des soins de soutien prodigués par les infirmières pivots en cancer du sein (IPCS) aux patientes qui en sont atteintes et qui fréquentent une clinique de santé du sein. Le processus d’évaluation a examiné la satisfaction des patientes envers le programme des infirmières pivots, qui vise à offrir aux patientes de l’information, du soutien émotionnel et de l’orientation tout au long de la trajectoire de soins. Les données ont été recueillies grâce à un sondage constitué de questions de type « échelle de Likert » et de questions ouvertes. Le sondage a été envoyé par la poste aux patientes qui étaient passées à la clinique entre juillet 2011 et juillet 2013. Nous avons reçu 154 réponses, ce qui représente un taux de réponse de 69 %. Plus de 90 % des participantes avaient compris l’information fournie par l’IPCS et étaient satisfaites des renseignements qu’elles avaient reçus. Le soutien psychosocial offert par les services de counseling aux patientes et aux familles, à l’agence même et dans la collectivité, comptait parmi les ressources les plus communément en demande. Parmi les recommandations formulées, mentionnons la prise de contact directement avec les patientes après le premier rendez-vous à la clinique, puis au moins une fois après le début des traitements pour assurer la continuité et le soutien. Le rôle de l’IPCS était considéré comme très utile et ayant une influence positive sur l’expérience de la patiente

An evaluation report of the nurse navigator services for the breast cancer support program

The purpose of this quality improvement project was to evaluate the effectiveness of breast cancer care support provided by breast cancer care navigators (BCCN) for women attending the breast health clinic (BHC). This evaluative process examined patients’ satisfaction with the nurse navigator program that focused on addressing breast cancer patients’ informational needs, emotional support, and guidance through the cancer trajectory. A survey approach using Likert-type scales and open-ended questions was utilized to gather data. Patients seen at the BHC between July 2011 and July 2013 were sent the surveys by mail. The 154 responses constituted a 69% response rate. More than 90% of participants understood the information provided by the BCCN and were satisfied with the information that had been received. Psychosocial support from patient/family counselling services at the agency and in the community were among the most common request for resources. Recommendations include contacting patients directly after their initial meeting at the clinic and at least once after their treatments began, to ensure continuity and support. BCCN role was identified as being valuable with a positive effect on patients' experience

Impact of a breast cancer care RN-coordinator program on patients’ distress level

The purpose of this study was to determine whether patients receiving navigation supportive care from a Breast Cancer Care Coordinator (BCCC), prior to initial oncology consultation at a British Columbia Cancer Agency, Abbotsford Centre (BCCA-AC), demonstrated different levels of anxiety and depression from those not receiving such support at the same BCCA centre. A retrospective review of the Psychological Screen for Cancer (PSSCAN) scores of new breast cancer patients seen for oncology consultation for the control cohort (receiving usual care) were compared to PSSCAN scores of those who had received care from a BCCC prior to the oncology consultation (the study cohort). A total of 91 PSSCANs were reviewed in the study, with 54 belonging to the treatment group and 37 to the control group. PSSCAN scores for anxiety and depression did not show significant differences between the two groups