Carole Farrell

Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study

Objectives Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs. Design Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis. Setting Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre. Participants Purposeful sample of 10 patients with a diagnosis of cancer–dementia, informal caregivers (n=9) and oncology HCPs (n=12). Results Four themes were identified: (1) leading to the initial consultation—HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information—informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care—patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment—there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making. Conclusions Although patients with cancer–dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway.

Are nurse-led chemotherapy clinics really nurse-led?:an ethnographic study

BACKGROUNDnThe number of patients requiring ambulatory chemotherapy is increasing year on year, creating problems with capacity in outpatient clinics and chemotherapy units. Although nurse-led chemotherapy clinics have been set up to address this, there is a lack of evaluation of their effectiveness. Despite a rapid expansion in the development of nursing roles and responsibilities in oncology, there is little understanding of the operational aspects of nurses roles in nurse-led clinics.nnnOBJECTIVESnTo explore nurses roles within nurse-led chemotherapy clinics.nnnDESIGNnA focused ethnographic study of nurses roles in nurse-led chemotherapy clinics, including semi-structured interviews with nurses.nnnSETTINGSnFour chemotherapy units/cancer centres in the UK PARTICIPANTS: Purposive sampling was used to select four cancer centres/units in different geographical areas within the UK operating nurse-led chemotherapy clinics. Participants were 13 nurses working within nurse-led chemotherapy clinics at the chosen locations.nnnMETHODSnNon-participant observation of nurse-led chemotherapy clinics, semi-structured interviews with nurse participants, review of clinic protocols and associated documentation.nnnRESULTSn61 nurse-patient consultations were observed with 13 nurses; of these 13, interviews were conducted with 11 nurses. Despite similarities in clinical skills training and prescribing, there were great disparities between clinics run by chemotherapy nurses and those run by advanced nurse practitioners. This included the number of patients seen within each clinic, operational aspects, nurses autonomy, scope of practice and clinical decision-making abilities. The differences highlighted four different levels of nurse-led chemotherapy clinics, based on nurses autonomy and scope of clinical practice. However, this was heavily influenced by medical consultants. Several nurses perceived they were undertaking holistic assessments, however they were using medical models/consultation styles, indicating medicalization of nurses roles.nnnCONCLUSIONSnFour different levels of nurse-led chemotherapy clinics were identified, illustrating disparities in nurses roles. Although clinics are run by nurses they are often controlled by medical consultants, which can reduce nurses autonomy and negatively impact on patient care.

A systematic review of the prevalence of comorbid cancer and dementia and its implications for cancer-related care.

ABSTRACT Objectives: A comorbid diagnosis of cancer and dementia (cancer–dementia) may have unique implications for patient cancer-related experience. The objectives were to estimate prevalence of cancer–dementia and related experiences of people with dementia, their carers and cancer clinicians including cancer screening, diagnosis, treatment and palliative care. Method: Databases were searched (CINAHL, Psychinfo, Medline, Embase, BNI) using key terms such as dementia, cancer and experience. Inclusion criteria were as follows: (a) English language, (b) published any time until early 2016, (c) diagnosis of cancer–dementia and (d) original articles that assessed prevalence and/or cancer-related experiences including screening, cancer treatment and survival. Due to variations in study design and outcomes, study data were synthesised narratively. Results: Forty-seven studies were included in the review with a mix of quantitative (n = 44) and qualitative (n = 3) methodologies. Thirty-four studies reported varied cancer–dementia prevalence rates (range 0.2%–45.6%); the others reported reduced likelihood of receiving: cancer screening, cancer staging information, cancer treatment with curative intent and pain management, compared to those with cancer only. The findings indicate poorer cancer-related clinical outcomes including late diagnosis and higher mortality rates in those with cancer–dementia despite greater health service use. Conclusions: There is a dearth of good-quality evidence investigating the cancer–dementia prevalence and its implications for successful cancer treatment. Findings suggest that dementia is associated with poorer cancer outcomes although the reasons for this are not yet clear. Further research is needed to better understand the impact of cancer–dementia and enable patients, carers and clinicians to make informed cancer-related decisions.

A scoping review of trials of interventions led or delivered by cancer nurses

BACKGROUNDnAdvances in research and technology coupled with an increased cancer incidence and prevalence have resulted in significant expansion of cancer nurse role, in order to meet the growing demands and expectations of people affected by cancer (PABC). Cancer nurses are also tasked with delivering an increasing number of complex interventions as a result of ongoing clinical trials in cancer research. However much of this innovation is undocumented, and we have little insight about the nature of novel interventions currently being designed or delivered by cancer nurses.nnnOBJECTIVESnTo identify and synthesise the available evidence from clinical trials on interventions delivered or facilitated by cancer nurses.nnnDATA SOURCES AND REVIEW METHODSnA systematic review of randomised controlled trials (RCT), quasi-RCTs and controlled before and after studies (CBA) of cancer nursing interventions aimed at improving the experience and outcomes of PABC. Ten electronic databases (CENTRAL, MEDLINE, AMED, CINAHL, EMBASE, Epistemonikos, CDSR, DARE, HTA, WHO ICTRP) were searched between 01 January 2000 and 31 May 2016. No language restrictions were applied. Bibliographies of selected studies and relevant Cochrane reviews were also hand-searched. Interventions delivered by cancer nurses were classified according to the OMAHA System. Heat maps were used to highlight the volume of evidence available for different cancer groups, intervention types and stage of cancer care continuum.nnnRESULTSnThe search identified 22,450 records; we screened 16,169 abstracts and considered 925 full papers, of which 214 studies (247,550 participants) were included in the evidence synthesis. The majority of studies were conducted in Europe (nu202f=u202f79) and USA (nu202f=u202f74). Interventions were delivered across the cancer continuum from prevention and risk reduction to survivorship, with the majority of interventions delivered during the treatment phase (nu202f=u202f137). Most studies (131/214) had a teaching, guidance or counselling component. Cancer nurse interventions were targeted at primarily breast, prostate or multiple cancers. No studies were conducted in brain, sarcoma or other rare cancer types. The majority of the studies (nu202f=u202f153) were nurse-led and delivered by specialist cancer nurses (nu202f=u202f74) or advanced cancer nurses (nu202f=u202f29), although the quality of reporting was poor.nnnCONCLUSIONSnTo the best of our knowledge, this is the first review to synthesise evidence from intervention studies across the entire cancer spectrum. As such, this work provides new insights into the nature of the contribution that cancer nurses have made to evidence-based innovations, as well as highlighting areas in which cancer nursing trials can be developed in the future.

Peripheral cannulae in oncology: nurses’ confidence and patients’ experiences.

The insertion and care of peripheral intravenous cannulae (PIVCs) is a role performed by clinical staff that is fundamental to oncology. Previous research indicates nurses confidence and experience could mediate successful first attempt insertion, increasing the longevity of PIVCs and improving the patient experience. nThe aim of this audit was to provide a snapshot of care and maintenance of PIVCs, patients experiences and nurses confidence at a specialist cancer hospital. nAn audit tool assessing PIVC care practices (nu2009=u200951) and a patient experience questionnaire (nu2009=u200965) were completed. A questionnaire assessing nurses confidence and training needs was completed by 36 nurses. nThe findings raise some concerns about clinical practice when inserting PIVCs and ongoing care, with 80% adherence to cannulation policies. Almost half of insertion procedures failed at the first attempt and 17% of nurses lacked confidence in PIVC insertion and in recognising or responding to common complications. Patient satisfaction was high for ongoing PIVC care (95%), although some reported increased pain and anxiety after PIVC insertion, with some unresolved concerns. nThis audit highlights several important areas for improvement in relation to PIVC insertion and maintenance and the need for greater adherence to clinical guidelines/policy and additional training were identified.