Grigorios Kotronoulas

Nurses’ knowledge, attitudes, and practices regarding provision of sexual health care in patients with cancer: critical review of the evidence

BackgroundThe experience of living with cancer is associated with a variety of consequences in several central aspects of a patient’s quality of life, including intimacy, body image, human relationships, sexuality, and fertility. Despite their importance, incidence, and impact on psychosocial well-being, sexual health care (SHC) is a matter not frequently dealt with by nurses in daily practice.Goals of workThe purpose of this study was to gather evidence regarding knowledge, attitudes, and behaviors of oncology nurses toward sexual health issues and to identify salient and latent key factors which influence provision of SHC in the context of cancer.Materials and methodsA critical review of the literature was conducted over a period of three decades and 18 original research articles were retrieved and analyzed.ResultsA comprehensive data analysis revealed that, although oncology nurses hold relatively liberal attitudes and recognize provision of sexual health care as an important nursing role, they possess limited sexual knowledge and communication skills, while often avoid or fail to effectively respond to patients’ sexual concerns. Nine possible influential key factors have been studied: incorrect assumptions toward sexual issues, comfort, sexual knowledge, professional nursing role, patient- and nurse-related issues, work environment-related issues, continuing education activities, and society-related factors. Conflicting findings are reported.ConclusionsThe findings of the present study propose that there is an evident need of dispelling the myths about sexual health in cancer care. Besides, continuing education activities and availability of education materials could assist nurses to adequately address sexual concerns while caring for patients with cancer.

A systematic review of the supportive care needs of women living with and beyond cervical cancer

BACKGROUND Women with cervical cancer constitute a patient population in need for ongoing, person-centred supportive care. Our aim was to synthesise current available evidence with regard to the supportive care needs of women living with and beyond cervical cancer. METHODS A systematic review was conducted according to the PRISMA Statement guidelines. Seven electronic databases (DARE, Cochrane, MEDLINE, CINAHL, BNI, PsychINFO and EMBASE) were searched to identify studies employing qualitative and/or quantitative methods. Pre-specified selection criteria were applied to all records published between 1990 and 2013. Methodological quality evaluation was conducted using the standardised QualSyst evaluation tool. Findings were integrated in a narrative synthesis. FINDINGS Of 4936 references initially retrieved, 15 articles (13 unique studies) met eligibility criteria. One study fell below a pre-specified 55% threshold of methodological quality and was excluded. Individual needs were classified into ten domains of need. Interpersonal/intimacy (10; 83.3%), health system/information (8; 66.7%), psychological/emotional (7; 58.3%) and physical needs (6; 50%) were those most frequently explored. Spiritual/existential (1; 8.3%), family-related (2; 16.7%), practical (2; 16.7%), and daily living needs (2; 16.7%) were only rarely explored. Patient-clinician communication needs and social needs were addressed in 4 studies (33.3%). Dealing with fear of cancer recurrence, concerns about appearance/body image, lack of sexual desire, requiring more sexuality-related information, dealing with pain, and dealing with difficulties in relationship with partner were the most frequently cited individual needs (≥4 studies). CONCLUSIONS Despite a host of additional needs experienced by women with cervical cancer, a predominant focus on sexuality/intimacy and information seeking issues is noted. Study limitations preclude drawing conclusions as to how these needs evolve over time from diagnosis to treatment and subsequently to survivorship. Whether demographic or clinical variables such as age, race/ethnicity, disease stage or treatment modality play a moderating role, only remains to be answered in future studies.

Development of a Novel Remote Patient Monitoring System: The Advanced Symptom Management System for Radiotherapy to Improve the Symptom Experience of Patients With Lung Cancer Receiving Radiotherapy

Background: The use of technology-enhanced patient-reported outcome measures to monitor the symptoms experienced by people with cancer is an effective way to offer timely care. Objective: This study aimed to (a) explore the feasibility and acceptability of the Advanced Symptom Management System with patients with lung cancer receiving radiotherapy and clinicians involved in their care and (b) assess changes in patient outcomes during implementation of the Advanced Symptom Management System with patients with lung cancer receiving radiotherapy in clinical practice. Methods: A repeated-measures, single-arm, mixed-methods study design was used involving poststudy interviews and completion of patient-reported outcome measures at baseline and end of treatment with 16 patients with lung cancer and 13 clinicians who used this mobile phone–based symptom monitoring system. Results: Only rarely did patients report problems in using the handset and they felt that the system covered all relevant symptoms and helped them to manage their symptoms and effectively communicate with clinicians. Clinical improvements in patient anxiety, drowsiness, and self-care self-efficacy were also observed. Clinicians perceived the use of “real-time” risk algorithms and automated self-care advice provided to patients as positively contributing to clinical care. Reducing the complexity of the system was seen as important to promote its utility. Conclusions: Although preliminary, these results suggest that monitoring patient symptoms using mobile technology in the context of radiotherapy for lung cancer is feasible and acceptable in clinical practice. Implications for practice: Future research would be most beneficial if the use of this technology was focused on the postradiotherapy phase and expanded the scope of the system to encompass a wider range of supportive care needs.

A critical review of women's sleep-wake patterns in the context of neo-/adjuvant chemotherapy for early-stage breast cancer

Complaints of poor nocturnal sleep and daytime dysfunction may be frequent among women receiving chemotherapy for breast cancer. A critical review of the literature was conducted, which aimed at summarising and critically analysing findings regarding sleep in women with early-stage breast cancer across neo-/adjuvant chemotherapy treatment. A systematic search of three electronic databases (Medline, CINAHL, EMBASE) was conducted from January 1980 to July 2011. Twenty-one articles reporting on 12 studies were included for analysis based on pre-specified selection criteria. Varying deficits in sleep parameters may be evident in a significant part of this population. Yet, research data are not equally distributed among the different sleep components, or across all major time points throughout chemotherapy. More systematic investigation of the experience of disrupted sleep in this population with longitudinal mixed-methods studies is warranted to ensure that person-tailored and clinically meaningful care is delivered.

Sleep patterns and sleep-impairing factors of persons providing informal care for people with cancer: a critical review of the literature.

Background: Sleep is increasingly recognized as an area of functioning that may be greatly affected in persons who are practically and emotionally involved in the care of patients with cancer. Clinician awareness is required to ensure that effective care for informal caregivers with sleep problems is provided. Objective: A 2-fold critical review of the published literature was conducted, which aimed at summarizing and critically analyzing evidence regarding sleep patterns of informal caregivers of adults with cancer and contributing factors to sleep-wake disturbances. Methods: Using a wide range of key terms and synonyms, 3 electronic databases (MEDLINE, CINAHL, EMBASE) were systematically searched for the period between January 1990 and July 2011. Results: Based on prespecified selection criteria, 44 articles were pooled to provide evidence on sleep-impairing factors in the context of informal caregiving, 17 of which specifically addressed sleep patterns of caregivers of people with cancer. Conclusions: At least 4 of 10 caregivers may report at least 1 sleep problem. Short sleep duration, nocturnal awakenings, wakefulness after sleep onset, and daytime dysfunction seem to be the areas most affected irrespective of stage or type of disease, yet circadian activity remains understudied. In addition, despite a wide spectrum of potential sleep-impairing factors, underlying causal pathways are yet to be explored. Implications for Practice: More longitudinal, mixed-methods, and comparison studies are warranted to explore caregiver sleep disorders in relation to the gravity of the caregiving situation in the context of diverse types of cancer and disease severity.

The eSMART study protocol: a randomised controlled trial to evaluate electronic symptom management using the advanced symptom management system (ASyMS) remote technology for patients with cancer

Introduction While some evidence exists that real-time remote symptom monitoring devices can decrease morbidity and prevent unplanned admissions in oncology patients, overall, these studies have significant methodological weaknesses. The electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology (eSMART) study is designed to specifically address these weaknesses with an appropriately powered, repeated-measures, parallel-group stratified randomised controlled trial of oncology patients. Methods and analysis A total of 1108 patients scheduled to commence first-line chemotherapy (CTX) for breast, colorectal or haematological cancer will be recruited from multiple sites across five European countries. Patients will be randomised (1:1) to the ASyMS intervention (intervention group) or to standard care currently available at each site (control group). Patients in the control and intervention groups will complete a demographic and clinical questionnaire, as well as a set of valid and reliable electronic patient-reported outcome measures at enrolment, after each of their CTX cycles (up to a maximum of six cycles) and at 3, 6, 9 and 12 months after completion of their sixth cycle of CTX. Outcomes that will be assessed include symptom burden (primary outcome), quality of life, supportive care needs, anxiety, self-care self-efficacy, work limitations and cost effectiveness and, from a health professional perspective, changes in clinical practice (secondary outcomes). Ethics and dissemination Ethical approval will be obtained prior to the implementation of all major study amendments. Applications will be submitted to all of the ethics committees that granted initial approval. eSMART received approval from the relevant ethics committees at all of the clinical sites across the five participating countries. In collaboration with the European Cancer Patient Coalition (ECPC), the trial results will be disseminated through publications in scientific journals, presentations at international conferences, and postings on the eSMART website and other relevant clinician and consumer websites; establishment of an eSMART website (www.esmartproject.eu) with publicly accessible general information; creation of an eSMART Twitter Handle, and production of a toolkit for implementing/utilising the ASyMS technology in a variety of clinical practices and other transferable health care contexts. Trial registration number NCT02356081.

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.

Feasibility and acceptability of the use of patient-reported outcome measures in the delivery of nurse-led, supportive care to women with cervical cancer

Purpose/Aims: Patient-reported outcome measures (PROMs) can be effectively used to uncover the unmet needs of women with cervical cancer for supportive care. Our aim was to explore the feasibility and acceptability of PROM-driven, nurse-led consultations to enhance delivery of supportive care to women with cervical cancer during active anticancer treatment. Design: A 2-phased, mixed-method prospective study was conducted. Main research variables included feasibility and acceptability parameters of the trialed intervention. Methods: Preconsultation PROM data were collected during 3 consecutive monthly consultations and used by the gynecology cancers nurse specialist (CNS) to deliver personalized supportive care. The problem checklist and Cervical Cancer Concerns Questionnaire were used to aid data collection. Findings: Because of considerable recruitment challenges, a recruitment rate of 27% (3/11 patients) was achieved. Two patients completed all 3 study assessments. Seven in-clinic patient assessments were performed over 6 months. The study participants praised the opportunity for dedicated time for patients to raise concerns and for the CNS to provide sensitive and personalized support. Conclusion: Women with cervical cancer perceive important benefits from participating in PROM-driven, time-protected sessions with their CNS. Our findings provide tentative evidence to support the feasibility and acceptability of this intervention model and warrant future confirmation. Implications for Practice:Use of patient-reported outcome measures (PROMs) to identify the unmet needs of women with cervical cancer is acceptable and must be implemented from the point of diagnosis.Cancer nurse specialists (CNS) are receptive to and able to act on PROM information, rendering them key professionals in addressing the supportive care needs of people with cancer.Women with cervical cancer perceive important benefits from participating in PROM-driven, time-protected, and private sessions with their CNS.

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

PurposeDeveloping 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.MethodsA 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.ResultsThe 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.ConclusionsNurse-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.

Personal domains assessed in multiple mini interviews (MMIs) for healthcare student selection: A narrative synthesis systematic review

OBJECTIVES To examine the personal domains multiple mini interviews (MMIs) are being designed to assess, explore how they were determined and contextualise such domains in current and future healthcare student selection processes DESIGN: A systematic review of empirical research reporting on MMI model design was conducted from database inception to November 2017. DATA SOURCES Twelve electronic bibliographic databases. REVIEW METHODS Evidence was extracted from original studies, and integrated in a narrative synthesis guided by the PRISMA statement for reporting systematic reviews. Personal domains were clustered into themes using a modified Delphi technique. RESULTS A total of 584 articles were screened. 65 unique studies (80 articles) matched our inclusion criteria of which seven were conducted within nursing/midwifery faculties. Six in 10 studies featured applicants to medical school. Across selection processes, we identified 32 personal domains assessed by MMIs, the most frequent being: communication skills (84%), teamwork/collaboration (70%), and ethical/moral judgement (65%). Domains capturing ability to cope with stressful situations (14%), make decisions (14%), and resolve conflict in the workplace (13%) featured in fewer than ten studies overall. Intra- and inter-disciplinary inconsistencies in domain profiles were noted, as well as differences by entry level. MMIs deployed in nursing and midwifery assessed compassion and decision-making more frequently than in all other disciplines. Own programme philosophy and professional body guidance were most frequently cited (~50%) as sources for personal domains; a blueprinting process was reported in only 8% of studies. CONCLUSIONS Nursing, midwifery and allied healthcare professionals should develop their theoretical frameworks for MMIs to ensure they are evidence-based and fit-for-purpose. We suggest a re-evaluation of domain priorities to ensure that students who are selected, not only have the capacity to offer the highest standards of care provision, but are able to maintain these standards when facing clinical practice and organisational pressures.