Susan Williamson

Comparing hospital and telephone follow-up after treatment for breast cancer: randomised equivalence trial

Objective To compare traditional hospital follow-up with telephone follow-up by specialist nurses after treatment for breast cancer. Design A two centre randomised equivalence trial in which women remained in the study for a mean of 24 months. Setting Outpatient clinics in two NHS hospital trusts in the north west of England Participants 374 women treated for breast cancer who were at low to moderate risk of recurrence. Interventions Participants were randomised to traditional hospital follow-up (consultation, clinical examination, and mammography as per hospital policy) or telephone follow-up by specialist nurses (consultation with structured intervention and mammography according to hospital policy). Main outcome measures Psychological morbidity (state-trait anxiety inventory, general health questionnaire (GHQ-12)), participants’ needs for information, participants’ satisfaction, clinical investigations ordered, and time to detection of recurrent disease. Results The 95% confidence interval for difference in mean state-trait scores adjusted for treatment received (−3.33 to 2.07) was within the predefined equivalence region (−3.5 to 3.5). The women in the telephone group were no more anxious as a result of foregoing clinic examinations and face-to-face consultations and reported higher levels of satisfaction than those attending hospital clinics (intention to treat P<0.001). The numbers of clinical investigations ordered did not differ between groups. Recurrences were few (4.5%), with no differences between groups for time to detection (median 60.5 (range 37-131) days in hospital group v 39.0 (10-152) days in telephone group; P=0.228). Conclusions Telephone follow-up was well received by participants, with no physical or psychological disadvantage. It is suitable for women at low to moderate risk of recurrence and those with long travelling distances or mobility problems and decreases the burden on busy hospital clinics. Trial registration National Cancer Research Institute 1477.

An exploratory randomized controlled trial comparing telephone and hospital follow-up after treatment for colorectal cancer.

Aim Following treatment for colorectal cancer it is common practice for patients to attend hospital clinics at regular intervals for routine monitoring, although debate persists on the benefits of this approach. Nurse‐led telephone follow‐up is effective in meeting information and psycho‐social needs in other patient groups. We explored the potential benefits of nurse‐led telephone follow‐up for colorectal cancer patients.

Patient experiences of nurse-led telephone follow-up following treatment for colorectal cancer.

PURPOSE Colorectal cancer is the third most prevalent cancer worldwide, although mortality rates across most of Europe have decreased in recent years. Historically, patients are asked to return to hospital outpatient clinics following treatment to monitor for disease progression. However, new approaches are being called for that focus on meeting the information and support needs of patients. Telephone follow-up (TFU) by specialist nurses is an alternative approach; this study aimed to explore patient views of TFU. METHODS Qualitative interviews were conducted with 26 colorectal cancer patients who had received TFU. One interview was also conducted with the specialist nurse who had used a structured intervention to provide TFU. Data were analysed using content analysis. RESULTS All patients found TFU to be a positive experience and all stated a preference for continuing with TFU. Three main themes emerged from the patient interviews; 1) accessible and convenient care, 2) personalised care, and 3) relationship with the specialist nurse. The themes from the specialist nurse interview were 1) knowing the patient, 2) the benefits of TFU and 3) the challenges of TFU. CONCLUSIONS TFU was well received by patients; it was perceived as highly convenient and had distinct advantages over hospital follow-up. Continuity of care was an important factor in building a trusting relationship between patient and nurse. Training in the use of the intervention is recommended and it may be useful for specialist nurses to initially meet eligible patients face to face to establish rapport before implementing TFU.

Comparing hospital and telephone follow‐up for patients treated for stage–I endometrial cancer (ENDCAT trial): a randomised, multicentre, non‐inferiority trial

To evaluate the effectiveness of nurse‐led telephone follow‐up (TFU) for patients with stage–I endometrial cancer.

What do measures of patient satisfaction with the doctor tell us

OBJECTIVE To gain an understanding of how patient satisfaction (PS) with the doctor (PSD) is conceptualized through an empirical review of how it is currently being measured. The content of PS questionnaire items was examined to (a) determine the primary domains underlying PSD, and (b) summarize the specific doctor-related characteristics and behaviors, and patient-related perceptions, composing each domain. METHODS A scoping review of empirical articles that assessed PSD published from 2000 to November 2013. MEDLINE and PsycINFO databases were searched. RESULTS The literature search yielded 1726 articles, 316 of which fulfilled study inclusion criteria. PSD was realized in one of four health contexts, with questions being embedded in a larger questionnaire that assessed PS with either: (1) overall healthcare, (2) a specific medical encounter, or (3) the healthcare team. In the fourth context, PSD was the questionnaires sole focus. Five broad domains underlying PSD were revealed: (1) Communication Attributes; (2) Relational Conduct; (3) Technical Skill/Knowledge; (4) Personal Qualities; and (5) Availability/Accessibility. CONCLUSIONS Careful consideration of measurement goals and purposes is necessary when selecting a PSD measure. PRACTICE IMPLICATIONS The five emergent domains underlying PSD point to potential key areas of physician training and foci for quality assessment.

Telephone follow-up after treatment for endometrial cancer: A qualitative study of patients' and clinical nurse specialists' experiences in the ENDCAT trial

PURPOSE Endometrial cancer is the sixth most common female cancer worldwide. There is little evidence that routine hospital surveillance increases survival or decreases morbidity following treatment. Gynaecology Oncology clinical nurse specialists (CNSs) are ideally placed to provide the care, information and support to enable women with a gynaecological cancer to self-manage and live well. A multi-centre randomised controlled trial (RCT) compared hospital follow-up (HFU) with telephone follow-up (TFU) by CNSs. The structured telephone intervention focused on information provision to meet patients psychosocial and information needs. This study aimed to explore the views of women who had received TFU and the CNSs who had delivered the service. METHOD A qualitative study to complement the RCT using semi-structured interviews was conducted. Twenty-five patients were randomly selected from participants in the TFU arm stratified by study site. Seven CNSs were interviewed. RESULTS Patient and CNS regarded TFU positively; Three themes emerged from the patient interviews; Convenient Care, Discrete Personalised Care, Confidence and Reassurance. Themes arising from the CNS interviews were Patient Centred Care, Holistic Care and, Confidence and Skills. Patients found that TFU with CNSs was convenient and enabled discussion of issues and information provision at time-points relevant to them. The CNSs found the structured format of TFU enabled them to utilise their skills and knowledge to identify and meet patients holistic needs. CONCLUSIONS Alternative models of care such as TFU provided by CNSs provides the care, information and support to enable women treated for endometrial cancer to self-manage and live well.

“It’s not just about prostate cancer, it’s about being a gay man”: A qualitative study of gay men’s experiences of healthcare provision in the UK

Following a diagnosis of prostate cancer, men require information and support from healthcare providers which is tailored to their individual needs. Studies reporting on the needs of gay men with prostate cancer, and their experiences of healthcare provision, are lacking. This study highlights the issues affecting this group of men and the implications for healthcare delivery in the United Kingdom. In-depth interviews were conducted with 12 gay men who had been diagnosed with prostate cancer. A phenomenological approach was used to collect and analyse data. Participants wanted, and expected, candid discussions with healthcare professionals, about how prostate cancer could affect their lives, sexual function, and how to access culturally relevant support before and after treatment. Participants perceived that their healthcare team had little knowledge about their needs, and if, or how, their experience differed due to their sexual orientation. Information provided was perceived as being misplaced or informed by heteronormative assumptions. Consideration should be given to requesting sexual orientation when recording patient information, if patients are willing to disclose. Training should be provided for healthcare professionals to enable them to provide information and support that is culturally relevant at all stages of the consultation.

85% of women with breast cancer reported changes to sexual well-being, with most wanting information on these changes

Commentary on: Ussher JM, Perz J, Gilbert E. Information needs associated with changes to sexual well-being after breast cancer. J Adv Nurs 2013;69:327–37.[OpenUrl][1][CrossRef][2][PubMed][3] Cancer treatment affects sexuality and physical intimacy during and often long after completion of treatment, with many cancer survivors suffering from permanent sexual dysfunction.1 ,2 However, discussions relating to the effect of cancer treatment on sexual function are rarely initiated by healthcare professionals either prior to treatment or during routine follow-up.1–4 … [1]: {openurl}?query=rft.jtitle%253DJ%2BAdv%2BNurs%26rft.volume%253D69%26rft.spage%253D327%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fj.1365-2648.2012.06010.x%26rft_id%253Dinfo%253Apmid%252F22500731%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1111/j.1365-2648.2012.06010.x&link_type=DOI [3]: /lookup/external-ref?access_num=22500731&link_type=MED&atom=%2Febnurs%2F17%2F2%2F34.atom

Abstracts; ENDCAT: Endometrial Cancer Telephone follow-up trial

BACKGROUND: The World Health Organisation reports that cancer mortality rates in developing African countries are rising because late diagnosis limits treatment options. In the UK there is evidence of inequalities in the delivery of cancer services to black and minority ethnic groups contributing to deaths from late diagnoses. UK studies of the African population are limited and focus on the African Caribbean community. Hence, UK cancer prevention strategies may not account for the African population’s cultural beliefs or attitudes towards cancer; this may affect awareness of the signs and symptoms. AIM: To identify evidence-based information about African immigrants’ views regarding cancer. METHODS: Six databases were searched: Academic Search Complete, AMED, CINAHL, MEDLINE, PsycInfo, and Soc Index. The literature search was extended to include grey literature and a search of reference lists of relevant studies. Publications not written in English were excluded. RESULTS: Six qualitative, nine quantitative, and one mixed method study were identified; all except two were conducted in the USA. The majority indicated that African people had low levels of knowledge about cancer risk factors, signs and symptoms. Misconceptions, cultural and religious belief and fear appear to influence African people’s views towards cancer; this may affects their behaviour in terms of seeking treatment. CONCLUSION: This review demonstrates a need for UK based studies to determine the relevance of review findings towards, and fill the gaps in knowledge about, the growing UK based African population.

An Exploration of the Psychosocial Impact of Prostate Cancer on Gay Men: A Review of Current Literature

BACKGROUND: The World Health Organisation reports that cancer mortality rates in developing African countries are rising because late diagnosis limits treatment options. In the UK there is evidence of inequalities in the delivery of cancer services to black and minority ethnic groups contributing to deaths from late diagnoses. UK studies of the African population are limited and focus on the African Caribbean community. Hence, UK cancer prevention strategies may not account for the African population’s cultural beliefs or attitudes towards cancer; this may affect awareness of the signs and symptoms. AIM: To identify evidence-based information about African immigrants’ views regarding cancer. METHODS: Six databases were searched: Academic Search Complete, AMED, CINAHL, MEDLINE, PsycInfo, and Soc Index. The literature search was extended to include grey literature and a search of reference lists of relevant studies. Publications not written in English were excluded. RESULTS: Six qualitative, nine quantitative, and one mixed method study were identified; all except two were conducted in the USA. The majority indicated that African people had low levels of knowledge about cancer risk factors, signs and symptoms. Misconceptions, cultural and religious belief and fear appear to influence African people’s views towards cancer; this may affects their behaviour in terms of seeking treatment. CONCLUSION: This review demonstrates a need for UK based studies to determine the relevance of review findings towards, and fill the gaps in knowledge about, the growing UK based African population.