Current Issue : October - December Volume : 2016 Issue Number : 4 Articles : 7 Articles
The quality of cancer care may be compromised in the near future because of\nwork force issues. Several factors will impact the oncology health provider work\nforce: an aging population, an increase in the number of cancer survivors, and\nexpansion of health care coverage for the previously uninsured. Between October\n2014 and March 2015, an electronic literature search of English language articles\nwas conducted using PubMedÃ?®, the Cumulative Index to Nursing and Allied\nHealth Sciences (CINAHLÃ?®), Web of Science, Journal Storage (JSTORÃ?®), Google\nScholar, and SCOPUSÃ?®. Using the scoping review criteria, the research question\nwas identified ââ?¬Å?How much care in oncology is provided by nurse practitioners\n(NPs)?ââ?¬Â Key search terms were kept broad and included: ââ?¬Å?NPââ?¬Â AND ââ?¬Å?oncologyââ?¬Â\nAND ââ?¬Å?workforceââ?¬Â. The literature was searched between 2005 and 2015, using\nthe inclusion and exclusion criteria, 29 studies were identified, further review\nresulted in 10 relevant studies that met all criteria. Results demonstrated that\nNPs are utilized in both inpatient and outpatient settings, across all malignancy\ntypes and in a variety of roles. Academic institutions were strongly represented\nin all relevant studies, a finding that may reflect the Accreditation Council for\nGraduate Medical Education (ACGME) duty work hour limitations. There was\nno pattern associated with state scope of practice and NP representation in this\nscoping review. Many of the studies reviewed relied on subjective information,\nor represented a very small number of NPs. There is an obvious need for an\nobjective analysis of the amount of care provided by oncology NPs....
Background: Challenges exist in recruitment to trials involving interventions delivered by different clinical specialties.\nCollaboration is required between clinical specialty and research teams. The aim of this study was to explore how\nteamwork influences recruitment to a multicentre randomised controlled trial (RCT) involving interventions\ndelivered by different clinical specialties.\nMethods: Semi-structured interviews were conducted in three centres with a purposeful sample of members of\nthe surgical, oncology and research teams recruiting to a feasibility RCT comparing definitive chemoradiotherapy\nwith chemoradiotherapy and surgery for oesophageal squamous cell carcinoma. Interviews explored factors\nknown to influence healthcare team effectiveness and were audio-recorded and thematically analysed. Sampling,\ndata collection and analysis were undertaken iteratively and concurrently.\nResults: Twenty-one interviews were conducted. Factors that influenced how team working impacted upon trial\nrecruitment were centred on: (1) the multidisciplinary team (MDT) meeting, (2) leadership of the trial, and (3) the\nrecruitment process. The weekly MDT meeting was reported as central to successful recruitment and formed the\nfocus for creating a ââ?¬Ë?study teamââ?¬â?¢, bringing together clinical and research teams. Shared study leadership positively\ninfluenced healthcare professionalsââ?¬â?¢ willingness to participate. Interviewees perceived their clinical colleagues to\nhave strong treatment preferences which led to scepticism regarding whether the treatments were being\ndescribed to patients in a balanced manner.\nConclusions: This study has highlighted a number of aspects of team functioning that are important for\nrecruitment to RCTs that span different clinical specialties. Understanding these issues will aid the production of\nguidance on team-relevant issues that should be considered in trial management and the development of\ninterventions that will facilitate teamwork and improve recruitment to these challenging RCTs....
This study aimed to analyze the concept of nursing care to patients with breast cancer on chemotherapy\ntreatment, according to the perspective of the person submitted to care. The study followed\nthe conceptual analysis methodology proposed by Walker and Avant according to Waldow,\nand it was developed through consultation to SCOPUS and CINAHL databases. The selection was\ncarried out by inclusion and exclusion criteria, constituting a sample of 7 articles. There have been\nidentified the main uses of the risk concept, defining attributes, antecedents and consequences of\nthe concept. The evaluation of the concept and nursing care to breast cancer patient on chemotherapy\ntreatment allowed a broader understanding of the phenomenon, with emphasis on the\nskills and competencies in nursing care dispensed to woman on chemotherapy treatment for breast\ncancer....
Objective: Evaluate user satisfaction before and after taking the Pap. Methodology: Observational\nand prospective study. It was carried out in two health centers in San Luis Potosicity, Mexico in 93\nusers which attended for a Pap test from February to June 2015. The satisfaction was assessed using\nmultidimensional scaling SERVQUAL whit 5 dimensions to evaluate the quality of services in\nan organization: reliability, responsibility, security, empathy and touchable and materials goods\n(tangible elements). This scaling was obtained internal consistency by Cronbach�s alpha coefficient\nwith a value of 0.74. For data analysis, nonparametric test Wilcoxon for related samples was\nused. Results: In all cases, perspective was less than expectancy where the means of the scores\nbefore attention (expectation) and after care (perspective) there was a statistically significant difference\n(p = 0.000). Before receiving care users had an expectation of 192.96 points, after care\nperspective score dropped to 184.49 points indicating that the care provided was not what they\nexpected. The difference in scores was 8.47 points (p = 0.004). Conclusions: Users of the screening\nprogram for cervical cancer were unsatisfied because the attention was not what they expected. In\nmost of the indicators studied, a high percentage of dissatisfaction was obtained....
Background: Men with localized prostate cancer often have unrealistic expectations. Practitioners are poor judges\nof men�s preferences, contributing to preference misdiagnosis and unwarranted practice variation. Patient decision\naids (PtDAs) can support men with decisions about localized prostate cancer. This is a comparative case study of\ntwo strategies for implementing PtDAs in clinical pathways for men with localized prostate cancer, evaluating (a)\nPtDA use; (b) impact on men, practitioners, and health system outcomes; and (c) factors influencing sustained use.\nMethods/design: Guided by the Knowledge to Action Framework, this comparative case study will be conducted\nusing administrative data, interviews, and surveys. Cases will be bound by geographic location (one hospital in\nOntario; province of Saskatchewan) and time. Eligible participants will be all men newly diagnosed with localized\nprostate cancer, with outcomes assessed using administrative data and interviews. Nurses, urologists, radiation\noncologists, and managers will be surveyed and a smaller sample interviewed. Cases will be established for each\nsetting with findings compared across cases. Changes in the proportions of men given the PtDA over 2 years will\nbe determined from administrative data. Factors associated with receiving the PtDA will be explored using\nmultivariable logistic regression analysis. To assess the impact of the PtDA, outcomes will be described using mean\nand standard deviation (men�s decisional conflict) and frequency and proportions (practitioners consulted, uptake of\ntreatment). To estimate the effect of the PtDA on these outcomes, adjusted mean differences and odds ratios will\nbe calculated using exploratory multivariable general linear regression and binary or multinomial logistic regression.\nFactors influencing sustained PtDA use will be assessed using descriptive analysis of survey findings and thematic\nanalysis of interview transcripts.\nDiscussion: Determining how to embed PtDAs effectively within clinical pathways for men with localized prostate\ncancer is essential. PtDAs have the potential to strengthen men�s active role in making prostate cancer decisions,\nenhance uptake of shared decision-making by practitioners, and reduce practice variation. Our team of researchers\nand knowledge users will use findings to improve current PtDA use and consider scaling-up implementation....
Background: Cancers are a leading cause of death worldwide. People with mental illness are 30 % more likely to die\nfrom cancer than the general population. One reason for this may be low uptake of nationally offered cancer screening\ntests by people with mental illness. We aimed to identify barriers and facilitators for breast, cervical and bowel cancer\nscreening uptake by people with mental illness in order to inform interventions to promote equal access.\nMethods: The interview study was conducted in both urban and rural settings. The study was informed by the\nTheoretical Domains Framework, using framework analysis and triangulation across participant groups. Participants\nincluded 45 mental health service users (service users) eligible for cancer screening, 29 mental health professionals and\n11 professionals involved in cancer screening.\nResults: Themes emerging from the data that affected uptake included knowledge of screening programmes by both\nservice users and healthcare providers; knowledge of, and attitudes towards, mental illness; health service-delivery\nfactors; service users� beliefs and concerns about cancer screening, and practical issues. These are relevant to different\nstages of the screening process. Service users do not receive invitations to screening or cancer testing kits if they are\nadmitted to hospital. They are not routinely invited for screening if they are not registered with a general practitioner\n(GP). Lack of integrated care means that mental health staff do not know if someone is overdue for a test and cancer\nscreening is often not considered during health promotion. Barriers including information processing problems, the\nextent to which the screening process aggravates symptoms, poor staff client relationships and travel difficulties vary\nbetween individuals. Screening professionals are motivated to help, but may lack time or training to manage mental\nhealth needs. Reactive measures are available, but service users must request help which they may find difficult.\nConclusions: There are specific barriers to cancer screening uptake for mental health service users that prevent\nequality of care. Interventions that can be personalised are needed at individual, policy and service-delivery levels.\nPrimary and secondary care staff and policy-makers should work together to develop an integrated approach to\ncancer screening in this population....
Background: Radiotherapy for localised prostate cancer has many known and distressing side effects. The efficacy\nof group interventions for reducing psychological morbidity is lacking. This study investigated the relative benefits\nof a group nurse-led intervention on psychological morbidity, unmet needs, treatment-related concerns and\nprostate cancer-specific quality of life in men receiving curative intent radiotherapy for prostate cancer.\nMethods: This phase III, two-arm cluster randomised controlled trial included 331 men (consent rate: 72 %; attrition:\n5 %) randomised to the intervention (n = 166) or usual care (n = 165). The intervention comprised four group and\none individual consultation all delivered by specialist uro-oncology nurses. Primary outcomes were anxious and\ndepressive symptoms as assessed by the Hospital Anxiety and Depression Scale. Unmet needs were assessed with\nthe Supportive Care Needs Survey-SF34 Revised, treatment-related concerns with the Cancer Treatment Scale and\nquality of life with the Expanded Prostate Cancer Index âË?â??26. Assessments occurred before, at the end of and 6\nmonths post-radiotherapy. Primary outcome analysis was by intention-to-treat and performed by fitting a linear\nmixed model to each outcome separately using all observed data.\nResults: Mixed models analysis indicated that group consultations had a significant beneficial effect on one of two\nprimary endpoints, depressive symptoms (p = 0.009), and one of twelve secondary endpoints, procedural concerns\nrelated to cancer treatment (p = 0.049). Group consultations did not have a significant beneficial effect on\ngeneralised anxiety, unmet needs and prostate cancer-specific quality of life.\nConclusions: Compared with individual consultations offered as part of usual care, the intervention provides a\nmeans of delivering patient education and is associated with modest reductions in depressive symptoms and\nprocedural concerns. Future work should seek to confirm the clinical feasibility and cost-effectiveness of group\ninterventions....
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