This report describes a recruitment strategy, including the employment and training of dedicated clinical recruiters, to improve recruitment to lifestyle interventions during breast cancer treatment.
This report describes a recruitment strategy, including the employment and training of dedicated clinical recruiters, to improve recruitment to lifestyle interventions during breast cancer treatment.
While many authors recommend the clinical use of psychoeducational interventions (PEI), the nature of such interventions varies widely and evidence for their effectiveness far from conclusive. Critical appraisals of the quality of review articles are warranted to consolidate the available evidence on the effectiveness of PEI.
This paper aims at critically reviewing 13 review articles of PEI that were published from 1985–2005. Knowledge gaps and lessons learnt from previous studies are identified to guide future studies.
The 13 review articles were selected through a systematic approach and clearly defined criteria. A checklist was used for appraising these review articles. Items of the checklist included purpose, search and inclusion criteria, qualitative assessment, quantitative assessment, differences, results and conclusion, and comments.
A total of 809 primary studies were included in the 13 reviews. Most reviews provided a clear and comprehensive description of their search methods and inclusion criteria. Ten out of thirteen reviews provided detailed and adequate data on the studies reviewed. Eight reviews did not pool or meta-analyze the results of these studies.
There was evidence that the effectiveness of patient education and progressive muscle relaxation (PMR) has been found to be positive and there was support for their clinical use. The overall effectiveness of PEI was inconclusive because a mixture of interventions was studied and both significant and non-significant results had been reported. Future large-scale studies focusing on some commonly used interventions such as PMR, education, and counseling are recommended. Special consideration is given to the selection of understudied subjects, the selection of well-defined intervention and control, the selection of outcome measures and the research design.
The Nursing and Midwifery Council (NMC), the regulatory body in the UK, is in the process of opening a new part of the register for Advanced Nurse Practitioners. This presents a potential opportunity for clinical research nurses within cancer care.
To explore the role of the clinical research nurse in cancer care whilst considering whether the role can be performed at a level that could be considered advanced practice. Consequently, a developmental model to enable the clinical research nurse to work towards an advanced level of practice is explored.
A literature review of the clinical research role in cancer care and analysis of published frameworks of advancing practice in nursing.
Advanced practice is not defined by the role but by the level of skill to which it is performed. There is scope within the role of the clinical research nurse to practice at a level beyond initial registration. A framework for development towards advanced practice within the cancer clinical research nurse role is suggested.
Advanced practice within clinical research nursing is possible and provides a further level of career development that may facilitate movement between research and clinical practice. This could aid awareness, recruitment and retention of research staff within cancer care and other specialities.
The North Trent Cancer Research Network’s Consumer Research Panel (NTCRN CRP) was established in December 2001 by the Academic Unit of Supportive Care at the University of Sheffield, UK. In three years, the CRP has succeeded in nurturing a climate of sustainable consumer involvement within the NTCRN and this has become embedded in the culture of the network. Furthermore, the Panel have championed a sustainable development of consumer involvement in health and social care research by testing new ground and forging a new way of working between health professionals and patients and carers. This UK based CRP model has been held up as an example to other cancer networks, with new Panels being set up around the country to emulate its success. This paper describes the Sheffield model of patient and public involvement and using the eight key principles of successful consumer involvement in research, identified in a recent paper by Telford and colleagues (Telford, R., Boote, J., Cooper, C., 2004. What does it mean to involve consumers successfully in NHS research? A consensus study. Health Expectations, 7, 209–220), provides a useful framework for analysing the work of the Panel. This demonstrates how consumers and professionals can inform each other to work constructively to achieve impressive research results. The need for measurable outcomes to assess the impact and effect of consumer involvement is explored.
The telephone is increasingly used in healthcare to provide valuable psychological support and information for patients and can provide an alternative to face to face consultations. As many patients with lymphoedema become ‘experts’ in the management of their condition, requiring minimal contact with their therapist, the use of the telephone to provide an alternative option to regular follow-up appointments was explored. A project was designed to promote and investigate a more patient focused approach to lymphoedema management according to clinical need and to offer patients an alternative to conventional follow-up clinic appointments enabling resources to be utilised more efficiently. Three hundred and thirteen patients with mild, uncomplicated lymphoedema were telephoned by a lymphoedema therapist prior to the allocation of an appointment. An assessment tool was used to promote discussion of key areas of lymphoedema management relevant to the patient. Outcomes of the project highlighted the value of this approach to follow-up, its valued convenience for some patients and positive impact upon workload planning and delivery.
As cancer survival rates continue to improve, it is necessary to consider the needs of those who will have completed treatment and must return to life out with the relative safety of the hospital. Recent policy initiatives, such as the NICE (2004) Supportive & Palliative Care Guidelines. http://www.nice.org.uk. Accessed 07/05/2006., provide a vehicle to examine the rehabilitation services available and ensure they are provided as effectively as possible. The lack of available research evidence on this topic suggests the need for a program of studies adopting an evaluative focus. The experiences of one specialist cancer setting are used in the paper to illustrate the approach adopted to promote the values of patient-centered cancer rehabilitation. It is argued that further investment is needed to ensure that all cancer patients receive adequate rehabilitation and long-term support following episodes of acute cancer care.
The purpose of this paper is to describe patients’ self-reported symptom occurrence, symptom intensity and symptom distress at post-treatment of cancer therapy. A total of 243 outpatients with heterogeneous solid tumours within 12 months following the completion of initial cancer treatment (chemotherapy or radiotherapy) were assessed using the Chinese version of the Memorial Symptom Assessment Scale (MSAS). The mean age of the sample was 54.2 ± 12 and over half (57.6%) were women. The most common diagnoses were breast cancer (26.3%) and colon cancer (23.5%). The median number of symptoms per patient was 8 (range 0–23 symptoms) and the most prevalent were dry mouth (49.8%), lack of energy (46.9%), worry (39.1%), pain (35%) and feeling drowsy (33.7%). The mean symptom severity and distress scores measured on the MSAS were 1.92 ± 0.2 (range 1.7–2.3) and 1.37 ± 0.3 (.9–2), respectively. The prevalence of certain symptoms was influenced by the primary site of cancer. Pain, worrying and difficulty in swallowing were the most clinically important symptoms. In conclusion, intense physical and psychological symptoms were highly prevalent and distressing to cancer survivors. Comprehensive symptoms assessment is a requisite toward effective symptom control.
The Hospital Anxiety and Depression Scale (HADS) [Zigmond, A.S., and Snaith, R.P., 1983. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandanavia 67, 361–370] is the most widely used instrument in oncology settings, however, its accuracy as a screening tool for minor and major depression is unclear.
A comprehensive search of the literature was conducted in order to identify primary studies examining the sensitivity and specificity of the HADS-Depression (HADS-D) subscale, when compared to a ‘gold standard’ interview to obtain psychiatric diagnosis.
Ten studies were identified. Estimates of sensitivity and specificity varied across the studies reflecting the heterogeneity of study populations and methodology. However, results suggest that [Zigmond, A.S., and Snaith, R.P., 1983. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandanavia 67, 361–370] recommended threshold of 11 for detecting ‘probable’ depression may need to be revised. Depending on disease and treatment status, lower threshold scores may be necessary for adequately detecting ‘caseness’ without necessarily compromising specificity.
The HADS-D should be used as a screening tool with caution, since recommended cut-off thresholds may result in under-recognition of depression among cancer patients. An integrated patient-centred approach is needed if screening for depression in cancer patients is to be truly effective.
To develop and evaluate a pilot multi disciplinary education and support group programme for patients with fatigue post cancer treatment.
Mixed method feasibility study.
Programme comprised face-to-face nursing assessment followed by 3 support and information giving workshops. Workshops delivered large group support and small group discussion with therapists of participants’ choice. Therapists included a clinical psychologist, nurse, dietician, physiotherapist and occupational therapist.
Six subjects with breast cancer.
The Brief Fatigue Inventory, Hospital Anxiety and Depression Scale, and the European Organisation for Research and Treatment of Cancer QLQ C30. Participants completed these prior to, immediately after, and six weeks following, the programme. They also completed a programme evaluation by telephone.
Preliminary results indicate the programme provided information, support and management strategies for fatigue specifically, and living with cancer generally. Patients appreciated the opportunity to share their experiences whilst at the same time gaining particular help and advice for their own specific problems and concerns. Whilst not reducing the level of fatigue there was some evidence that impact on function was lessened.
Whilst the number of participants was small, findings from this study are sufficiently encouraging to warrant continuing this service development and its evaluation.
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