"Promoting continuity of care"-Specialist nurses' role experiences in gynaecological oncology: A qualitative study.

AIMS AND OBJECTIVES: To investigate the experiences of specialist nurses in Switzerland concerning their role of caring for women with gynaecological cancer. BACKGROUND: Women with gynaecological cancer often face complex situations, which require an integrative and quality-assured approach by the healthcare system. Specialist nurses can play an important role in supporting these patients. However, in countries where the role of specialist nurses is at a developmental stage, their role lacks clarity. DESIGN: A qualitative descriptive design was chosen to gain insights into experiences of specialist nurses who care for women with gynaecological cancer. METHODS: We conducted three focus groups with 12 specialist nurses to access their experiences with regard to their role. Thematic qualitative text analysis was used to interpret the results. RESULTS: Divided into six main themes, the study results describe specialist nurses' (1) current and (2) aspired role. (A) Counselling, (B) guidance, (C) key contact person and (D) team support are relevant themes in their current role. The themes (E) provision of resources and (F) extended knowledge are relevant to their aspired role. Within their current and aspired roles, the specialist nurses' scope of practice is defined as "promoting continuity of care." CONCLUSIONS: The results indicate aspects of specialist nurses' current and aspired roles. Detailed role descriptions and legal requirements are necessary to further support nurses towards an extended and specialised practice. In the context of gynaecological cancer survivors, services should be developed, where specialist nurses can play an important role in providing continuous care. RELEVANCE TO CLINICAL PRACTICE: To support implementation of specialist nursing in clinical practice, resources have to be mobilised and role descriptions should be provided. By creating an appropriate framework, the specialist nurse can turn into an important support for women with gynaecological cancer, in addition to current healthcare services.

Are written information or counseling (WOMAN-PRO II program) able to improve patient satisfaction and the delivery of health care of women with vulvar neoplasms? Secondary outcomes of a multicenter randomized controlled trial / Können schriftliche Informationen oder eine Beratung (WOMAN-PRO II Programm) bei Frauen mit vulvären Neoplasien die Patientenzufriedenheit und den Versorgungsprozess verbessern? Sekundäre Outcomes einer multizentrischen randomisiert kontrollierten Studie

Background: Patients with vulvar neoplasms report a lack of information, missing support in self-management and a gap in delivery of health care. Aim: The aim of the study was to investigate if written information or counseling based on the WOMAN-PRO II program are able to improve patient satisfaction and the delivery of health care from the health professional's perspective of women with vulvar neoplasms. Method: Patient satisfaction and the delivery of health care have been investigated as two secondary outcomes in a multicenter randomized controlled parallel-group phase II study (Clinical Trial ID: NCT01986725). In total, 49 women, from four hospitals (CH, AUT), completed the questionnaire PACIC-S11 after written information (n = 13) and counseling (n = 36). The delivery of health care was evaluated by ten Advanced Practice Nurses (APNs) by using the G-ACIC before and after implementing counseling based on the WOMAN-PRO II program. Results: There were no significant differences between the two groups identified (p = 0.25). Only few aspects were rated highly by all women, such as the overall satisfaction (M = 80.3 %) and satisfaction with organization of care (M = 83.0 %). The evaluation of delivery of health care by APNs in women who received counseling improved significantly (p = 0.031). Conclusions: There are indications, that the practice of both interventions might have improved patient satisfaction and counseling the delivery of health care. The aspects that have been rated low in the PACIC-S11 and G-ACIC indicate possibilities to optimize the delivery of health care.

Recommendations for symptom management in women with vulvar neoplasms after surgical treatment: An evidence-based guideline.

PURPOSE: To develop an evidence-based guideline for nurses and other health care professionals involved in pre- and postsurgical care of women with vulvar cancer (VC) or vulvar intraepithelial neoplasia (VIN). METHODS: This evidence-based guideline was developed according to six domains of the methodological framework AGREE II. Literature research with focus on cancer care, symptom management and self-management/counselling was conducted from April to August 2013 in the databases CINAHL, Cochrane Library, PsycINFO, PubMed as well as in 14 international guideline databases. Interdisciplinary experts (n = 14) were involved in the development of the guideline from December 2013 to January 2014. This guideline is currently tested in the WOMAN-PRO II RCT (Clinical Trial No: NCT01986725). RESULTS: For the definition of recommendations, five guidelines, one meta-analysis, two systematic reviews and two randomized controlled trials were included. In total, 24 recommendations were formulated to answer 22 clinical questions based on patients' perspective and experts' opinion. Evidence ranged from 3.5 to 5 (3.5 = weak evidence and/or clinical relevance, 5 = best evidence and/or clinical relevance). The recommendations were subsumed under different themes regarding physical, psychological and psychosocial aspects. CONCLUSIONS: The clinical practice guideline developed in this study firstly provides recommendations for symptom management issues focusing on self-management interventions for women with VC or VIN. As an interdisciplinary guideline it should be used in addition to the existing medical guideline in the German speaking context.