RESUMO
BACKGROUND: Interest in the application of predictive risk models (PRMs) in health care to identify people most likely to experience disease and treatment-related complications is increasing. In cancer care, these techniques are focused primarily on the prediction of survival or life-threatening toxicities (eg, febrile neutropenia). Fewer studies focus on the use of PRMs for symptoms or supportive care needs. The application of PRMs to chemotherapy-related symptoms (CRS) would enable earlier identification and initiation of prompt, personalized, and tailored interventions. While some PRMs exist for CRS, few were translated into clinical practice, and human factors associated with their use were not reported. OBJECTIVE: We aim to explore patients' and clinicians' perspectives of the utility and real-world application of PRMs to improve the management of CRS. METHODS: Focus groups (N=10) and interviews (N=5) were conducted with patients (N=28) and clinicians (N=26) across 5 European countries. Interactions were audio-recorded, transcribed verbatim, and analyzed thematically. RESULTS: Both clinicians and patients recognized the value of having individualized risk predictions for CRS and appreciated how this type of information would facilitate the provision of tailored preventative treatments or supportive care interactions. However, cautious and skeptical attitudes toward the use of PRMs in clinical care were noted by both groups, particularly in relationship to the uncertainty regarding how the information would be generated. Visualization and presentation of PRM information in a usable and useful format for both patients and clinicians was identified as a challenge to their successful implementation in clinical care. CONCLUSIONS: Findings from this study provide information on clinicians' and patients' perspectives on the clinical use of PRMs for the management of CRS. These international perspectives are important because they provide insight into the risks and benefits of using PRMs to evaluate CRS. In addition, they highlight the need to find ways to more effectively present and use this information in clinical practice. Further research that explores the best ways to incorporate this type of information while maintaining the human side of care is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081.
Assuntos
Grupos Focais , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Adulto , Idoso , Neoplasias/tratamento farmacológico , Neoplasias/psicologia , Medição de Risco/métodos , Entrevistas como Assunto , Atitude do Pessoal de Saúde , Pesquisa Qualitativa , PercepçãoRESUMO
Breast cancer is now the most commonly diagnosed cancer worldwide. Approximately 30% of those who present with early breast cancer later develop advanced breast cancer (ABC). Additionally, approximately 6% have advanced breast cancer at diagnosis. New treatment options result in an extended lifespan dominated by cycles of deterioration and stable disease. Specialist nurse knowledge is key to multidisciplinary care of people with ABC; however, access to education on ABC for nurses is not universally available in Europe. This paper describes the development and implementation of an online bespoke program on ABC care for specialist and generalist nurses in Europe. The project team is affiliated with the European Oncology Nurses Society (EONS) and comprises specialist breast cancer nurses, oncology nurse academics and breast cancer advocates associated with EUROPA DONNA Turkey, an independent non-profit European breast cancer organisation. The program development involved (1) a systematic review of ABC educational resources for cancer nurses; (2) a modified four-round Delphi study to seek agreement on curriculum content and (3) curriculum development, conversion to an interactive online platform and translation into four European languages. The program evaluation will be guided by Kirkpatrick's framework. The phases described in this short report could guide others involved in developing bespoke cancer education programs.
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Neoplasias da Mama , Educação a Distância , Educação em Enfermagem , Enfermeiras e Enfermeiros , Humanos , Feminino , Competência Clínica , CurrículoRESUMO
The COVID-19 response introduced legal restrictions on social distancing globally, affecting healthcare staff personally and professionally. These restrictions suspended routine hospital visiting, which may have left staff feeling they had to compromise on the care they provided. Such conflict may be experienced as moral injury. This scoping review aimed to synthesise international evidence, to answer this question: "Have COVID-19 restrictions affected healthcare staff's experiences of moral injury? If so, how?" Nine studies met the search criteria. Although healthcare staff seemed to be aware of the risks and effects of moral injury, they were still reluctant to "name" it. Healthcare staff's own emotional and spiritual needs were mostly ignored. Although psychological support is often the recommended approach by organisations, a greater focus on spiritual and emotional support is recommended.
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COVID-19 , Transtornos de Estresse Pós-Traumáticos , Humanos , Atenção à SaúdeRESUMO
BACKGROUND: Patients hospitalised with COVID-19 have increased morbidity and mortality, which requires extensive involvement of specialist Hospital Palliative Care Teams. Evaluating the response to the surge in demand for effective symptom management can enhance provision of Palliative Care in this patient population. AIM: To characterise the symptom profile, symptom management requirements and outcomes of hospitalised COVID-19 positive patients referred for Palliative Care, and to contextualise Palliative Care demands from COVID-19 against a 'typical' caseload from 2019. DESIGN: Service evaluation based on a retrospective cohort review of patient records. SETTING/PARTICIPANTS: One large health board in Scotland. Demographic data, patient symptoms, drugs/doses for symptom control, and patient outcomes were captured for all COVID-19 positive patients referred to Hospital Palliative Care Teams between 30th March and 26th April 2020. RESULTS: Our COVID-19 cohort included 186 patients (46% of all referrals). Dyspnoea and agitation were the most prevalent symptoms (median 2 symptoms per patient). 75% of patients were prescribed continuous subcutaneous infusion for symptom control, which was effective in 78.6% of patients. Compared to a 'typical' caseload, the COVID-19 cohort were on caseload for less time (median 2 vs 5 days; p < 0.001) and had a higher death rate (80.6% vs 30.3%; p < 0.001). The COVID-19 cohort replaced 'typical' caseload; overall numbers of referrals were not increased. CONCLUSIONS: Hospitalised COVID-19 positive patients referred for Palliative Care may have a short prognosis, differ from 'typical' caseload, and predominantly suffer from dyspnoea and agitation. Such symptoms can be effectively controlled with standard doses of opioids and benzodiazepines.
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Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/enfermagem , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/mortalidade , Pneumonia Viral/enfermagem , Avaliação de Sintomas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Cuidados Paliativos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Escócia/epidemiologiaRESUMO
PURPOSE: Developing 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. METHODS: A 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. RESULTS: The 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. CONCLUSIONS: Nurse-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.
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Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Neoplasias Pulmonares/enfermagem , Enfermeiros Clínicos , Aceitação pelo Paciente de Cuidados de Saúde , Medidas de Resultados Relatados pelo Paciente , Encaminhamento e Consulta , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Grupos Focais , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/métodos , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/organização & administração , Humanos , Liderança , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Enfermeiros Clínicos/organização & administração , Enfermeiros Clínicos/normas , Projetos Piloto , Padrões de Prática em Enfermagem/organização & administração , Padrões de Prática em Enfermagem/normas , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normasRESUMO
Close monitoring of chemotherapy toxicity can be instrumental in ensuring prompt symptom management and quality care. Our aim was to develop a brief clinical tool to enable daily assessment of chemotherapy toxicity and investigate/establish its content validity, feasibility/applicability, internal consistency and stability. Development of the Daily Chemotherapy Toxicity self-Assessment Questionnaire (DCTAQ) was based on an initial item pool created from two scoping reviews. Expert panel review (n = 15) and cognitive debriefing with patients with cancer (n = 7) were used to establish content validity. Feasibility/acceptability, applicability (self-report vs. interview-like administration), internal consistency (KR-20) and test-retest reliability (at 1-hr intervals) of the DCTAQ were field-tested with 82 patients with breast or colorectal cancer receiving active chemotherapy at eight hospitals. Initial development/content validity stages enabled item revisions and re-wording that led to a final, 11-item DCTAQ version with 10 core symptom items plus one open-ended "any other symptom" item. Feasibility and acceptability were demonstrated through the absence of participant withdrawals, absence of missing data and no complaints about tool length. The DCTAQ was found to have modest internal consistency (KR-20 = 0.56), but very good test-retest reliability. The DCTAQ is a brief clinical tool that allows for rapid and accurate daily assessments of chemotherapy toxicity in clinical practice.
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Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias Colorretais/tratamento farmacológico , Monitoramento de Medicamentos/métodos , Adulto , Idoso , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/diagnóstico , Diarreia/induzido quimicamente , Diarreia/diagnóstico , Fadiga/induzido quimicamente , Fadiga/diagnóstico , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde , Reprodutibilidade dos Testes , Autorrelato , Transtornos de Sensação/induzido quimicamente , Transtornos de Sensação/diagnóstico , Inquéritos e Questionários , Vômito/induzido quimicamente , Vômito/diagnósticoRESUMO
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.
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Avaliação das Necessidades , Qualidade de Vida , Apoio Social , Sobreviventes/psicologia , Neoplasias do Colo do Útero/psicologia , Acesso à Informação , Feminino , Humanos , Saúde Mental , Assistência Centrada no Paciente , Relações Médico-Paciente , Neoplasias do Colo do Útero/terapia , Saúde da MulherRESUMO
BACKGROUND: Worldwide, bladder cancer (BC) has been regarded as the tenth most common cancer with more than 573 000 new cases in 2020. This research presents a systematic review and meta-analysis of studies examining the quality of life (QOL) among patients with BC. METHODS: The study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 11 articles were extracted from a literature search conducted through electronic databases including PubMed, EMBASE, Scopus and Web of Science from the onset of January 2000 to June 2022. A random-effects model was applied to estimate the pooled QOL in patients with BC. RESULTS: We included 11 primary studies in the final meta-analysis. Based on random effect analysis, total score of QOL was 53.92 (95% CI: 47.84 to 60) representing a moderate level of QOL among patients. Based on the analysis, it was found that physical items with a score of 49.82 (95% CI: 45.8 to 53.84) had a lower score in comparison with mental items at a score of 52 (95% CI: 49.54 to 54.47). In addition, the item of role limitations due to physical health with a score of 46.26 (95% CI: 20.11 to 72.41), and social functioning with a score of 46.25 (95% CI: 18.85 to 73.66), respectively, had the lowest QOL in patients with BC. CONCLUSION: Generally, the QOL among patients with BC was in a moderate condition, which can be improved through determining the influencing factors on QOL as a crucial strategy to define future treatment procedures in an effective manner.
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Qualidade de Vida , Neoplasias da Bexiga Urinária , HumanosRESUMO
PURPOSE: Caregiver burden considerably affects the lives of families providing care to people with advanced cancer. The aim of this study was to validate the Greek translation of the revised Bakas Caregiving Outcomes Scale (BCOS) with a sample of informal caregivers of people with advanced cancer receiving outpatient palliative radiotherapy. METHODS: Following a formal "forward-backward" method to translate the original BCOS into Greek, the scale was administered to 100 consecutive family caregivers. Participants also completed the Greek Hospital Anxiety and Depression Scale (G-HADS) and five quality-of-life related linear analogue scale assessment (LASA) scales. Validity and reliability analyses were performed. RESULTS: The Cronbach's α coefficient for the total BCOS score was 0.83. Test-retest reliability analysis in a subgroup of caregivers (n = 40) revealed good short-term stability over a 2-week interval. Exploratory factor analysis generated a one-factor structure for the Greek translation, which was further confirmed through confirmatory factor analysis. Construct validity was supported through the scale's high correlations with G-HADS anxiety (-0.524; p < 0.001) and depression (-0.533; p < 0.001) scores, and LASA quality of life scores (0.696; p < 0.001). The BCOS discriminated well between groups of caregivers with different levels of quality of life. A total score of 52.5 offered high sensitivity (91 %) and specificity (86 %) in detecting highly burdened caregivers. CONCLUSIONS: The Greek version of the BCOS is a psychometrically sound instrument that can be usefully implemented into clinical practice to identify family caregivers in need for support, and stimulate relevant research in our country.
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Cuidadores/psicologia , Neoplasias/radioterapia , Avaliação de Resultados em Cuidados de Saúde , Cuidados Paliativos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/métodos , Estudos Transversais , Análise Fatorial , Feminino , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Inquéritos e Questionários , Fatores de TempoRESUMO
OBJECTIVES: To present a comprehensive overview of key constructs of experimental and nonexperimental quantitative research, drawing on one example case from cancer care. DATA SOURCES: Published scientific articles, research textbooks, and expert advice were used in this article. CONCLUSION: Quantitative research turns information collected about people or about processes into numerical data. Depending on the underlying purpose, the goal is to address questions that have to do with intervention, prognosis, causation, association, description, or assessment. In experimental research, an intervention is manipulated. True experimental research (randomized controlled trial) controls confounding variables via use of both randomization and a control group; quasi-experimental research misses one or both of these elements. In either case, the aim is to generate evidence to confidently say that an intervention is the true cause of an observed outcome. Nonexperimental research is multifaceted. Cohorts and case-control studies can be used to test cause-and-effect relationships where experimental research is unethical or impractical. Correlational research aims to explore possible associations (exploratory) or help anticipate outcomes (predictive) and, quite often, is the precursor of experimental research. Descriptive research (simple, comparative, survey, retrospective chart review) can be used to describe and assess situations, conditions, or behaviors. IMPLICATIONS FOR NURSING PRACTICE: Understanding the different aims and goals of the different types of quantitative research can help increase capacity and confidence in understanding, appraising, and applying quantitative evidence among health care students, professionals, and novice researchers in the quest for the provision of quality cancer care.
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Neoplasias Bucais , Nicotiana , Humanos , Estudos Retrospectivos , Atenção à Saúde , Neoplasias Bucais/etiologia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: Family caregivers in West Java, Indonesia, care for their family members at home or in a shelter with limited sources. This study aims to establish the needs of family caregivers when providing informal care to family members with cancer in the resource-challenged context of West Java, Indonesia DATA SOURCES: This cross-sectional survey involved family caregivers, using convenience sampling. Data were collected using the Supportive Care Needs Survey-Partners and Caregivers, translated into Indonesian. Descriptive statistics were computed and reported. We recruited 220 individuals. Our typical participant was a married (49.5%), housewife (35.5%) with primary school level education (35.6%). Just more than half the sample were men (50.9%). Our participants had a mean age of 40.2 years, had been caregivers for a mean 1.2 years, and traveled a mean 164.7 km to accompany patients to medical appointments. Our participants reported unmet supportive care needs in all domains, except for sexuality. The topmost unmet need was finding out about financial support CONCLUSION: Our sample struggled to balance their living allowance and budget for cancer treatment. They also need information to care for their family. The need for financial support for patients and family caregivers was the most important finding. Our findings will be valuable in planning ahead to enhance the status of supportive and palliative care provided in West Java, Indonesia. IMPLICATIONS FOR NURSING PRACTICE: Flexible and comprehensive nurse-led interventions should be developed to support family caregivers fulfill their roles and sustaining their quality of life.
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Cuidadores , Neoplasias , Masculino , Humanos , Adulto , Feminino , Indonésia , Qualidade de Vida , Estudos Transversais , Apoio Social , Neoplasias/terapia , Família , Assistência ao Paciente , Necessidades e Demandas de Serviços de SaúdeRESUMO
OBJECTIVES: This article provides practical guidance on developing a comprehensible abstract, including those required for funding applications, conferences, and publication. In addition, we discuss and demonstrate the practicalities of editing and revising an abstract for conference or peer review and identify emerging formats that may be more relevant to nurses and researchers. DATA SOURCES: This article has been informed by literature and the coauthors' respective experiences of preparing and reviewing abstracts for publication and conference presentation. CONCLUSION: Abstracts are a valuable tool to communicate the most important elements of the methods and results of a research project for a conference, manuscript, or even a research funding application. However, abstracts may often be an overlooked part of the dissemination process. An abstract determines whether or not a piece of research is relevant for presentation at a conference or valuable enough to be considered for peer review and subsequent publication. A strong and clearly written abstract positively predisposes reviewers of grant applications. IMPLICATIONS FOR NURSING PRACTICE: Writing an abstract is arguably the most challenging component of academic writing, summarizing the results of a substantive research project in three to five sentences and positioning them concisely within the background and implications for future practice, policy, and research. A well-written abstract is clear, concise, and critical and requires time and revision to ensure success.
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Indexação e Redação de Resumos , Redação , Humanos , Revisão por Pares , IdiomaRESUMO
BACKGROUND: Patient-reported outcomes (PROs) are key indicators of health status and functioning, coming directly from the patient. Comprehensive monitoring of PROs enables implementation of person-centred care. Currently, the PROs that patients with advanced renal cell carcinoma (RCC) or hepatocellular carcinoma (HCC) consider of greatest importance remains unknown. METHODS: A rapid literature review was carried out to identify PROs commonly reported in clinical studies of patients with advanced RCC/HCC. We searched MEDLINE, CINAHL & PsycInfo for relevant peer-reviewed publications in the period from 2000 to 2021. Pre-specified selection criteria were applied to all retrieved records. Findings were integrated into a narrative synthesis. RESULTS: Eighty-one studies met our selection criteria and were retained. Most research was on advanced RCC (n = 64, 79%); 46 studies (57%) were drug trials. Only twenty-six studies (32%) employed PROs as their primary endpoint. Most PROs concerned physical symptoms (45% RCC, 54% HCC) and emotional wellbeing (19% RCC, 16% HCC). The most common outcome measured was quality of life (65% of the total), followed by fatigue (62%) and pain (54%). Whether selection of these PROs was patient-driven was not reported. CONCLUSIONS: A wide range of PROs were assessed. Deficits in PROs often cause patients to seek out help; however, which PROs matter the most to people with advanced RCC/HCC must be further clarified. Targeting, monitoring, and responding to the 'right' PROs can enhance provision of person-centred care in advanced RCC/HCC and augment the clinical efficacy of established and emerging targeted therapies.
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Carcinoma Hepatocelular , Carcinoma de Células Renais , Neoplasias Renais , Neoplasias Hepáticas , Humanos , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/patologia , Qualidade de Vida , Medidas de Resultados Relatados pelo Paciente , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/patologiaRESUMO
PURPOSE: This study is to evaluate healthcare needs, preferences, and expectations in supportive cancer care as perceived by cancer survivors, family caregivers, and healthcare professionals. METHODS: Key stakeholders consisted of cancer survivors diagnosed with breast cancer, prostate cancer, or melanoma; adult family caregivers; and healthcare professionals involved in oncology. Recruitment was via several routes, and data were collected via either online surveys or telephone interviews in Greece, Spain, Sweden, and the UK. Framework analysis was applied to the dataset. RESULTS: One hundred and fifty-five stakeholders participated: 70 cancer survivors, 23 family caregivers, and 62 healthcare professionals (13 clinical roles). Cancer survivors and family caregivers' needs included information and support on practical/daily living, as frustration was apparent with the lack of follow-up services. Healthcare professionals agreed on a multidisciplinary health service with a "focus on the patient" and availability closer to home. Most healthcare professionals acknowledged that patient-reported outcomes may provide "better individualised care". Cancer survivors and family caregivers generally felt that the digital platform would be useful for timely personalised support and aided communication. Healthcare professionals were supportive of the "proactive" functionality of the platform and the expected advantages. Anticipated challenges were integration obstacles such as workload/infrastructure and training/support in using the new technology. CONCLUSIONS: Obtaining key stakeholders' insights provided a foundation for action to further co-create the LifeChamps digital platform to meet needs and priorities and deliver enhanced supportive care to "older" cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Co-creation provided insight into gaps where digital support may enhance health and well-being.
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Neoplasias da Mama , Sobreviventes de Câncer , Adulto , Masculino , Humanos , Motivação , Cuidadores , Atenção à SaúdeRESUMO
OBJECTIVES: There is little research to help health care professionals understand what patient outcomes are considered a priority in advanced liver or kidney cancer. Knowing what is important to patients can help promote person-centered approaches to treatment and disease management. The aim of this study was to identify those patient-reported outcomes (PROs) that patients, carers, and health care professionals consider as "core" when providing care to those with advanced liver or kidney cancer. DATA SOURCES: A three-round Delphi study was undertaken to ask experts by profession or experience to rank PROs identified from a previous literature review. Fifty-four experts, including people living with advanced liver or kidney cancer (44.4%), family members and caregivers (9.3%), and health care professionals (46.8%), reached consensus on 49 PROs including 12 new items (eg, palpitations, hopefulness, or social isolation). Items with the highest rate of consensus included quality of life, pain, mental health, and capacity to do daily activities. CONCLUSION: People living with advanced liver or kidney cancer experience complex health care needs. Some important outcomes were not actually captured in practice in this population and were suggested as part of this study. There are discrepancies between the views of health care professionals, patients, and family in what is important, highlighting the need of using measures to facilitate communication. IMPLICATIONS FOR NURSING PRACTICE: Identification of priority PROs reported here will be key to facilitate more focused patient assessments. The actual use of measures in cancer nursing practice to allow monitoring of PROs must be tested for feasibility and usability.
Assuntos
Carcinoma Hepatocelular , Carcinoma de Células Renais , Neoplasias Renais , Neoplasias Hepáticas , Humanos , Qualidade de Vida , Carcinoma de Células Renais/terapia , Técnica Delphi , Neoplasias Hepáticas/terapia , Medidas de Resultados Relatados pelo Paciente , Neoplasias Renais/terapiaRESUMO
OBJECTIVES: To navigate the field of digital cancer care and define and discuss key aspects and applications of big data analytics, artificial intelligence (AI), and data-driven interventions. DATA SOURCES: Peer-reviewed scientific publications and expert opinion. CONCLUSION: The digital transformation of cancer care, enabled by big data analytics, AI, and data-driven interventions, presents a significant opportunity to revolutionize the field. An increased understanding of the lifecycle and ethics of data-driven interventions will enhance development of innovative and applicable products to advance digital cancer care services. IMPLICATIONS FOR NURSING PRACTICE: As digital technologies become integrated into cancer care, nurse practitioners and scientists will be required to increase their knowledge and skills to effectively use these tools to the patient's benefit. An enhanced understanding of the core concepts of AI and big data, confident use of digital health platforms, and ability to interpret the outputs of data-driven interventions are key competencies. Nurses in oncology will play a crucial role in patient education around big data and AI, with a focus on addressing any arising questions, concerns, or misconceptions to foster trust in these technologies. Successful integration of data-driven innovations into oncology nursing practice will empower practitioners to deliver more personalized, effective, and evidence-based care.
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Inteligência Artificial , Neoplasias , Humanos , Big Data , Oncologia , Tecnologia Digital , Neoplasias/terapiaRESUMO
BACKGROUND: Specialist nursing care is a core indicator of quality care for people living with advanced breast cancer. However, access to and quality of nurse education programmes in advanced breast cancer is variable. OBJECTIVES: This study aims to define the topics for inclusion in an international curriculum for an advanced breast cancer education programme. METHODS: A modified four-round Delphi study was undertaken with experts by profession and experience in advanced breast cancer. Thirty-four topics related to advanced breast cancer and six online teaching and learning methods were pre-selected following a systematic review. Between September 2021 and March 2022, the expert panel determined the importance of topics for inclusion in the education programme. Consensus was defined by at least 80 % agreement on the highest three points on a 9-point Likert scale. RESULTS: A total of 31 experts participated in rounds 1-3 of this study, and 156 experts by profession and experience participated in an additional fourth round, including people living with advanced breast cancer (n = 72, 46 %), healthcare professionals (n = 46, 29 %), family members or caregivers of a person diagnosed with advanced breast cancer (n = 30, 19 %) and advocacy professionals working in the area of advanced breast cancer (n = 8, 5 %). In round 4, 36 topics and five of six learning methods reached consensus. CONCLUSIONS: The results of this study provide a framework to develop education programmes in advanced breast cancer, defining the essential elements of curriculum content for such programmes. The results highlight the need for advanced breast cancer education programmes to use multiple teaching and learning methods to promote nurses' understanding of person-centred supportive care and the physical, psychosocial and spiritual issues experienced by people living with advanced breast cancer.
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Neoplasias da Mama , Enfermeiras e Enfermeiros , Humanos , Feminino , Consenso , Técnica Delphi , Competência Clínica , CurrículoRESUMO
PURPOSE: Identifying cancer nursing research priorities is central to influencing the direction of cancer care research. The aim of this rapid review was to explore research priorities identified by oncology nurses for cancer care delivery between 2019 and 2022. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis informed the design of the rapid review. MEDLINE, CINAHL, PUBMED, Web of Science, and Cochrane databases were searched for studies published between December 1st, 2018, and September 30th, 2022. This timeframe was chosen to account for the latest relevant evidence synthesis, as well as changes in cancer care necessitated by the COVID-19 pandemic. The Quality Assessment of Diverse Studies tool was used to appraise quality. RESULTS: Four studies met the inclusion criteria. Many of the research priorities identified were influenced by the COVID-19 pandemic. The top cancer nursing research priority identified was the role of technology in improving patient and caregiver symptoms and health outcomes. Other most prevalent research priorities were focused on symptom management, culturally sensitive palliative and psychosocial care, early/integrated palliative care, financial toxicity, modifiable risk factors related to social determinants of health, public and patient involvement in research, and oncology nurses' well-being and scope of practice. CONCLUSION: The findings indicate a need to steer a strategic programme of cancer nursing research towards digitalisation in cancer care to meet the current needs of people living with cancer and their caregivers. However, cancer nurses' burnout, staff shortages and disparities in specialist education will hinder the implementation of certain models of care.
Assuntos
COVID-19 , Neoplasias , Humanos , Pandemias , Enfermagem Oncológica , Cuidados Paliativos , Atenção à SaúdeRESUMO
OBJECTIVES: To provide an overview of three consecutive stages involved in the processing of quantitative research data (ie, data management, analysis, and interpretation) with the aid of practical examples to foster enhanced understanding. DATA SOURCES: Published scientific articles, research textbooks, and expert advice were used. CONCLUSION: Typically, a considerable amount of numerical research data is collected that require analysis. On entry into a data set, data must be carefully checked for errors and missing values, and then variables must be defined and coded as part of data management. Quantitative data analysis involves the use of statistics. Descriptive statistics help summarize the variables in a data set to show what is typical for a sample. Measures of central tendency (ie, mean, median, mode), measures of spread (standard deviation), and parameter estimation measures (confidence intervals) may be calculated. Inferential statistics aid in testing hypotheses about whether or not a hypothesized effect, relationship, or difference is likely true. Inferential statistical tests produce a value for probability, the P value. The P value informs about whether an effect, relationship, or difference might exist in reality. Crucially, it must be accompanied by a measure of magnitude (effect size) to help interpret how small or large this effect, relationship, or difference is. Effect sizes provide key information for clinical decision-making in health care. IMPLICATIONS FOR NURSING PRACTICE: Developing capacity in the management, analysis, and interpretation of quantitative research data can have a multifaceted impact in enhancing nurses' confidence in understanding, evaluating, and applying quantitative evidence in cancer nursing practice.
Assuntos
Gerenciamento de Dados , Projetos de Pesquisa , Humanos , Coleta de DadosRESUMO
OBJECTIVES: LifeChamps is an EU Horizon 2020 project that aims to create a digital platform to enable monitoring of health-related quality of life and frailty in patients with cancer over the age of 65. Our primary objective is to assess feasibility, usability, acceptability, fidelity, adherence, and safety parameters when implementing LifeChamps in routine cancer care. Secondary objectives involve evaluating preliminary signals of efficacy and cost-effectiveness indicators. DATA SOURCES: This will be a mixed-methods exploratory project, involving four study sites in Greece, Spain, Sweden, and the United Kingdom. The quantitative component of LifeChamps (single-group, pre-post feasibility study) will integrate digital technologies, home-based motion sensors, self-administered questionnaires, and the electronic health record to (1) enable multimodal, real-world data collection, (2) provide patients with a coaching mobile app interface, and (3) equip healthcare professionals with an interactive, patient-monitoring dashboard. The qualitative component will determine end-user usability and acceptability via end-of-study surveys and interviews. CONCLUSION: The first patient was enrolled in the study in January 2023. Recruitment will be ongoing until the project finishes before the end of 2023. IMPLICATIONS FOR NURSING PRACTICE: LifeChamps provides a comprehensive digital health platform to enable continuous monitoring of frailty indicators and health-related quality of life determinants in geriatric cancer care. Real-world data collection will generate "big data" sets to enable development of predictive algorithms to enable patient risk classification, identification of patients in need for a comprehensive geriatric assessment, and subsequently personalized care.