Cruickshank S (2014) The effectiveness of an intervention by specialist breast care nurses to address the perceived needs and enhance the quality of life of women with breast cancer receiving follow-up care: A randomised controlled trial, Doctor of Philosophy, Edinburgh Napier University.
Approximately 550,000–570,000 women are alive in the UK who have had a diagnosis of breast cancer with further predictions that this will rise by 3% annually. Most of these women will be receiving follow-up care in a hospital setting and the value of this approach has been questioned for a number of years. Women transition from a very individual, personalised treatment plan to follow-up care which is not organised around individual patient need. Rather a blanket approach is used which does not consider age, risk profile, treatment or need. There is evidence that the current out-patient follow-up provision does not meet the physical, psychological and information needs of women with breast cancer, with women leaving the clinic with unmet needs. While the aim of follow-up is multifactorial, including the provision of psychosocial care, there is little evidence of how this service assesses and addresses unmet needs.
The current study sought to examine the effectiveness of providing patient reported needs and psychosocial information to the Specialist Breast Care Nurse at the breast cancer follow-up clinic in reducing cancer needs and improving quality of life compared to standard care. The primary outcome was a change in needs scored at baseline (time 1) and 12 months (time 2). The study also aimed to investigate a number of secondary outcomes namely changes in quality of life at baseline and 12 months, as well as looking at possible effects of the intervention on variables such as age, severity of treatment and time since diagnosis.
This study was a prospective single blind randomised controlled trial (RCT) involving 93 women who had completed primary treatment for breast cancer and were attending follow-up in a hospital setting. Women were randomised to receive standard follow-up care (control) or a nurse-delivered intervention. The intervention was structured and guided by the self-reported needs and psychosocial information provided by the woman and coupled with a person-centred conversation. This conversation explored the options for the intervention, desire of the woman for assistance and best way to provide it.
There were high levels of need, anxiety and depression among women attending the follow-up clinic. There was a statistically significant fall in level of need, anxiety and depression in both groups after the intervention. However, no differences between groups in relation to the primary outcome; changes in needs between baseline and time 2, were seen. Quality of life scores fell in both groups; however only the overall quality of life score showed a statistically significant difference between groups in relation to the secondary outcome, changes in quality of life over time.
The results of this study have shown that using patient-reported needs and psychological information by the specialist breast care nurse in the follow-up clinic to inform an intervention proved to be no better than standard care, but neither is there sufficient evidence to state it was worse. This study has contributed to the methodological evidence base regarding the development and measurement of complex interventions in nursing practice.
Thesis is available from here.
breast cancer; needs; unmet needs; nurse; follow-up
|Supervisors||Donaldson J, Raeside R, Gray M, Barber M|
|Institution||Edinburgh Napier University|
|Qualification||Doctor of Philosophy|