Changes in cancer services to out-patient care have resulted in patients spending limited time in hospital. The use of IT within healthcare has seen the development of innovative ways to support patients in the community. This study aimed to test the procedures and technical systems involved in using an advanced symptom management system (ASyMS) in the home monitoring and symptom management of patients receiving chemotherapy. Ten patients were recruited from two centres in Scotland. Patients in the intervention group used the mobile phone to record and send their symptom reports to their hospital and receive self-care advice, while the control group received standard care. A risk model was developed which alerted health professionals of symptoms that were severe or life threatening. Patient and professional perceptions were evaluated throughout. Patients believed that the ASyMS system improved the management of their symptoms and felt reassured they were being monitored at home. Health professionals also found the system beneficial in the management of symptoms and the promotion of timely interventions. The full randomised controlled trial is now underway. The ASyMS system has the potential to improve the management of symptoms in patients with cancer receiving chemotherapy.
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.
Within this paper a review of the literature on the area of reflection and reflective practice is presented. Lecturers at Trinity College Dublin currently face a dilemma with regard to including these concepts in the nursing curricula. They are faced on the one hand with national recommendations for the use of reflection and reflective practice, and on the other with personal and professional concerns about the practical, legal, ethical and moral implications raised in teaching and assessing this subj ect. The literature reveals that there is little consensus of opinion regarding the exact nature of reflection. There is also little empirical evidence to support the benefits of teaching and assessing of reflection or reflective practice from either an educational or clinical perspective. This, together with the practical difficulties of teaching and assessing reflection, may negate against the incorporation of reflection and reflective practice into the nursing curriculum. It is suggested that, rathe r than isolate reflection as a distinct topic, that the skills of critical thinking, problem solving, self-awareness and analysis be developed within the curriculum.
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.
This article describes the initial development and testing of an educational needs assessment tool for patients with arthritis in the UK. Following formative development of the tool, the study took the form of a test–retest questionnaire study. Participants were asked to complete the tool on two occasions, separated by two weeks, to assess reliability. Subjects were recruited from the out-patient department of a district general hospital in the north of England. The sample consisted of 97 patients with arthritis recruited consecutively from a rheumatology out-patient department. Scores from the questionnaire were the main outcome measure used. Additional variables included gender, age, educational level, and duration of disease. The tool was well received by patients. Higher scores, indicating greater educational needs, were recorded by women, older people, those with lower levels of education, and those with shorter disease duration. The greatest educational needs were in the domain of information about arthritis itself. The tool demonstrated good test–retest reliability. The tool showed some validity and reliability, and was acceptable to patients. Further development work is needed if the tool is to be used in interventional studies.
The relationship of self-esteem to other indicators of psychological distress such as anxiety and depression has seldom been explored in relation to antenatal care. However, there is increasing evidence that low self-esteem has a significant negative impact on a variety of health outcomes during pregnancy and following delivery. The current study investigated the predictive ability of self-esteem, assessed by self-report questionnaire, in predicting the psychological status of women early in pregnancy. A cross-sectional study design was used with all observations taken on one occasion. Participants were recruited from two hospital antenatal clinics and a community antenatal clinic. A convenience sample of 129 women recruited consecutively from the above settings at 14 weeks gestation. The adult version of the Culture-Free Self-Esteem Inventory version 2 (CFSEI-2) and self-report measures of anxiety and depression. Personal self-esteem was found to be a significant predictor of psychological status in terms of both anxiety and depression. It is concluded that self-esteem is an easily assessed, but clinically useful psychological domain that health professionals should consider during their encounters with this clinical group.
To assess surgical patient education interventions and to explore the outcomes of experimental and quasiexperimental studies from 1990 to 2003. Systematic literature review. Database searches were carried out in May and September 2003 on Medline and Cochrane Library files from 1990 to 2003, using the inclusion criteria of adult surgical patients, patient education in experimental and quasiexperimental studies, English language and nursing. Data analysis in September–October 2003 focused on assessing the interventions and the outcomes of the studies. The database search yielded 32 articles involving 2723 participants. Most of the interventions concerned preoperative surgical patient education and focused on cardiological patients. The most common outcome measures were experiential related (87.5%) and cognitive related (59%). None of the studies measured social or ethical aspects of patient education. Half of the studies (50%) reported both statistically significant and non-significant outcomes. There were also a number of studies (41%) which reported no statistically significant findings. Educational interventions may have many positive effects, but it is difficult unequivocally to demonstrate those effects. This review did produce some evidence on the effectiveness of patient education, but more rigorous research with strict intervention designs and measures is still needed.
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.
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 purpose of the study was to refine and validate the self-medication risk assessment instrument for use as a reliable screening method to identify people who may have difficulty managing their medication safely. Specific objectives of the study were to demonstrate the reliability of the instrument. The study, using a correlational design, was designed to test inter- and intra-rater reliability of the instrument using a sample of 45 patients and 45 pairs of assessors. Each pair of assessors assessed the same patient on the same day and one of the original assessors returned to reassess the patient approximately one week later. The data collection took place in Acute medical and Community Rehabilitation settings and via Community Nursing, Pharmacy and Social Care staff in Hull and the East Riding of Yorkshire. 45 patients and 45 pairs of assessors from Nursing, Pharmacy and Social Care backgrounds. Reliability of the instrument when used by different and same assessors and identification of key risk factors related to self-medication risk assessment. The instrument has demonstrated strong inter- and intra-rater reliability for both outcome of assessment findings and risk category. Three key elements of the assessment criteria, mental state, attitude and knowledge about medications and severe visual impairment demonstrated a high level of criterion validity. The self-medication assessment instrument shows promise in terms of reliability but further testing is required to demonstrate its validity and the possible weighting of individual items in the instrument.
Cancer and its treatment place significant demands on the nutritional status of patients. This can be exacerbated by admission to hospital. The study aimed to identify factors that are barriers and facilitators to oncology in-patients receiving adequate nutrition in an acute cancer unit. Qualitative non-participant observational techniques were used to explore practice relating to nutrition. The study was carried out on two 30 bedded wards in a UK cancer centre. Five observations, each lasting three hours, were conducted on each of the wards. Framework analysis techniques were used to analyse the data. Nutrition was influenced by a complex interaction of factors relating to both the physical and social environment. Characteristics of each of these were identified. In the hospital setting nutrition takes place in a context that balances the needs of the individual patient with the needs of the organisation, the busyness of the ward and staff schedules. The ongoing formal and informal assessment of the range of barriers and facilitators to nutrition may influence nutritional intake. A positive and proactive culture around food may also be important.