Patients' outcomes related to person-centred nursing care in radiation oncology: A case study
Introduction
Patients undergoing a course of radiation therapy face a series of challenges ranging from the physical to the psychosocial. Each person will react differently to the radiation based on a range of treatment and tumour-related toxicities and personal factors (Holland, 2007, Carper, 2007). Appropriate care for these patients requires health professionals to address the various domains of their personal well-being across the course of the radiation therapy. This supportive care occurs within the context of the multidisciplinary team, but it is often the nurse who is a primary source of contact and the person that initiates referrals to other health professionals (Honea, 2007, Rose and Yates, 2013).
Radiation therapy may be used to treat many cancers either alone or in combination with other treatment modalities, such as surgery, chemotherapy, targeted or hormonal therapies (Wilkes and Hartshorn, 2009). The vast majority of patients undergo a course of radiation therapy as outpatients, and therefore require specific information and support to manage the treatment toxicities beyond the hospital setting (Iwamoto et al., 2012, Haas, 2010). The physical side effects of radiotherapy are the result of the cumulative radiation dose to normal tissues surrounding the targeted tumour area, and can be both acute, occurring during the radiation therapy, or late, occurring some time, even years, after the completion of treatment (Rose, 2011). Patients and their families may have limited knowledge about these toxicities, and can therefore lack the skills, abilities and personal resources to manage and minimise these side effects effectively. Patients may also need reassurance and support to manage the psychoemotional aspects of radiation therapy (Gosselin-Acomb, 2006, Carper and Haas, 2006, Semple et al., 2008), and they may be coping with the residual or concurrent effects of other treatment modalities (Mallick and Waldron, 2009). Important considerations for these patients, therefore, include being able to maintain their quality of life, being properly informed to manage the side effects of the radiation therapy, and feeling comfortable in their decision-making about treatment (McMenamin et al., 2014; Katz, 2007).
As well as having to manage the potential treatment toxicities, patients also need to deal with the complexities of the care environment. Hospital environments, according to Kolcaba et al. (2006:543), can be perceived as ‘comfort places’, encompassing both positive and negative aspects. Given the high-technology and unfamiliar nature of radiation oncology settings, patients may be especially concerned about their treatment. It is therefore important to provide a comfort environment despite the ‘high-tech’ nature of the department. This may occur through the interpersonal nature of care in this setting (Rose and Yates, 2013, Suhonen et al., 2011).
Nursing in the radiotherapy setting is an integral component of supportive care that assists patients to manage the various issues that arise throughout the course of the radiation therapy (Iwamoto et al., 2012). Radiation oncology nurses work closely with other health professionals to support the patient and their family, and they provide specialist clinical nursing care, education, information, counselling and referral (Rose and Yates, 2013, Katz, 2007). Radiation and medical oncology technologies and treatment regimens continuously change as a result of new technologies and clinical trials, and it is important that nurses are knowledgeable and specialised to practise in this setting. They need to translate this knowledge for the patients/careers and also integrate their own role as a member of the radiation oncology interdisciplinary team (Rose and Yates, 2013, Iwamoto et al., 2012). To achieve this, a Primary Nursing/Collaborative Practice (PN/CP) model was introduced to enhance supportive care of patient undergoing radiation therapy.
This paper reports a component of a larger case study that evaluated patient and clinical staff perceptions to changing the nursing model of care from a task-based approach to a primary nursing/collaborative practice framework in a radiation oncology department. The study evaluated outcomes from the perspective of multiple health professionals involved in the change as well as from patients. The perspective of health care professionals involved in the implementation of the model has been reported elsewhere (Rose and Yates, 2013, Rose, 2010). This paper focuses on reporting patient outcomes.
Section snippets
Study design
This instrumental case study design involved interviews with health professionals at the beginning of, and twelve months following, the implementation of the new model of care. To complement this qualitative data, surveys of two separate cohorts of patients prior to and at 12 months following implementation of the model was used, as well as surveys of the radiation oncology health professionals. A full description of the study design is reported previously (Rose and Yates, 2013, Rose, 2010.
Patients' demographic characteristics
A total of 86 out of 106 eligible patients (81% response rate) consented to participate in Cohort 1 and 108 out of 110 eligible patients (98%) consented to participate in Cohort 2. The main reason for patient non-participation included worsening medical condition or non-return of the questionnaire. Demographic variables and medical characteristics for both cohorts are summarised in Table 1. Patients in both cohorts were predominantly female and in the older age group. Large numbers of patients
Discussion
The overall aim of this study was to improve the nursing model of care for patients undergoing radiation therapy. This care requires nurses to address all domains of patients' well-being across the course of the radiation therapy, including their physical, informational, practical, social and emotional needs (Honea, 2007, Rose and Yates, 2013). Patient outcomes are an important source of data to assess the extent to which the new model achieved improvements in care outcomes. In interpreting the
Conclusion
Nursing in this radiation oncology setting aims to provide person-centred care for patients undergoing radiation therapy for cancer. This study reported on key areas of patient well-being following a change in the nursing practice framework. While this particular case study was limited by the lack of a control group, responses from the two cohorts of patients in the radiation oncology department showed evidence of positive outcomes in the various domains as a result of the care provided by
Conflicts of interest
The authors wish to state that there is no known conflict of interest in this manuscript.
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