Health professionals' views of the feasibility and acceptability of an oral care diary by patients during chemotherapy.
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Attitude of Health Personnel↗
Biomedical subjects
Morven Miller
Publications and source records attributed to Morven Miller.
Patterns of fatigue during a course of chemotherapy: results from a multi-centre study.
Fatigue is a highly prevalent condition among patients with cancer affecting between 70% and 100% and patients describe their fatigue experiences as the most distressing of symptoms. However, the management of fatigue is complicated by our current lack of understanding of its pathophysiology. This study aimed to gain an insight into the longitudinal fatigue experiences of patients receiving chemotherapy. A convenience sample of patients receiving chemotherapy (n=249) were recruited and recorded their fatigue experiences using a paper questionnaire for 14 consecutive days following each cycle of chemotherapy. Fatigue was reported in 57% of all completed questionnaires. Patients report fatigue as a relatively constant presence following chemotherapy. Moreover, fatigue experiences increase over consecutive cycles of chemotherapy. This study supports the existing evidence illustrating fatigue as a significant problem for patients with cancer and provides new data demonstrating patterns of fatigue over the duration of a course of chemotherapy. Understanding this experience of fatigue should prompt health professionals providing care for this patient population to seek and test a range of management strategies to help patients maintain their quality of life during cancer treatment.
Adolescent↗
Evaluation of the feasibility and acceptability of an oral care diary by patients during chemotherapy.
BACKGROUND: A significant proportion of patients undergoing chemotherapy for many cancer types may experience oral problems, such as mucositis and any deterioration in the health of the oral cavity can have a significant effect on a person's well-being. Trends towards shorter hospital stays and the increase in out-patient chemotherapy mean that patients are required to adopt increasingly participatory roles in their self-care and are subsequently coping with mouth problems while they are at home without the direct support of oncology health professionals. OBJECTIVES: This study aimed to evaluate the acceptability and feasibility of an oral care diary by patients receiving chemotherapy. DESIGN: An oral care diary was developed to incorporate oral assessment using the Oral Assessment Guide (Eilier, J., Berger, A., Peterson, M., 1988. Development, testing and application of the oral assessment guide. Oncology Nurse Forum 15, 325-330) and guidance about oral self-care. This exploratory study utilised purpose designed pre- and post-study questionnaires and semi-structured interviews to evaluate patients' perceptions and experiences of the oral care diary. SETTING: The study took place in 2-day chemotherapy units in Scotland: 1 in a cancer centre and 1 in a district general hospital. PARTICIPANTS: A consecutive sample of patients (n=45) receiving out-patient chemotherapy for a range of cancer diagnoses participated in the study over 2 cycles of chemotherapy. METHODS: Following recruitment, patients were instructed in the use of the oral care diary to assess their mouth daily while at home on a daily basis. Patients were asked to complete 2 structured purpose designed questionnaires-the first prior to starting diary completion and the second following their participation in the study. Nine patients participated in semi-structured interviews to explore their actual experiences of using the oral care diary in more depth. RESULTS: The participants found the oral care diary acceptable and feasible. Awareness of oral symptoms and related mouth self-care post-chemotherapy improved. CONCLUSIONS: The oral care diary is an acceptable and feasible method of enhancing oral self-care during a course of chemotherapy. Further study is required to evaluate its impact on clinical outcomes.
Adaptation, Psychological↗
Older people with cancer: perceptions and feelings about information, decision-making and treatment--a pilot study.
Several studies have identified inadequacies in the care and treatment received by older patients with cancer, as opposed to their younger counterparts. These include over or under diagnosis, ineffective symptom management and lower survival rates in older people with cancer. Despite these inadequacies, there is lack of evidence of older peoples' perspectives regarding their cancer diagnosis and treatment. This on going 2-site hospital based study focuses on older people's perceptions of information and decision-making in relation to treatment for cancer by using a semi-structured interview schedule. Results of the pilot study with 6 patients are presented and discussed in the light of research and clinical implications.
Age Factors↗
Guidelines for clinical practice: development, dissemination and implementation.
Clinical guidelines are one of the most promising and effective advances for defining and improving the quality of care. However, their development, dissemination and implementation in practice are rarely straightforward. Within nursing practice, guidelines have the potential to ensure the clinical application of research findings, thus ensuring that the profession rejects ineffective practices while employing those shown to work. Nevertheless, the benefits and limitations of clinical guidelines should be carefully considered by practitioners, managers and consumers of health care alike.
Attitude of Health Personnel↗
Institutional management of cancer-related fatigue: a comparison of clinical specialties.
Fatigue is the most common symptom associated with cancer and its treatment and is now widely recognized as a significant problem for patients with cancer (Ream & Richardson 1999). As a result of the restructuring of cancer services, much of the care given to patients is delivered by a multitude of nurses across a spectrum of clinical settings. While some research, albeit minimal, has evaluated nurses' knowledge and attitudes of cancer-related fatigue in various clinical settings, factors associated with institutional management of fatigue and the support and encouragement given to nurses by institutions regarding cancer-related fatigue appears to be unexplored. Nurses were recruited from community, general medical, general surgical and oncology clinical settings. A postal questionnaire to evaluate institutional cancer-related fatigue management was administered. Data were analysed descriptively. Institutional management of fatigue is poor across the clinical specialties involved in this survey. Topics addressed were interdisciplinary working, documentation and standards, accountability, information giving, staff education and quality assurance initiatives. Little difference was detected across the clinical specialties for the majority of these issues. Although individual health professionals have a personal responsibility to ensure the care they provide addresses patients' needs appropriately, institutional support and direction is essential. It seems that health-care institutions have not recognized the importance of this issue. This unacceptable situation must be resolved to ensure all health professionals are supported by their institutions to make every effort to improve the management of this symptom for patients with cancer.
Journal Article↗
Developing, delivering, and evaluating cancer nursing services: searching for a United Kingdom evidence base for practice.
The drive toward evidence-based healthcare aims to promote effectiveness and thereby improve quality. The challenge for cancer nursing is to continually evaluate what it does, retaining effective interventions and working to develop new ones and refine those interventions that require improvement, thereby enhancing both practice and patient outcomes. The aim of the project was to assimilate an evidence base to support the development, delivery, and evaluation of cancer nursing services in the United Kingdom. It was believed that determining the extent of the current United Kingdom evidence base through a review of the literature and current and recent research endeavors would allow for comparison with current priorities and facilitate informed strategic planning regarding the process of research commissioning. A rigorous, explicit, and thorough literature review was undertaken of all United Kingdom literature pertaining to cancer nursing and related issues published between 1980 and 2000. Fourteen individual databases were searched using specific keywords, thesaurus terms, and additional search terms. Data were extracted from each individual publication and stored in a purpose-designed database. Current and recent United Kingdom cancer nursing research projects were identified through a mailed survey questionnaire sent to people and organizations involved in cancer-related research. Research projects were categorized according to Royal College of Nursing research priority themes: Care and Caring Practices, Healthcare Environment, Organization and Management of Care, and Healthcare Workforce. Four-hundred forty-six pieces of literature were considered appropriate for inclusion in the review. Two-hundred sixty-four pieces of evidence were included in the Care and Caring Practices theme, which also had the greatest number of current and recent research projects (48%, n = 50). The Healthcare Environment theme included 80 pieces of evidence but only 3% (n = 3) of the current and recent research projects. Thirty-two percent (n = 33) of the current/recent research projects fell into the third theme of Organization and Management of Care, which contained a total of 104 pieces of evidence. The final theme, Healthcare Workforce, included 17% (n = 18) of the current and recent research projects, and the literature review incorporated 49 pieces of evidence in this theme. A number of recommendations have been drawn, which focus on methodological challenges, research considerations, and gaps in the evidence base. The drive toward evidence-based practice is essential for cancer nurses to establish who they are, what they do, and what effect they have on patient outcomes. Currently, although the United Kingdom evidence base for practice is vast, it frequently lacks depth. Although evaluating national evidence for practice is valuable, a more global approach to evidence synthesis is required. Through such endeavors, cancer nurses should realize their potential, support the strategic development of cancer nursing research, and so generate an evidence base that supports their unique contribution to patient outcomes.
Attitude of Health Personnel↗
Organising UK cancer nursing services: a review.
This article describes an NTResearch survey which outlines how UK cancer nursing services have evolved over the past seven years in response to changes in government policy.
Attitude of Health Personnel↗