Optimising the care of patients receiving oral systemic anti-cancer treatments: a mixed methods study
Background: The use of oral systemic anti-cancer treatment (SACT) has increased significantly in recent decades. Patient experience of receiving these treatments is relatively unknown and under-reported. In response to national recommendations and the National Patient Safety alert (2008) regarding the safe care of patients receiving an oral SACT, a local cancer centre implemented a joint nurse- and pharmacist-led oral education clinic (OEC) to educate patients on how to manage their oral SACT and care at home. Aim: To explore the experiences and views of patients receiving oral SACT to inform models of care. Methodology: An applied health research study using a mixed-methods approach was conducted. The study included a questionnaire survey distributed to patients who attended the OEC, and a second questionnaire posted 6 weeks later. Descriptive statistics were used to analyse results from the 84 respondents. Semi-structured interviews were conducted with a sub-sample of 28 questionnaire respondents and with 23 health professionals, which were analysed using Framework (Ritchie and Spencer, 1994). Integration of data sets was achieved through ‘Following a Thread’ (Moran-Ellis et al, 2006). Results: Patients held strong beliefs about the importance of taking their oral SACT medication, and preferred oral to intravenous administration. Patients were satisfied with the OEC, but some identified a lack of information on treatment efficacy and living well with cancer. No preference was reported regarding SACT nurse or cancer pharmacist delivered education. The idea of telephone follow-up was welcomed by most study participants; patient experience of side effects suggests this would be best placed within the first and second week of commencing oral SACT. All patients established a routine in taking their medication, which contributed to high levels of adherence. Instances of non-adherence were unintentional and attributed to forgetfulness. A typology of activation to self-manage was identified highlighting that some patients were activated to self-manage their care whilst others required enhanced support. Health professionals regarded the OEC as an effective means to prepare a patient to commence oral SACT, but identified some organisational barriers to delivering the care they perceived patients required. Conclusion: Patients receiving an oral SACT benefit from education about their treatment, when delivered by an experienced SACT nurse or cancer pharmacist. The OEC was well received by both patients and health professionals, but findings highlight the importance of a more person-centred approach to optimise patient experience and outcomes following prescription of oral SACT.
Networked Digital Library of Theses and Dissertations