Background: The incidence of haematological cancers is increasing, however developments in treatment and survival rates mean that longer-term prognosis is improving. Nonetheless, the impact of cancer and its treatments remains with both short-term and long-term effects for patients and carers, which often results in persisting unmet supportive care needs. In addition, the shift of care delivery from inpatient to ambulatory setting and earlier hospital discharge, emphasises the need for services to support patients ability to self-manage. The healthcare team in an Italian Comprehensive Cancer Centre hospital implemented an ad hoc symptom management and supportive care telephone intervention based patients expressed feelings of abandonment after discharge. The intervention was unsustainable due to personnel resources and lacked a rigorous evaluation of patient acceptability. The aim of the PhD study was to develop a telephone intervention providing support and symptom management that is acceptable to patients undergoing or having undergone treatment for a haematological malignancy, based on the best available evidence. Methods: The MRC Framework was used as the basis for the development of the intervention. The evidence base to inform development was drawn from 3 sources. Firstly a systematic review of existing literature, and secondly qualitative research with key stakeholders: in-depth interviews with 20 patients with haematological malignancies and focus group(s) with a total of 10 expert haematology nurses. Framework Analysis was used to analyse data from the qualitative research. A synthesis of these findings was presented to a consensus group of key stakeholders within the local hospital setting in the subsequent modelling phase of the intervention development. Results: The application of telephone-based interventions to address cancer patients needs was evident throughout the literature within a variety of settings. Whilst it is said to be convenient, provide accessible and timely reassurance and continuity of care, it was not necessary or desirable for everyone. Stakeholders in qualitative research confirmed these findings, emphasising the need for individuality in interventions to adequately address the uniqueness of needs at different time points in the cancer trajectory. Factors including effective training for the intervention delivery, organisational support and integration into current practice were imperative for the sustainability of an intervention. The consensus group meeting agreed the definition and outline of an intervention delivered by the Primary Nurse, to monitor patients for physical, social or psychological needs and provide support through individualised care planning that can be trialled in practice. Conclusion: Unmet needs persist in patients with haematological malignancies throughout their survival trajectory, and telephone based interventions are one means of addressing these supportive care needs. The use of the MRC Framework as a guide has resulted in the development of a detailed intervention incorporating evidence from key stakeholders in order to arrive at an intervention that is acceptable both for those receiving and those delivering the intervention. Such a model may be the basis for supportive intervention in other clinical areas.
|Date of Award
|1 Aug 2018
- The University of Manchester
|Karina Lovell (Supervisor) & Penny Bee (Supervisor)
- MRC Framework