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Incorporating Supportive Care Into Routine Cancer Care: The Benefits and Challenges to Clinicians' Practice

Eli Ristevski

Sibilah Breen

Melanie Regan

cancer care
ONF 2011, 38(3), E204-E211. DOI: 10.1188/11.ONF.E204-E211

Purpose/Objectives: To investigate clinicians' experiences with supportive care screening and referral, and identify perceived barriers and benefits associated with implementation into the clinical setting.

Design: Qualitative, exploratory approach based on interviews.

Setting: A large regional hospital in Victoria, Australia, that provides chemotherapy and radiotherapy services to patients with cancer.

Sample: 5 chemotherapy nurses and 1 radiation therapist.

Methods: Semistructured interviews were conducted, documented, and analyzed with qualitative techniques.

Main Research Variables: Clinical benefits of supportive care screening and referral, and barriers to clinical implementation.

Findings: Clinicians perceived that supportive care screening benefited their practice by improving communication and rapport with patients. Clinicians supported each other during screening implementation, and although they initially were hesitant about the process, they ultimately endorsed screening for wider implementation. Time constraints and scope of practice were identified as significant barriers.

Conclusions: Supportive care screening was endorsed as part of future clinical practice, but barriers to implementation need to be addressed.

Implications for Nursing: With current psychosocial guidelines recommending routine supportive care screening of patients with cancer and statewide mandatory screening targets set in Australia, healthcare organizations need to carefully consider implementation processes. Although nurses are ideally placed to complete screening, organizations need to ensure that appropriate training and support mechanisms have been developed, as well as adequate resources, to enable integration into routine practice.

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    References

    Andrews, G., & Slade, T. (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health, 25, 494-497. http://dx.doi.org/10.1111/j.1467-842X.2001.tb00310.x
    Arora, N. K. (2003). Interacting with cancer patients: The significance of physicians' communication behavior. Social Science and Medicine, 57, 791-806. http://dx.doi.org/10.1016/S0277-9536(02)00449-5
    Bakker, D. A., Fitch, M. I., Gray, R., Reed, E., & Bennett, J. (2001). Patient-health care provider communication during chemotherapy treatment: The perspectives of women with breast cancer. Patient Education and Counseling, 43, 61-71.
    Botti, M., Endacott, R., Watts, R., Cairns, J., Lewis, J., & Kenny, A. (2006). Barriers in providing psychosocial support for patients with cancer. Cancer Nursing, 29, 309-316. http://dx.doi.org/10.1097/00002820-200607000-00010
    Boyes, A., Girgis, A., & Lecathelinais, C. (2009). Brief assessment of adult cancer patients' perceived needs: Development and validation of the 34-item Supportive Care Needs Survey (SCNS-SF34). Journal of Evaluation in Clinical Practice, 15, 602-606.
    Boyes, A., Newell, S., Girgis, A., McElduff, P., & Sanson-Fisher, R. (2006). Does routine assessment and real-time feedback improve cancer patients' psychosocial well-being? European Journal of Cancer Care, 15, 163-171. http://dx.doi.org/10.1111/j.1365-2354.2005.00633.x
    Butt, Z., Wagner, L. I., Beaumont, J. L., Paice, J. A., Straus, J. L., Peterman, A. H., … Cella, D. (2008). Longitudinal screening and management of fatigue, pain, and emotional distress associated with cancer therapy. Supportive Care in Cancer, 16, 151-159. http://dx.doi.org/10.1007/s00520-007-0291-2
    Corbin, J., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory (3rd ed.). Los Angeles, CA: Sage.
    Detmar, S. B., Aaronson, N. K., Wever, L. D., Muller, M., & Schornagel, J. H. (2000). How are you feeling? Who wants to know? Patients' and oncologists' preferences of discussing health-related quality-of-life issues. Journal of Clinical Oncology, 18, 3295-3301.
    Fallowfield, L. (2001). Participation of patients in decisions about treatment for cancer: Desire for information is not the same as a desire to participate in decision making. BMJ, 323, 1144. http://dx.doi.org/10.1136/bmj.323.7322.1144
    Fogarty, L. A., Curbow, B. A., Wingard, J. R., McDonnell, K., & Somerfield, M. R. (1999). Can 40 seconds of compassion reduce patient anxiety? Journal of Clinical Oncology, 17, 371-379.
    Ford, S., Fallowfield, L., & Lewis, S. (1996). Doctor-patient interactions in oncology. Social Science and Medicine, 42, 1511-1519. http://dx.doi.org/10.1016/0277-9536(95)00265-0
    Fulcher, C. D., & Gosselin-Acomb, T. K. (2007). Distress assessment: Practice change through guideline implementation. Clinical Journal of Oncology Nursing, 11, 817-821. http://dx.doi.org/10.1188/07.CJON.817-821
    Glaser, B., & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago, IL: Aldine Transaction.
    Hedström, M., Skolin, I., & von Essen, L. (2004). Distressing and positive experiences and important aspects of care for adolescents treated for cancer: Adolescent and nurse perceptions. European Journal of Oncology Nursing, 8, 6-17. http://dx.doi.org/10.1016/j.ejon.2003.09.001
    Hoffman, B. M., Zevon, M. A., D'Arrigo, M. C., & Cecchini, T. B. (2004). Screening for distress in cancer patients: The NCCN rapid screening measure. Psycho-Oncology, 13, 792-799. http://dx.doi.org/10.1002/pon.796
    Keller, M., Sommerfeldt, S., Fischer, C., Knight, L., Riesbeck, M., Löwe, B., … Lehnert, T. (2004). Recognition of distress and psychiatric morbidity in cancer patients: A multi-method approach. Annals of Oncology, 15, 1243-1249. http://dx.doi.org/10.1093/annonc/mdh318
    Kenny, A., Endacott, R., Botti, M., & Watts, R. (2007). Emotional toil: Psychosocial care in rural settings for patients with cancer. Journal of Advanced Nursing, 60, 663-672. http://dx.doi.org/10.1111/j.1365-2648.2007.04453.x
    Kruijver, I. P., Garssen, B., Visser, A. P., & Kuiper, A. J. (2006). Signalising psychosocial problems in cancer care: The structural use of a short psychosocial checklist during medical or nursing visits. Patient Education and Counseling, 62, 163-177. http://dx.doi.org/10.1016/j.pec.2005.10.001
    Maguire, P. (1999). Improving communication with cancer patients. European Journal of Cancer Care, 35, 2058-2065.
    Maguire, P., & Pitceathly, C. (2003). Improving the psychological care of cancer patients and their relatives: The role of specialist nurses. Journal of Psychosomatic Research, 55, 469-474. http://dx.doi.org/10.1016/S0022-3999(03)00539-7
    McIllmurray, M. B., Thomas, C., Francis, B., Morris, S., Soothill, K., & Al-Hamad, A. (2001). The psychosocial needs of cancer patients: Findings from an observational study. European Journal of Cancer Care, 10, 261-269. http://dx.doi.org/10.1046/j.1365-2354.2001.00280.x
    McLachlan, S. A., Allenby, A., Matthews, J., Wirth, A., Kissane, D., Bishop, M., … Zalcberg, J. (2001). Randomized trial of coordinated psychosocial interventions based on patient self-assessments versus standard care to improve the psychosocial functioning of patients with cancer. Journal of Clinical Oncology, 19, 4117-4125.
    National Breast Cancer Centre & National Cancer Control Initiative. (2003). Clinical practice guidelines for the psychosocial care of adults with cancer. Camperdown, Australia: National Breast Cancer Centre.
    National Comprehensive Cancer Network. (2008). NCCN Clinical Practice Guidelines in OncologyTM. Distress management [v.1.0]. Retrieved from http://www.nccn.org/professionals/physician_gls/PDF/distress.pdf
    Newell, S., Sanson-Fisher, R. W., Girgis, A., & Bonaventura, A. (1998). How well do medical oncologists' perceptions reflect their patients' reported physical and psychosocial problems? Data from a survey of five oncologists. Cancer, 83, 1640-1651.
    O'Leary, Z. (2004). The essential guide to doing research. London, England: Sage.
    Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage.
    Redman, S., Turner, J., & Davis, C. (2003). Improving supportive care for women with breast cancer in Australia: The challenge to modifying health systems. Psycho-Oncology, 12, 521-531. http://dx.doi.org/10.1002/pon.690
    Robinson, J. W., & Roter, D. L. (1999). Psychosocial problem disclosure by primary care patients. Social Science and Medicine, 48, 1353-1362. http://dx.doi.org/10.1016/S0277-9536(98)00439-0
    Schofield, P., Carey, M., Bonevski, B., & Sanson-Fisher, R. (2006). Barriers to the provision of evidence-based psychosocial care in oncology. Psycho-Oncology, 15, 863-872. http://dx.doi.org/10.1002/pon.1017
    Sivesind, D., Parker, P. A., Cohen, L., Demoor, C., Bumbaugh, M., Throckmorton, T., … Baile, W. F. (2003). Communicating with patients in cancer care: What areas do nurses find most challenging? Journal of Cancer Education, 18, 202-209. http://dx.doi.org/10.1207/s15430154jce1804_7
    Snyder, C. F., Dy, S. M., Hendricks, D. E., Brahmer, J. R., Carducci, M. A., Wolff, A., & Wu, A. W. (2007). Asking the right questions: Investigating needs assessments and health-related quality-of-life questionnaires for use in oncology clinical practice. Supportive Care in Cancer, 15, 1075-1085. http://dx.doi.org/10.1007/s00520-007-0223-1
    Strong, V., Waters, R., Hibberd, C., Rush, R., Cargill, A., Storey, D., … Sharpe, M. (2007). Emotional distress in cancer patients: The Edinburgh Cancer Centre symptom study. British Journal of Cancer, 96, 868-874. http://dx.doi.org/10.1038/sj.bjc.6603626
    Towers, R. (2007). Providing psychological support for patients with cancer. Nursing Standard, 22, 50-57.
    Turner, J., Clavarino, A., Yates, P., Hargraves, M., Connors, V., & Hausmann, S. (2007). Oncology nurses' perceptions of their supportive care for parents with advanced cancer: Challenges and educational needs. Psycho-Oncology, 16, 149-157. http://dx.doi.org/10.1002/pon.1106
    Victorian Government Department of Human Services. (2008). Victoria's Cancer Action Plan 2008-2011. Retrieved from http://www.health.vic.gov.au/cancer/vcap.htm
    Victorian Government Department of Human Services. (2009). Providing optimal cancer care: Supportive care policy for Victoria. Retrieved from http://www.health.vic.gov.au/cancer/docs/suppcare/supportive_care_policy.pdf
    Vitek, L., Rosenzweig, M. Q., & Stollings, S. (2007). Distress in patients with cancer: Definition, assessment, and suggested interventions. Clinical Journal of Oncology Nursing, 11, 413-418. http://dx.doi.org/10.1188/07.CJON.413-418
    Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10, 19-28. http://dx.doi.org/10.1002/1099-1611(200101/02)10:1<19::AID-PON501>3.0.C…