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Traditional or individualised follow-up in women after breast cancer surgery
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim was to compare different follow-up approaches after breast cancer surgery, i.e. traditional follow-up to a physician and individualised approaches, with specific emphasis on satisfaction, well-being and self-care. Both quantitative and qualitative research methods have been employed. This thesis is based on two study cohorts; in studies 1-III, 264 women who had undergone surgery for breast cancer between 1991-2001 at two hospitals in Sweden were consecutively randomised to two parallel groups (study I). From this study cohort 20 women were interviewed about their experience of traditional follow-up to a physician (study II) and 19 women were interviewed about their experience from the nurse-led follow-up on demand (study III). Study I compared and evaluated the two systems; traditional physician follow-up and nurse led follow-up on demand. Studies II and III explored the needs of women after breast cancer surgery. Study IV contains a new study cohort of 96 women who had undergone surgery for breast cancer and who were consecutively selected and divided into two parallel groups between 2001-2003 at two hospitals in Sweden. Study IV compared traditional physician follow-up with a multi-disciplinary educational programme. Instruments such as The Hospitality Anxiety and Depression-scale, the Functional Assessment of Cancer Therapy-General scale and the Sense of Coherence scale as well as semi-structured interviews were used for the data collection. Analysis of the data was mainly performed by inferential statistical mainly non-parametric methods and by a phenomenographic approach. The result showed that women with breast cancer in stages I to II could be followed up by a specialist nurse leading to high patient satisfaction and good medical safety (study I). Women tend to vary in their appreciation of different aspects of the follow-up; some need routine while others require accessibility, continuity, confidence and security were demanded as self-care education and individualised information (studies II, III). A multidisciplinary education programme based on patients' needs led to a similar level of well-being, self-care and coping ability as that resulting from traditional physician follow-up and thus, can be considered as a viable alternative (study IV).

The women value the nurses professional knowledge and skills. Accessibility and early assessment by healthcare professionals or an oncology nurse are essential in a system without routine follow-up. There are good reasons for reviewing and changing the design of the traditional follow-up system in order to ensure the most effective and well-functioning system possible, to better meet the needs of women with breast cancer and to involve them in decision making concerning follow-up.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2004. , 62 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 873
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-24054Local ID: 3613ISBN: 91-7373-852-2 (print)OAI: oai:DiVA.org:liu-24054DiVA: diva2:244370
Public defence
2004-12-03, Berzeliussalen, Hälsouniversitetet, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-25Bibliographically approved
List of papers
1. Nurse-led follow-up on demand or by a physician after breast cancer surgery: a randomised study
Open this publication in new window or tab >>Nurse-led follow-up on demand or by a physician after breast cancer surgery: a randomised study
2004 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 8, no 2, 109-117 p.Article in journal (Refereed) Published
Abstract [en]

The value of routine follow-up with frequent visits to a breast cancer specialist—both in terms of detection of recurrence and patient satisfaction—has been questioned.

The aim of this study was to compare nurse-led follow-up on demand versus physician follow-up after breast cancer treatment with regards to patients’ well-being, satisfaction, access to medical care and medical safety.

Two hundred and sixty-four consecutively selected women with newly diagnosed breast cancer, classified as UICC stage I or stage II, were randomised to follow-up at two hospitals in Sweden, either by routine medical follow-up, the physician group (PG, n=131), or on demand by a specialist nurse, the nurse group (NG, n=133). Measures were done at baseline and twice a year over a period of 5 years by means of a questionnaire containing the Hospital Anxiety and Depression Scale (HAD), and the Satisfaction and Accessibility (SaaC) scale. Number of contacts with the health care services, number of diagnostic procedures, and time to recurrence or death were monitored.

The ratings of HAD and SaaC did not show any statistically significant differences between the groups. The levels of anxiety and depression were generally low and levels of patient satisfaction high. There were no differences between the groups concerning time to recurrence or death.

This study indicates that women with breast cancer in stages I to II can be followed up by a specialist nurse with high patient satisfaction and good medical safety.

Abstract [de]

Der Wert festgelegter Operationsnachsorge mit häufigen Besuchen beim Brustkrebsspezialisten ist in Frage gestellt worden, und zwar sowohl was die Zufriedenheit der Patientinnen als auch die Entdeckungswahrscheinlichkeit eines Rückfalls betrifft.

Das Ziel dieser Studie war es, die Versorgung nach einer Brustkrebsbehandlung durch Krankenschwestern auf Verlangen mit jener durch einen Arzt zu vergleichen. Dabei wurden das allgemeine Befinden der Patientinnen, ihre Zufriedenheit mit der Prozedur, die Zugangsmöglichkeiten zu medizinischer Nachsorge und Sicherheitsfragen in Betracht gezogen.

264 Frauen mit kürzlich diagnostiziertem Brustkrebs (UICC Stadium I oder II) wurden ausgewählt und zwei Kliniken in Schweden zur Nachsorge zugewiesen. Dabei erfolgte die Verteilung der Patientinnen auf die so genannte ‘Arztgruppe’ (PG, n=131) mit festgelegter Routinenachsorge durch einen Arzt oder die so genannte ‘Schwesterngruppe’ (NG, n=133) mit Untersuchung durch eine spezialisierte Krankenschwester in einem Zufallsverfahren. Zu Beginn der Nachsorge und zweimal jährlich über einen Zeitraum von fünf Jahren Fragebogens wurden Daten mit Hilfe eines erhoben, der die Hospital Anxiety and Depression Scale (HAD, Maß der Ängste und Niedergeschlagenheit in einem Krankenhaus) und die Satisfaction and Accessibility Scale (SaaC, Maß der Zufriedenheit mit und Zugangsmoglichkeiten zu medizinischer Nachsorge) enthielt. Die Anzahl der Kontakte mit medizinischen Versorgungsstellen, die Anzahl der Diagnosevorgänge sowie die Zeiträume bis zu einem eventuellen Wiederauftreten der Krankheit oder zum Tode wurden aufgezeichnet.

Die Auswertung der HAD-bzw. SaaC-Skalen ergab keine statistisch signifikanten Unterschiede zwischen den Gruppen. Im Allgemeinen war das Niveau von Angst und Niedergeschlagenheit niedrig, dasjenige der Patientenzufriedenheit hoch. Hinsichtlich des Zeitraums bis zu einem Rückfall oder zum möglichen Ableben konnten keine Unterschiede zwischen den Gruppen nachgewiesen werden.

Die Untersuchung lässt den Schluss zu, dass die Nachsorge von Frauen mit Brustkrebs im Stadium I oder II zur vollen Zufriedenheit der Patientinnen und mit hoher fachlicher Sicherheit durch spezialisierte Pflegekräfte durchgeführt werden kann.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24166 (URN)10.1016/j.ejon.2003.12.005 (DOI)3752 (Local ID)3752 (Archive number)3752 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-25Bibliographically approved
2. Satisfaction with routine follow-up visits to the physician?: the needs of patients with breast cancer
Open this publication in new window or tab >>Satisfaction with routine follow-up visits to the physician?: the needs of patients with breast cancer
2001 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 40, no 4, 454-459 p.Article in journal (Refereed) Published
Abstract [en]

Follow-up visits after surgery for breast cancer constitute a large proportion of the outpatient consultations at surgical and oncological clinics. The reasons for the follow-ups include early detection of relapse, patients' well-being, and data collection for quality assurance and scientific studies. The aim of this study was to describe the needs of the patient with breast cancer and satisfaction with routine follow-up visits to the physician. A strategic sample of 20 women with breast cancer, routinely followed-up at an oncology outpatient clinic, was interviewed. A qualitative descriptive design inspired by the phenomenographic method was used. The results identified the need for routines, accessibility, security, continuity, confidence and information. The women's views demonstrated that there are strong reasons for reviewing and changing the design of the traditional follow-up system to obtain the most effective and well-functioning system possible to better meet these women's needs.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-48346 (URN)10.1080/02841860119793 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2012-10-25Bibliographically approved
3. Breast cancer patients' satisfaction with a spontaneous system of check-up visits to a specialist nurse
Open this publication in new window or tab >>Breast cancer patients' satisfaction with a spontaneous system of check-up visits to a specialist nurse
2002 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 3, 209-215 p.Article in journal (Refereed) Published
Abstract [en]

Aim:  To describe breast cancer patients' satisfaction with a spontaneous system of check-up visits to a specialist nurse.

Background:  There is little evidence that routine follow-up visits after breast cancer surgery influence survival or patient satisfaction. Consequently, there is a need to evaluate alternative follow-up programmes.

Sample:  A strategic sample of 19 breast cancer patients, who were not involved in a routine follow-up system but who had the possibility of contacting a specialist nurse when necessary, were interviewed.

Method:  A qualitative descriptive design inspired by the method of phenomenographic analysis was used.

Findings:  Five description categories and 606 statements showing similarities and differences in conceptions were obtained. The patients satisfaction with the knowledgeable and professional skills of the nurses was high. Confirmation and trust were important and necessary in order for the women with breast cancer to feel secure. Patients had a need for information and self-care education . Accessibility and early assessment by professional personnel or an oncology nurse were essential in a system without routine follow-ups.

Discussion:  This study identifies key issues in a specialist nurse-led check-up system. The findings can be used for developing an education programme for women who have undergone breast cancer surgery. Additionally, the findings emphasize the need to introduce more flexible solutions to the follow-up programmes, one alternative being specialist nurse-led check-ups.

Keyword
breast cancer, follow-up, information, nursing, phenomenography, psychosocial, qualitative analysis, satisfaction, self-care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24786 (URN)10.1046/j.1471-6712.2002.00040.x (DOI)7048 (Local ID)7048 (Archive number)7048 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-25Bibliographically approved
4. The usefulness of a multidisciplinary educational programme after breast cancer surgery: a prospective and comparative study
Open this publication in new window or tab >>The usefulness of a multidisciplinary educational programme after breast cancer surgery: a prospective and comparative study
2006 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 10, no 4, 273-282 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to compare and evaluate a multidisciplinary educational programme with traditional follow-up visits to a physician after breast cancer surgery in terms of well-being, aspects of self-care and coping ability 1 year after diagnosis.

A reduction in the intensity of follow-up after breast cancer surgery is recommended. New follow-up models are being debated and could be of interest. The study design was non-randomised and comparative. Ninety-six consecutively selected women with newly diagnosed breast cancer, classified as stage I or stage II, participated in either a multidisciplinary educational programme (n=50), or traditional follow-up by a physician (n=46). Three questionnaires were used: Functional Assessment of Cancer Therapy-General (FACT-G), a study specific questionnaire regarding self-care aspects (SCA) and Sense of Coherence (SOC). With the exception of physical well-being at baseline there was no significant difference between the groups. The women in the multidisciplinary educational programme increased their physical and functional well-being (P<0.01). The women in traditional follow-up by a physician increased their functional well-being while social/family well-being (P<0.01) decreased over time. There was a statistically significant difference in SOC (P<0.001) in the traditional follow-up by a physician between baseline (mean=74.4, SD=12.4) and the 1-year follow up (mean=67.7, SD=11.4). Thus, women in the traditional follow-up by a physician scored lower in the area of SOC 1 year after diagnosis.

A multidisciplinary educational programme may be an alternative to traditional follow-up by a physician after breast cancer surgery, but more research is needed about the financial benefits and effectiveness of such a programme.

Abstract [de]

Das Ziel der Studie bestand darin, ein multidisziplinäres Schulungsprogramm zu evaluieren und mit konventionellen Follow-up-Untersuchungen bei einem Arzt im Anschluss an eine operative Brustkrebs-Behandlung zu vergleichen; dieser Vergleich bezog sich auf das Wohlbefinden, die Selbstversorgung sowie die Kompetenz zur Problembewältigung (Coping-Fähigkeit) ein Jahr nach Diagnosestellung. Eine Verringerung der Follow-up-lntensität nach erfolgter Mammachirurgie wird empfohlen. Neue vielversprechende Follow-up-Modelle werden derzeit diskutiert.

Methoden: Es handelte sich um eine nicht-randomisierte Vergleichsstudie. Insgesamt 96 konsekutiv ausgewählte Frauen mit neu-diagnostiziertem Brustkrebs (Klassifiziert als Stadium I oder II) nahmen entweder an einem multidisziplinären Schulungsprogramm (n=50) oder an konventionellen Follow-up-Untersuchungen bei einem Arzt (n=46) teil. Es wurden drei Fragebögen verwendet: ein Fragebogen zur allgemeinen Lebensqualität (Functional Assessment of Cancer Therapy General [FACT-G]), ein studienspezifischer Fragebogen zu Aspekten der Selbstversorgung (self-care aspects, SCA) sowie ein Fragebogen zur Erfassung des Kohärenzgefühls (sense of coherence, SOC). Mit Ausnahme des körperlichen Wohlbefindens zu Studienbeginn wurden keine signifikanten Unterschiede zwischen beiden Gruppen beobachtet. Bei den Probandinnen des multidisziplinären Schulungsprogramms besserte sich das körperliche und funktionelle Wohlbefinden (p<0,01). Bei den Probandinnen in der Gruppe der konventionellen Follow-up-Untersuchungen bei einem Arzt besserte sich das funktionelle Wohlbefinden, wohingegen das soziale/familiäre Wohlbefinden mit der Zeit abnahm (p<0,01). Ein statistisch signifikanter Unterschied ergab sich hinsichtlich des Kohärenzgefühls (p<0,001) in der Gruppe der konventionellen Follow-up-Untersuchungen bei einem Arzt zwischen den Baseline-Werten (Mittelwert 74,4, Standardabweichung 12,4) und den Werten nach einjährigem Follow-up (Mittelwert 67,7, Standardabweichung 11,4). Die Probandinnen der Gruppe der konventionellen Follow-up-Untersuchungen bei einem Arzt erzielten also ein Jahr nach Diagnosestellung geringere Werte hinsichtlich des Kohärenzgefühls.

Keyword
Breast cancer, Coping ability, Education, Follow-up, Self-care, Well-being
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-50150 (URN)10.1016/j.ejon.2005.11.005 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2012-10-25Bibliographically approved

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