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Nurse-led follow-up on demand or by a physician after breast cancer surgery: a randomised study
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
School of Social and Health Sciences, Halmstad University, Halmstad, Sweden and Department of Nursing, Lund University, Lund, Sweden.
Department of Oncology, Örebro, University Hospital, Örebro, Sweden.
Division of Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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.

Place, publisher, year, edition, pages
2004. Vol. 8, no 2, 109-117 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-24166DOI: 10.1016/j.ejon.2003.12.005Local ID: 3752OAI: diva2:244483
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-25Bibliographically approved
In thesis
1. Traditional or individualised follow-up in women after breast cancer surgery
Open this publication in new window or tab >>Traditional or individualised follow-up in women after breast cancer surgery
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.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 873
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-24054 (URN)3613 (Local ID)91-7373-852-2 (ISBN)3613 (Archive number)3613 (OAI)
Public defence
2004-12-03, Berzeliussalen, Hälsouniversitetet, Linköping, 13:00 (Swedish)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-25Bibliographically approved

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