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The usefulness of a multidisciplinary educational programme after breast cancer surgery: a prospective and comparative study
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Red-Cross University College of Nursing, Stockholm, Sweden and Department of Nursing, Karolinska Institutet, Stockholm, Sweden.
Department of Surgical Sciences, Division of Surgery, Uppsala University, Uppsala, Sweden.
School of Social and Health Sciences, Halmstad University, Halmstad, Sweden and Department of Health Sciences, Lund University, Lund, Sweden.
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.

Place, publisher, year, edition, pages
2006. Vol. 10, no 4, 273-282 p.
Keyword [en]
Breast cancer, Coping ability, Education, Follow-up, Self-care, Well-being
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-50150DOI: 10.1016/j.ejon.2005.11.005OAI: oai:DiVA.org:liu-50150DiVA: diva2:271046
Available from: 2009-10-11 Created: 2009-10-11 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.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 873
National Category
Medical and Health Sciences
Identifiers
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)
Opponent
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-25Bibliographically approved

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