Aim: The aim of the study was to diagnose the socioeconomic burden and impact of a diagnosis of cervical cancer in rural women in the context of a low-resourced country, Uganda, through a descriptive qualitative enquiry. Methods: This was a multi-site descriptive qualitative inquiry, conducted at three hospice settings; Mobile Hospice Mbarara in the Southwest, Little Hospice Hoima in Midwest, and Hospice Africa Uganda Kampala in Central Uganda. A purposive sample of women with a histologically confirmed diagnosis of cervical cancer were recruited. Data were collected using open-ended audio-recorded interviews conducted in the native languages of the participants. Interviews were transcribed verbatim in English. Braun and Clarke's (2019) framework of thematic analysis was used. Results: A total of 13 women, with mean age 49.2 years (range 29–71), participated in the study. All participants were of low socioeconomic status. The majority (84.6%) had advanced disease at diagnosis. A detailed reading of transcripts produced three major themes: (1) the impact of cervical cancer on women's relationships (2) the disrupted and impaired activities of daily living (ADLs), and (3) economic disruptions. Conclusions: A diagnosis of cervical cancer introduces significant socioeconomic disruptions in a woman's and her family's life. Cervical cancer causes disability, impairs the woman and her family's productivity and exacerbates levels of poverty in the home. High and expensive out-of-pocket expenditure on investigations, treatments and transport costs further compound the socioeconomic burden.
Background: Health workers are likely to document patients' care inaccurately, especially when using new and revised case tools, and this could negatively impact patient care. Aim: To assess nurses' and clinicians' documentation practices when using a new patients' continuation case sheet (PCCS) and explore nurses' and clinicians' experiences regarding the documentation of patients' information in the new PCCS. The purpose of introducing the PCCS was to improve the continuity of care for patients attending clinics at which they were unlikely to consistently see the same clinician or nurse. Method: This was a mixed-methods study. The cross-sectional inquiry retrospectively reviewed 100 case notes of active patients in a hospice and palliative care programme. Data were collected using a structured questionnaire with constructs formulated from the new PCCS under study. The qualitative element was face-to-face, audio-recorded, open-ended interviews with a purposive sample of one palliative care clinician and four palliative care nurse specialists. Thematic analysis was used. Results: Patients' biogeographic information was missing in 5% to 10% case notes. Spiritual and psychosocial issues were not documented in 42.6% of patients' case notes and vital signs, in 49.2%. The poorest documentation practices were observed in the past medical history part of the PCCS, noted in 40%–63% of the 100 case notes included in this study. Four themes emerged from interviews with clinicians and nurses: (1) what remains unclear and challenges; (2) comparing the past with the present; (3) experiential thoughts, and; (4) transition and adapting to change. Conclusion: The PCCS seems to be a comprehensive and simple tool that can be used to document patients' information at subsequent visits. To increase its reliability and validity, clinicians and nurses need training on how to use it. Clinicians and nurses need to prioritise accurate and complete documentation of patient care in the PCCS to ensure quality care provision. This study should be extended to other sites using similar tools to ensure representative and generalisable findings.
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