Completion of the audit cycle: standardised nurse-led information for patients

Abstract

Background: It is increasingly accepted that patients want information about their proposed treatment, and that provision of such information may alleviate fear and may improve the process of obtaining informed consent. It is not yet clear what form such information should take. Objective: Based on differences shown previously between patients receiving standard treatment and those in clinical trials, a system of routine appointments with a chemotherapy nurse at least one day before the patient offered consent to treatment was established for all patients receiving chemotherapy in Leicestershire, at which time patients were given standardised written information regarding outpatient chemotherapy and specific drugs. Method: In order to complete the audit cycle, the previous questionnaire study was repeated. Results: From 160 questionnaires distributed, 131 complete replies were received. Compared with the previous audit, a significantly higher proportion of patients receiving standard chemotherapy remembered being given written information about chemotherapy from a nurse before starting their treatment and remembered signing a consent form. The significant difference in feelings of involvement in the decision to have chemotherapy between patients receiving standard chemotherapy and those in clinical trials detected in the previous audit was no longer detectable, suggesting the clinical effectiveness of the intervention performed. Conclusion: Implementation of nurse-led appointments with provision of standardised information before formal consent being taken should be studied further for its potential to improve patients' involvement in medical decision making.

The paradoxical image of chemotherapy: a phenomenological description of nurses' experiences of administering chemotherapy

“…It has been identified that overwhelming the patient with information could potentially lead to confusion, and unnecessary anxiety for the patient and their families (McCaughan & Thompson 2000), as was believed by some of the participants. A further consideration, evident in this study, and supported by others was patients needed time to digest information before consenting to the treatment (McCaughan & Thompson 2000; Sharma et al . 2003).…”

“…Providing information to patients to enable them to make informed decisions is a complex process, made more so in the diagnosis of cancer where statistics about survival and low probabilities of response to treatment are combined with consideration of the potential toxicity of chemotherapy, and need to be addressed within discussions with patients (Sharma et al . 2003).…”

“…Sharma et al . (2003) report on an audit using a questionnaire that found patients who were involved in clinical trials were significantly more likely to feel that they had taken part in the decision making than those receiving standard treatment.…”

“…As a result of the audit, a system of routine appointments with a chemotherapy nurse at least 1 day before consenting to treatment was established for all patients receiving chemotherapy. A follow‐up audit revealed that a significantly higher proportion of patients receiving standard treatment felt more involved in the decision‐making process (Sharma et al . 2003).…”

“…‘Not getting the full picture’ about the rationale and the side effects of the chemotherapy treatment was a concern for nurses in this study and caused conflict between them and medical staff, in some instances. Recent practices demonstrate that the information needs of patients receiving chemotherapy are being met by more rigorous attention given to the process of consenting (Sainio & Eriksson 2003; Sharma et al . 2003).…”