Evaluation of nurse-led follow up for patients undergoing pelvic radiotherapy

Abstract

Summary This study reports results from a randomised controlled trial of nurse-led care and was designed to determine whether nurse-led follow up improved patients morbidity and satisfaction with care in men treated with radical radiotherapy for prostate and bladder cancer. The aim was to compare outcomes in terms of toxicity, symptoms experienced, quality of life, satisfaction with care and health care costs, between those receiving nurse-led care and a group receiving standard care. The study population was of men prescribed radical radiotherapy (greater than 60 Gy). Participants completed self-assessment questionnaires for symptoms and quality of life within the first week of radiotherapy treatment, at week 3, 6 and 12 weeks from start of radiotherapy. Satisfaction with clinical care was also assessed at 12 weeks post-treatment. Observer-rated RTOG toxicity scores were recorded pre-treatment, weeks 1, 3, 6 and 12 weeks from start of radiotherapy. The results presented in this paper are on 115 of 132 (87%) of eligible men who agreed to enter the randomised trial. 6 men (4%) refused and 11 (8%) were missed for inclusion in the study. Data were analysed as a comparison at cross-sectional time points and as a general linear model using multiple regression. There was no significant difference in maximum symptom scores over the time of the trial between nurse-led follow-up care and conventional medical care. Differences were seen in scores in the initial self assessment of symptoms (week 1) that may have been as a result of early nursing intervention. Those men who had received nurse-led care were significantly more satisfied (P < 0.002) at 12 weeks and valued the continuity of the service provided. There were also significant (P < 0.001) cost benefits, with a 31% reduction in costs with nurse-led, compared to medically led care. Evidence from this study suggests that a specialist nurse is able to provide safe follow up for men undergoing radiotherapy. The intervention focused on coping with symptoms, and provided continuity of care and telephone support. Further work is required to improve the management of patients during and after radiotherapy.

Nurse led telephone follow up in ovarian cancer: A psychosocial perspective

“…Within this section, patients were asked to rate the support they had received during telephone follow up and identify what has been particularly good about their follow up care, and which approach they preferred. The experience of care questionnaire has been used in a number of other cancer studies (Avis et al 1995;Thomas et al 1996;Faithfull et al 2001).…”

“…There is a belief that nurse led services are a cost effective method of addressing the increasing pressure on follow up services (Faithfull et al 2001). However, discussions considering service redesign should primarily focus on improving the quality of service provision and the potential of nurses to enhance aspects of patient care.…”

“…However, discussions considering service redesign should primarily focus on improving the quality of service provision and the potential of nurses to enhance aspects of patient care. The acceptability of nurse led follow up has been demonstrated in a range of cancer sites including lung (Moore et al 2002;Cox et al 2006b), breast (Koinberg et al 2004), and prostate cancer (Faithfull et al 2001;Booker et al 2004). A qualitative breast cancer study of patient perceptions of routine follow up care (Pennery and Mallet 2000) reported that 54% of women questioned would prefer their follow up care to be provided by the nurse specialist as they were more 'supportive' and had the necessary 'time, skills and knowledge'.…”

Radiation therapist‐led weekly patient treatment reviews

“…1,9,21 Roles traditionally undertaken by health professionals are less likely to be defined by traditional boundaries and are increasingly becoming more of a "team approach". 9 The rationale behind the appointment of ROs as treatment reviewers is based on the theory that they are highly trained medical specialists, and the most appropriate professional to review the patient during treatment.…”

“…This reasoning fails to acknowledge the role of the treatment review as not only a medical assessment and a source for advice on treatment reactions for the patient, but also as an opportunity for the patient and their carers to discuss and address their informational, psychological and social needs. 1,8,[11][12][13][14][15] Considering this, the role of the reviewer is broad including, but not limited to, information provider, medical specialist, counsellor, patient advocate and friend. 13 The reviewer needs to be skilled to competently address all areas encouraging open communication and providing appropriate resources to support the patient.…”