The Support, Education, and Advocacy (SEA) Program of Care for Women With Metastatic Breast Cancer: A Nurse-Led Palliative Care Demonstration Program

Abstract

Background: Women with metastatic breast cancer (MBC) experience unique symptom management and psychosocial needs due to aggressive, yet palliative treatment with a progressive, chronic illness. Objective: This article describes the effect of a quality improvement project for coordination of supportive care in MBC. Program evaluations included referral rates for supportive services, patient-reported outcomes of symptom distress, generalized anxiety, and overall well-being. Design: An interdisciplinary Support, Education and Advocacy Program (MBC-SEA) was developed. The 1-hour, weekly, patient review included collaborative assessments to determine needs for social service, psychological counseling, and palliative care. A prospective pre- and postexperimental cohort design with convenience sampling was used. Analysis was conducted with paired t test analysis of pre- and postimplementation outcomes. Setting/Participants: Program outcomes of 118 women with MBC visiting an urban outpatient breast cancer clinic during September 2016 to November 2016 (pre) and January 2017 to March 2017 (post) were evaluated. Measurements: Referral rates to social work and palliative care, symptom, anxiety, and overall well-being scores. Results: Following program implementation, referrals to palliative care and social work supportive services increased significantly including patient-reported outcomes symptom distress scores mean difference 1.4 (95% confidence interval [CI]: 0.4306-2.6428), P = .004; generalized anxiety scores mean difference 1.5 (95% CI: 0.5406-2.5781), P = .003; and overall well-being mean difference of −0.7 (95% CI: −1.3498 to −0.0570), P = .03. Conclusions: Purposeful nurse-led assessment for social service and palliative care needs increases referrals with improvement in patient-reported outcomes.

Palliative care access in the elderly metastatic breast cancer population: obstacles and opportunities

“…This model was measured according to referral rates to social work and palliative care, symptoms, anxiety and overall well-being scores of 118 women with metastatic breast cancer receiving treatment at an urban outpatient breast cancer clinic ( 22 ). This study showed that patient navigators have a positive influence on care coordination, physical functioning, financial burden, access to clinical trials and overall improved access to all services ( 22 ). The role of patient navigator is found to be most successful when delivered earlier in the metastatic cancer disease trajectory rather than closer to end of life.…”

“…The role of patient navigator is found to be most successful when delivered earlier in the metastatic cancer disease trajectory rather than closer to end of life. Earlier intervention provides patients with better access to the resources that will help improve the quality and extend the length of their lives ( 22 ). These models of outpatient palliative care can help in the overall care of metastatic and advanced cancer patients and should be able to be adapted to the resources of any cancer care setting.…”

Contribuições e dificuldades da equipe de enfermagem na implementação de cuidados paliativos ao paciente oncológico

“…Os enfermeiros relataram uma sensação de realização pessoal e profissional ao fornecer os cuidados paliativos primários, enquanto observaram também o risco de aumento do apego emocional aos pacientes. Foi evidente que o treinamento melhorou as habilidades de comunicação da enfermagem, e o apoio no local de trabalho ajudou a minimizar o estresse relacionado à incorporação do cuidado paliativo Reiser et al (2019). estudaram os efeitos de um projeto de melhoria da qualidade de vida no Programa de assistência a mulheres com câncer de mama metastático estágio IV.…”

A Importância Da Investigação Do Distress Em Pacientes Oncológicos: Revisão Integrativa

“…Percebeu-se que as ações realizadas pela enfermagem para prevenir foi investigando a rotina dos pacientes (ALMEIDA et al, 2020. LIMA et al, 2015. REISER et al, 2019.…”

“…Manhães et al, 2019. Agarwal et al, 2019. Reiser et al, 2019.Sofrimento espiritualFonte: Elaboração própria, 2021.A importância da enfermagem na investigação do distress em pacientes oncológicos possibilita que o enfermeiro identifique as ações e intervenções que garantam o direito do paciente, tal como a forma que influencia no tratamento do indivíduo.…”