Perspectives and Experiences of Healthcare Professionals Involved in a Community Nurse-Delivered Shared Care Model Intervention Designed to Support Outpatients Receiving Chemotherapy: A Qualitative Study Using Interviews

Author:

Kim Bora123ORCID,Boustany Chantale123ORCID,Acret Louise23ORCID,McLeod Jodi4,Cook Natalie5ORCID,McKenzie Heather3ORCID,Hayes Lillian3,Fethney Judith3ORCID,Simpson Judy M.6ORCID,Willcock Simon7,White Kate123ORCID

Affiliation:

1. The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney 2050, Australia

2. Cancer Care Research Unit, Sydney Local Health District, Sydney 2050, Australia

3. Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney 2050, Australia

4. Sydney District Nursing, Sydney Local Health District, Sydney 2050, Australia

5. Healthdirect, Sydney 2000, Australia

6. Sydney School of Public Health, The University of Sydney, Sydney 2050, Australia

7. MQ Health, Macquarie University Hospital, Primary Care, Sydney 2109, Australia

Abstract

Background. Chemotherapy can cause a range of side effects including nausea, vomiting, diarrhea, and infection, which can have a significant impact on an individual’s quality of life. Survival outcomes can be impacted when side effects are poorly managed, leading to failure to complete the defined dose of treatment. Objective. This study presents clinicians’ experiences with a shared care model involving home-based community nurse (CN) support to improve side-effect management of individuals receiving chemotherapy as an outpatient. Methods. A qualitative study was conducted with CNs, cancer nurses, medical oncologists, and a general practitioner involved in the CN intervention delivered as part of a randomized controlled trial (RCT) aimed at reducing unplanned presentations to hospital of cancer patients receiving outpatient chemotherapy. Semistructured individual and focus group interviews were conducted. Key themes were identified using thematic analysis. Findings. Twenty-three healthcare professionals were interviewed. Three themes were identified: (1) being able to enhance patient-centered care and clinical practice during chemotherapy; (2) importance of effective communication and collaborative relationships between different care settings; and (3) ways to adapt the intervention for implementation in routine clinical practice. Participants reported that it was feasible for CNs to care for this patient group, and their home visits enabled preemptive symptom management. Suggestions to improve and modify the intervention to implement this care model within existing clinical care included a flexible approach, such as a blended delivery with face-to-face visits and telephone calls; a risk- or needs-based approach to prioritize patient groups more likely to benefit from the intervention; and sharing of electronic medical records for more effective collaboration and communication. Conclusions. A CN-delivered shared care model provided a feasible approach to the provision of individualized support for outpatients receiving chemotherapy. This study suggests ways to adapt this care model into existing clinical workflow and structures. This trial is registered with ACTRN12614001113640.

Funder

National Health and Medical Research Council

Publisher

Hindawi Limited

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