Unexpected Cancer Diagnosis (UCD)
Research type
Research Study
Full title
Patients’ and Professionals’ View of the Impact of a Diagnosis of Cancer being Made Following an Unplanned Hospital Attendance; a pilot study.
IRAS ID
264894
Contact name
Karen Wingfield
Contact email
Sponsor organisation
Cardiff University
Duration of Study in the UK
0 years, 4 months, 31 days
Research summary
Summary of Research
Between June 2015 and December 2018, Cwm Taf Morgannwg University Health Board (CTMUHB)Acute Oncology Service (AOS) have been involved with 479 patients diagnosed within CTM UHB as a result of an unplanned hospital admission or attendance.
From anecdotal evidence this is a very stressful time for patients and family. The AOS Clinical Nurse Specialist (CNS) acts as a contact and support for the patient and family until the patient is under the care of a cancer site specific team or the palliative care services (hospital or community palliative care services). The AOS team especially the Clinical Nurse Specialists (CNSs) are heavily involved with these patients, however there is little or no evidence about the benefit of AOS with these patients or the patients’ and the health care professionals’ (HCPs) experiences who are involved with these patients.
RESEARCH QUESTION/AIM(S)
• Qualitative insight into the patients’ perception of their cancer diagnosis when made in an emergency setting.
• Qualitative insight into HCPs perception of management of this cohort of patients.
• Highlighting areas of future research in this cohort of patients.Objectives
• Inform and influence awareness, education and training needs of HCPs.
• Inform and influence future research in AOS.
• Inform the management of this cohort of patientsData will be gained from qualitative semi-structured interviews with patients and HCPs. This study will produce insights into the impact of a cancer diagnosis on this cohort of patients/relatives and HCPs experiences.
Summary of Results
The original plan was to include patients however due to COVID pandemic and my ethical approval finishing I was unable to carry out this part of the project. Also I had more HCPs willing to participate but due to COVID pandemic and my ethical approval finishing I was unable to interview more HCPs.
Four HCPs signed consent forms and were interviewed as described. 3 female, 1 male all medical consultants with varying lengths of time as a consultant from 3-10 years. The following themes were found in the interviews:-
• Negotiating with other departments
• Wishing to do a good job
• Appreciate AOS
• Emotional Aspect
Discussion
Implications of this study
The ongoing input of AOS and increased AOS staffing would help support the medical teams and patients with this cohort of patients. Team work between AOS and the acute medical teams has grown since AOS started in 2015. Many referrals to AOS come from this group of acute medical consultants. Furthermore since the Royal Glamorgan clinical lead for AOS is also an acute medical consultant this has helped the AOS CNS become more ingrained with the acute medical team.Outside of the remit of AOS is negotiating with other departments. At times AOS can help negotiate however often discussions are needed at a higher medical level than an AOS CNS.
Wishing to do a good job
AOS needs to continue supporting all HCPs involved with these patients. However the AOS would benefit from increased nursing staff to ensure equitable service across the UHB and to cover leave, regardless of type.
Education/Training gaps
There were some knowledge gaps raised in the interviews. Some of these i.e. support services available for patients could be covered by a short education session with the acute medical teams. The acute medical team have a regular education sessions which I need to link into and offer to provide a session.
The AOS is very well appreciated and the support provided to patients and HCPs is very welcome as it is an emotional group of patients to care for.
Challenges
As part of the interviews some cases were discussed- I knew most of the cases and able to update the interviewees on some of the cases. Not all had happy endings. One case mentioned by one of the interviewees is also a member of staff so we knew her well.Final Outcome/Conclusion
HCPs experience significant emotional effort relating to managing this cohort of patients in relation to breaking bad news. AOS is appreciated and beneficial to stakeholders and patients, its team work is valued. Further research with this group of stakeholders and extend to patient interviews as originally planned would be beneficial.
Recommendations
Data is too small to provide meaningful recommendations for policy/practice/education.
I plan to link in with the medical team and offer educational session (s) regarding some of the gaps highlighted in the interviews.REC name
Wales REC 5
REC reference
19/WA/0368
Date of REC Opinion
20 Dec 2019
REC opinion
Favourable Opinion