Nursing - Theses
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ItemExploring post-treatment care for women with high-intermediate and high-risk endometrial cancer: A mixed methods study( 2022)Endometrial cancer (EC) imposes a significant burden on women and the health system. Intense post-treatment follow-up (FU) for women with high-intermediate (H-I) and high-risk (H-R) disease lasts five years or longer with only 20% likely to develop recurrence. Death from pre-existing conditions is more likely than from EC. No evidence supports FU improving long-term survival or quality of life. Alternative FU needs consideration. The aim of this thesis was to explore current post-treatment FU models for women with H-I and H-R EC to: - Understand the current model of patient care in addressing survivorship issues. - Identify deficiencies in post-treatment care. - Make recommendations that support optimal care based on women's perspectives and needs. A sequential explanatory mixed methods study was conducted in two phases to: examine patterns of care and disease outcomes; explore the extent to which the current model of care 1) meets women’s physical and emotional needs; 2) addresses survivorship issues. Phase 1: A retrospective case audit was conducted of women referred for adjuvant radiation treatment between 2004 and 2014 who subsequently recurred. Data were analysed using descriptive statistics. Phase 2 recruited women without evidence of disease, attending medically-led FU. Purposive sampling targeted a range of experiences post-treatment. Semi-structured interviews were analysed using inductive thematic approach. Quantitative data results revealed of 786 women referred, 19% developed recurrence. Most (63%) had at least two pre-existing comorbidities. Few notes (9%) documented lifestyle discussions. A third (31%) experienced mild/moderate treatment-related side-effects. Most notes (84%) contained no references to emotional status; few (12%) contained exercise recommendations; few (17%) for those working pre-treatment indicated return to work discussions; seven documented nursing consultation. Most recurrence (87%) occurred within three years post-surgery, 70% was symptomatic. Although treating clinicians detected 59% of recurrences, only 46% were during scheduled FU. The majority (59%) had multi-focal recurrence and poor outcomes. Two years post-treatment for recurrence, 31% were alive, 15% without evidence of disease. Eleven survived four years. Analysis of 25 interviews yielded four themes: ‘The safe haven of FU’; ‘Fear of cancer recurrence’ (FOR); ‘It is more than absence of cancer’; ‘Attitudes and relationships to health care professionals’. Women reported little preparation for survivorship. FU focused on physical symptoms; recurrence detection; treatment toxicity. Attending FU both escalated and alleviated FOR. Generally emotional needs were unmet. Health promotion and practical support toward making lifestyle changes was absent. Women valued specialist-led FU and ongoing connection with them. Women perceived limited contact with nurses in FU. Nurse-led care could provide for unmet needs, including emotional and healthy lifestyle support. In conclusion, this thesis indicates the current model is effective in dealing with medical issues from a disease perspective but is inefficient. In 70% of cases recurrence detection was from symptomatic disease rather than FU. For many, the current model is burdensome and does not comprehensively address survivorship issues. Findings indicate revision of national EC FU guidelines, and reforming EC survivorship care models as needed. Shifting the focus of FU towards addressing women’s post-treatment experiences is overdue. Specialist nurse-led FU should be considered.