Holistic needs assessment and care plans for women with gynaecological cancer: do they improve cancer-specific health-related quality of life? A randomised controlled trial using mixed methods.

OBJECTIVES: Holistic needs assessment (HNA) and care planning are proposed to address unmet needs of people treated for cancer. We tested whether HNA and care planning by an allied health professional improved cancer-specific quality of life for women following curative treatment for stage I-III gynaecological cancer. METHODS: Consecutive women were invited to participate in a randomised controlled study (HNA and care planning vs usual care) at a UK cancer centre. Data were collected by questionnaire at baseline, 3 and 6 months. The outcomes were 6-month change in European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-C30 (version 3), global score (primary) and, in EORTC subscales, generic quality of life and self-efficacy (secondary). The study was blinded for data management and analysis. Differences in outcomes were compared between groups. Health service utilisation and quality-adjusted life years (QALY) (from Short Form-6) were gathered for a cost-effectiveness analysis. Thematic analysis was used to interpret data from an exit interview. RESULTS: 150 women consented (75 per group); 10 undertook interviews. For 124 participants (61 intervention, 63 controls) with complete data, no statistically significant differences were seen between groups in the primary endpoint. The majority of those interviewed reported important personal gains they attributed to the intervention, which reflected trends to improvement seen in EORTC functional and symptom scales. Economic analysis suggests a 62% probability of cost-effectiveness at a £30 000/QALY threshold. CONCLUSION: Care plan development with an allied health professional is cost-effective, acceptable and useful for some women treated for stage I-III gynaecological cancer. We recommend its introduction early in the pathway to support person-centred care.

Influencing organisational culture: a leadership challenge.

In the wake of the Francis report, the need for NHS trusts and hospitals to adopt a culture of learning, safety and transparency has been highlighted. This article considers different aspects of culture in health care, and hones in on the link between culture and safety for patients in putting the patient first, embedding the 6Cs and considering the options to measure and influence organisational culture. The article reflects more deeply on how leadership across all levels can influence and inspire change in organisational culture, ensuring that the patient remains the focus of any changes in care delivery.

Cancer survivorship: evolutionary concept analysis.

AIM: This paper is a report of a concept analysis of cancer survivorship in adults. BACKGROUND: The concept of cancer survivorship appears frequently in cross-discipline literature but does not seem to have any precise definition or meaning. Substantive research into the experience of surviving cancer is long overdue. However, if a concept has not been clearly defined any theoretical work based on that concept will also be unclear. DATA SOURCES: The analysis was based on literature published in English between 1994 and 2006 (n = 43) and seminal work in the field. REVIEW METHODS: Rodgers' method of evolutionary concept analysis was used, allowing the concept to be viewed within a sociocultural and temporal context and capturing both lay and emic perspectives. RESULTS: Cancer survivorship in adults is a process beginning at diagnosis and involving uncertainty. It is a life-changing experience with a duality of positive and negative aspects, and is unique to the individual but has some universality. The primary antecedent is a cancer diagnosis and the consequences can be divided into four main themes: physical health, psychological health, social health and spiritual health. CONCLUSION: Surviving cancer is now an established reality for millions of people worldwide. Nurses can benefit from a deeper understanding of the patient experience, both theoretically and in practice. Clarification of a concept provides a heuristic for further inquiry and a basis for theory generation.