The research provides valuable results, and these results are discussed in the sections below. The main three questions of the research were the following: what transitional nursing strategies need to be developed to address patients with cancer, how can transitional nursing improve the life of patients with cancer and cancer survivors, and would it be helpful to patients to develop a plan of care after discharge?
Results
First and foremost, sample characteristics are to be presented. The interviews were completed with 25 patients, although, initially, 38 patients agreed to participate. Nevertheless, eight patients refused to take part in the interviews due to lack of time, three patients were too ill to be interviewed, and two patients were not available during the interview time that was previously scheduled with them. Thirteen patients were male, and twelve patients were female.
Ten patients were adolescents, thirteen patients were adults (28-50 years old), and two patients were older adults (>65 years old). The median age of the participants was 38 years (28-69). Six patients were diagnosed with lung cancer, five patients with skin cancer, three patients with bladder cancer, three patients with bone cancer, two patients with colon cancer, two patients with breast cancer, and the remaining four patients had brain, cervical, oral, and testicular cancer respectively. Twelve patients were non-Hispanic white, ten patients were Black, two patients were Asian, and one was Native American. Most of the patients were non-manual workers (thirteen patients); adolescents and elderly patients were not employed. Five patients had a history of cancer, and two patients were cancer survivors.
As for the healthcare professionals, ten oncology nurses that worked with oncology patients were interviewed. Eight participants were female; two participants were male. Their median age was 30 years old (25-44). Two nurses have been working more than five years with transitional patients, five nurses less than three years, and three nurses less than one year. All nurses were acquainted with the transitional care model and had visited workshops and lectures about the TCM.
Transitional Nursing Strategies
According to Hirschman, Shaid, McCauley, Pauly, and Naylor (2015), the core strategies of the TCM include maintaining relationships, engaging patients in the development of care plans, educating and promoting self-management, collaborating, and fostering coordination between patients, nurses, and caregivers. Six nurses confirmed that they maintained relationships with their patients via telephone calls and E-Mail correspondence.
According to the interviews with cancer patients and cancer survivors, seven patients agreed that they would like to establish trusting relationships with the nursing professional that took care of them. The author of the research also noticed that adolescents were more prone to correspond with their nurse using online tools such as E-Mails or social networks.
Five of the interviewed nurses stated that they had engaged family caregivers when frail elderly patients were treated. One of the interviewed elderly patients said that “my nurse collaborated with the family caregiver, and it greatly improved the treatment” (O. Jackson, personal communication, February 23, 2017). However, six of the interviewed patients mentioned that their nurse (or nurses) did not try to collaborate with the family caregiver, which sometimes led to confusion and misunderstandings.
All ten interviewed nurses agreed on the importance of education and promotion of self-management, especially in elderly patients. Furthermore, education as a tool of communication and promotion of health-related practices is also supported by other researchers (Bleyer, Barr, Ries, Whelan, & Ferrari, 2016). Adolescent patients noticed that they received information about cancer from their doctor and the nursing professionals that were responsible for their treatment; being educated about the clinical choices they had helped several patients to overcome the cancer-related anxiety (National Cancer Institute, n.d.).
Nevertheless, three patients, including one cancer survivor, stated that being educated about the disease and its possible outcomes negatively influenced their perception of the situation and resulted in fear, depression, and anxiety.
Seven interviewed nurses agreed that the continuity of care during the transition was able to positively influence the patient’s well-being and ensure that no crucial mistakes were made during it. Three nurses agreed that the continuity of care was necessary but could be interrupted if the circumstances demanded it (e.g. patients moved to other cities or countries). Visiting their patients after discharge was supported by the majority of the interviewed nurses (eight out of ten) (Hirschman et al., 2015).
Discharge Plans
Cancer survivors agreed that it was helpful to develop a plan after discharge with their doctor because it increased the efficiency of the transitional period (Christ, Behar, & Messner, 2015). The treatment summary was also received by the interviewed cancer survivors, who pointed out that they provided it to the clinicians during other procedures if it was needed. When nursing professionals were interviewed about treatment summaries and plans developed after the discharge, four interviewees stated that they either developed the plan with the patient and their doctor or received such a plan from a patient (L. McLeod, personal communication, February 21, 2017). Both nurses and interviewed cancer survivors agreed that medical facilities needed to see discharge plans as a routine strategy rather than an innovative one.
Discussion
As it can be seen, transitional strategies are implemented in oncology, but not as efficiently as one might expect. To ensure that transitional care model is used by the majority of nurses, detailed and clear rules of transitional care in oncology need to be developed so that nurses, doctors, and patients can rely on these guidelines during treatment. Furthermore, little attention is paid to the emotional distress of patients, especially cancer-specific distress (Chambers et al., 2012).
Collaboration with caregivers can be the strategy that will gradually and significantly improve the treatment of patients during transitional periods. The continuity of care is yet another issue that often remains unaddressed in transitional care in oncology. Of course, there are situations in which the continuity of care is impossible; however, healthcare professionals should pay attention to it because it does not only make the transition more efficient but also improves patient’s quality of life during it.
It should be noted that education and promotion of self-management are implemented widely and mostly supported both by nurses and by patients. Some patients might be afraid of being educated about cancer; however, these fears need to be addressed by psychological support. Both adult and adolescent patients and cancer survivors agree that education and self-management are helpful during treatment and after discharge because they help the patients control their treatment and manage the effects it causes.
One of the major concerns is the plan of care after discharge. As it can be seen from the interviews, plans of care are rarely written after discharge, which can adversely influence the transition (Earle & Ganz, 2012). Cancer survivorship is neglected; nevertheless, the transition from hospital to home can be challenging as well. Therefore, it is advisable for national institutes and healthcare professionals who work with cancer patients to develop discharge plans and guidelines for cancer survivors.
The situations when patients remain without the needed psychological and physiological care should be avoided because the lack of discharge treatment does not align with the promotion of education and collaboration in transitional care. Some of the treatment effects might appear much later, and patients need to be informed about them.
Limitations and Implications for Future Research
The study includes several limitations. First, the small sample size is one of the main disadvantages of qualitative studies. Second, some of the patients found it difficult to openly speak about their disease which could negatively influence the fidelity of the results. Third, the interviewed nurses were selected from several medical facilities that possibly had a similar approach towards transitional care in oncology, which influenced their responses. Nevertheless, the findings discussed in this study are supported by other studies (Bleyer et al., 2016; Chambers et al., 2012).
A prospective study with a larger sample size conducted by professionals from different cities and states could provide more detailed, accurate, and reliable results. This study can serve as the first step of a nation-wide research about transitional care in oncology. Furthermore, more patients with cancer and cancer survivors need to be interviewed to evaluate what issues there are in other areas, states, or even countries. It is also possible to suggest conducting a comparative study on transitional care in oncology among American and European hospitals to understand what issues are related to local policies and legal regulations.
References
Bleyer, W. A., Barr, R. D., Ries, L., Whelan, J., & Ferrari, A. (2016). Adolescent and young adult oncology: Historical and global perspectives. New York, NY: Springer.
Chambers, S. K., Girgis, A., Occhipinti, S., Hutchison, S., Turner, J., Morris, B., & Dunn, J. (2012). Psychological distress and unmet supportive care needs in cancer patients and carers who contact cancer helplines. European Journal of Cancer Care, 21(2), 213-223.
Christ, G. H., Behar, L. C., & Messner, C. (2015). Handbook of oncology social work: Psychosocial care for people with cancer. Oxford, England: Oxford University Press.
Earle, C. C., & Ganz, P. A. (2012). Cancer survivorship care: Don’t let the perfect be the enemy of the good. Journal of Clinical Oncology, 30(30), 3764-3768.
Hirschman, K., Shaid, E., McCauley, K., Pauly, M., & Naylor, M. (2015). Continuity of care: The transitional care model. OJIN: The Online Journal of Issues in Nursing, 20(3), 1-7.
National Cancer Institute. (n.d.). Adolescents and young adults with cancer. Web.