Continuity of care in patients with cancer: development and evaluation of a complex intervention


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Michael King1, Louise Jones2, Irwin Nazareth3, Alison Richardson4, Adrian Tookman2, Ona McCarthy1, Mary Rogers1

1University College London, London, UK, 2Marie Curie Palliative Care Research Unit, University College, London, London, UK, 3MRC General Practice Research Framework, London, UK, 4Department Cancer and Palliative Care Nursing, Kings College London, London, UK

Abstract

Continuity of care in patients with cancer: development and evaluation of a complex intervention

Background

High experienced continuity of care in patients with cancer is associated with lower needs for care, better quality of life and psychological outcomes. This phase II study developed and evaluated a complex intervention to improve experienced continuity. Exploratory work informed an intervention, which consisted of two components: 1) a 17 item patient completed continuity assessment; 2) feedback to clinical nurse specialists and action to address the needs identified.

Method

Multidisciplinary team meetings and oncology outpatient clinics were observed, and patients and staff were interviewed. After qualitative work and reliability testing of the assessment, the two part intervention was evaluated against standard cancer care in an exploratory three arm, parallel group, randomised trial.

Results

Ninety-three patients were recruited; 61 provided data for analysis. No statistically significant differences were found in continuity (primary outcome) between the trial arms, although important trends were seen in the secondary outcome (needs for care) in favour of those receiving the intervention with a gradient of improvement favouring the intervention.

Conclusion

Feeding back findings from the continuity assessment to clinicians reduced patients’ needs for care. Mechanisms are required to ensure regular attention is paid to patients' perceptions of continuity of care in cancer, should include patients' self-assessments and should target patients with inadequate experienced continuity. Attitudes to organisational change must be considered to implement an intervention and strategies to overcome barriers are needed. Results from phase II indicate the potential usefulness of a phase III randomised controlled trial targeting patients with inadequate experienced continuity of care.