Optimising Supported Early Discharge Follow-up care for women with Breast Cancer in the UK – a qualitative analysis


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Lyndel Moore1, Eila Watson2, Lyndel Moore1, Lauren Matheson2, Jo Brett2, Verna Lavender3, Bernadette Lavery4, Anne Kendall1
1Great Western Hospital, 2Oxford Brookes University, 3Guy’s and St Thomas’ NHS Foundation Trust, 4Oxford University Hospitals NHS Foundation Trust

Abstract

Background

Cancer follow-up care is moving away from routine, consultant-led pathways to patient-initiated care, incorporating supported self-management. A qualitative evaluation of a nurse-led supported early discharge follow-up service for breast cancer patients was conducted to explore how this follow-up pathway could be optimised to best meet patients’ needs.

Method

Breast cancer patients (n=150) on a supported early discharge follow-up pathway from two UK centres (one cancer centre and one district general hospital) were recruited as part of a mixed methods study.  Women were recruited during clinic appointments.  In-depth, semi-structured telephone interviews were conducted with a purposive maximum variation subsample (n=20) of survey respondents. Qualitative data was analysed using thematic analysis.

Results

Most women described positive views towards being on supported early discharge follow-up pathway. A significant minority, however, reported unmet needs and struggled with navigating uncertainties related to accessing ongoing care and support, performing breast self-examination, managing ongoing side-effects, future care pathways and fear of recurrence. Key themes were constructed which related to women’s varying experiences of the supported early discharge pathway: empowerment over health and wellbeing and confidence in self-management; perceptions of healthcare as a ‘safety net’ and confidence in care; preparedness and support for managing treatment side-effects; the role and timing of Holistic Needs Assessments (HNAs); and influences on managing fear of recurrence. A novel conceptual model indicating the key influences on patients’ ability to self-manage and navigate uncertainties during patient-initiated follow-up pathways has been developed.

Conclusion

Important recommendations for optimising patient-initiated follow-up pathways have emerged from the study.  These include: targeted provision of psychological support; education on breast self-examination and how to recognise a recurrence; reassurance to encourage help-seeking; ensuring patients understand what to expect on a patient-initiated early discharge follow-up pathway and are clear who they can contact and how; greater support to manage ongoing side-effects. Ehealth interventions might be useful tools warranting future investigation. 

Impact statement

The findings from this study will help optimise follow-up care for women with breast cancer.