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

Year: 2021

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.