Browse
Recent Submissions
Item Open Access Brachytherapy for cervical cancer : guidelines to facilitate quality patient management in a multidisciplinary environment(University of the Free State, 2014-10) Long, Deirdré; Friedrich-Nel, H. S.; Joubert, G.English: This study was undertaken to establish guidelines to facilitate quality patient management for cervical cancer patients, receiving high dose rate-intracavitary brachytherapy, in a multidisciplinary environment. An extensive literature search found that guidance to service providers and members of multidisciplinary teams (radiation oncologists, radiation therapists and oncology nurses) is limited to the organisational and technical aspects of high dose rate-intracavitary brachytherapy treatment delivery. The aim was thus to formulate patient-centred guidelines that could be used as a tool to guide members of multidisciplinary teams in providing quality patient management to this group of women in governmental and private brachytherapy units in South Africa. A prospective, qualitative study with a phenomenological approach was chosen as the framework for the study. The study was approved by the management of the hospital and the department and by the Ethics Committee of the Faculty of Health Sciences, University of the Free State. All participants gave written informed consent before participation. The study objectives were approached in five stages. In stage one the study utilised semi-structured, one-to-one interviews in English, Afrikaans or Sesotho in order to gain a detailed picture of a participant’s experience and perceptions of patient management while undergoing brachytherapy. In order to include the opinions of women across the age spectrum into the study, the researcher purposively recruited participants from each of the following three age groups: 30-45 years; 46-60 years and 61years and older. Each age group included at least one private and one local oncology patient. Hospitalised patients were also included in the study sample. The sample size for this study was determined by saturation of the data. Saturation was reached having interviewed twenty-eight participants. Interviews were conducted by a multilingual female social worker. An open-ended interview schedule in English, Afrikaans and Sesotho were designed by the researcher and provided the interviewer with a set of predetermined questions that guided the interviewing process. The participants had to respond to open-ended questions (with probes) at the department of Oncology, Universitas Annex, Bloemfontein after their third brachytherapy treatment. The order of questions in the interview schedule simulated the path of events that each participant had gone through at the department (from the new patient clinic up until brachytherapy treatment delivery). Interviews were audio recorded and transcribed before qualitative analysis by the researcher. Understanding and acknowledging the patient’s unmet needs were fundamental to the development of the proposed guidelines. The analysis identified shared and unique experiences amongst the 28 interviewed participants. Four themes with sub-themes were identified from the data: (1) informational needs, (2) patient disposition towards treatment, (3) psychological experience and (4) physical experience. In stage two the scope of the proposed guidelines was formulated by (1) the integration of the patient experience of stage one, together with (2) a literature search and (3) the knowledge and experience of the researcher. The proposed guidelines addressed logistical matters of the practice setting and the collective and exclusive roles and responsibilities of members of the multidisciplinary team at the new patient clinic and the brachytherapy unit of the department. The proposed guidelines were aligned with the flow of patient management in the Department of Oncology. In stage three of the research study the proposed guidelines were reviewed by members of the multidisciplinary team of the Department of Oncology who regularly interact with this group of patients. Twenty members of the multidisciplinary team working at the brachytherapy unit of the Department of Oncology, Bloemfontein, with at least a year’s experience of service delivery at the brachytherapy unit, were purposively selected to participate in the focus group interviews. Focus groups usually include six to ten participants and therefore the twenty selected participants were divided into two focus groups. Each focus group was compiled in such a way that the members were comparable regarding professional category and years of experience. Medical physicists were excluded as they are not directly involved with the management or care of patients at this unit. The two focus group interviews took place on the same day. The setting was familiar and in close vicinity for the participants. The focus group interviews were conducted in English so as to accommodate all participants. The duties of the group facilitator were performed by the study promoter, while the duties of assistant facilitator during the focus group interviews were performed by the study co-promoter. The topic guide for the focus group interviews was the list of proposed guidelines. The focus group interviews were guided by the interview schedule, during which general and specific, open-ended questions were asked. After discussions by the focus group, each section was summarised in agreement with the focus group by the assistant facilitator. An opportunity was provided for the focus group members to add additional information to the proposed guidelines. The proposed guidelines proved to be clear and concise and structured and formulated in an explanatory and understandable manner that is easy to apply by all disciplines working at the new patient clinic and the brachytherapy unit. In total, six additional guidelines were proposed, twelve guidelines were amended and four guidelines were omitted. The words “shared responsibilities” were changed to collective responsibilities and the roles and responsibilities of members of the multidisciplinary team were allocated to a specific member/s. In stage four of the research study the amended guidelines were reviewed by heads or designated representatives of governmental and private brachytherapy units in South Africa. This stage was undertaken to gather their opinions and views on the applicability and feasibility of the guidelines. Electronic mail interviews in English were conducted with seven heads or designated representatives. The layout and formulation of the guidelines were accepted by all the participants as it was found to be well compartmentalised with well-defined mandates. In addition the guidelines would be practical to implement at brachytherapy units as the layout and formulation of the guidelines are logical, clear and concise. Seventeen additional guidelines were proposed, two guidelines were amended and one guideline was omitted. The feedback assisted the researcher in further refining the proposed guidelines, before the final presentation in stage five of the research. The final guidelines presented in stage five of this research study provide a framework that clearly defines the collective and exclusive roles and responsibilities of members of multidisciplinary teams for implementation at the new patient clinic and brachytherapy unit, respectively. In addition, the guidelines address the practice setting of brachytherapy units, ensuring a secure environment for the patient. Although individual unit activities may differ and resource constraints may prevent the full implementation of the guidelines, these guidelines could be implemented with some refining and focussing on what is already in practice. The researcher therefore conclude that the study aim and objectives have been achieved and that the guidelines will make a significant difference to the patient’s experience of patient management at brachytherapy units in the country.