Brachytherapy for cervical cancer : guidelines to facilitate quality patient management in a multidisciplinary environment
| dc.contributor.advisor | Friedrich-Nel, H. S. | |
| dc.contributor.author | Long, Deirdré | |
| dc.contributor.other | Joubert, G. | |
| dc.date.accessioned | 2015-09-21T09:22:16Z | |
| dc.date.available | 2015-09-21T09:22:16Z | |
| dc.date.copyright | 2014-10 | |
| dc.date.issued | 2014-10 | |
| dc.date.submitted | 2014-10 | |
| dc.description.abstract | 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. | en_ZA |
| dc.description.abstract | Afrikaans: Hierdie studie is onderneem om riglyne vir gehalte pasiëntbestuur te fasiliteer vir pasiënte met servikale kanker wat hoë dosis tempo-intrakavitêre bragiterapie ontvang in ’n multidissiplinêre omgewing. ’n Omvattende literatuursoektog het bevind dat leiding vir diensverskaffers en lede van multidissiplinêre spanne (bestralingsonkoloë, bestralingsterapeute en onkologieverpleegkundiges) beperk is tot die organisatoriese en tegniese aspekte van die lewering van hoë dosis tempo-intrakavitêre bragiterapie behandeling. Die doelwit was gevolglik om pasiënt-gesentreerde riglyne te formuleer wat gebruik kan word as ’n hulpmiddel om lede van multidissiplinêre spanne te lei in die verskaffing van gehalte pasiëntbestuur van hierdie groep vroue in staats- en privaat bragiterapie-eenhede in Suid-Afrika. ʼn Prospektiewe, kwalitatiewe studie met ʼn fenomenologiese benadering is gebruik as die studie-raamwerk. Die studie is goedgekeur deur die bestuur van die hospitaal en die departement, en die etiekkomitee van die Fakulteit Gesondheidswetenskappe, Universiteit van die Vrystaat. Alle deelnemers het geskrewe ingeligte toestemming gegee voor deelname. Die doelwitte van die studie is in vyf fases benader. In fase een van die studie is semi-gestruktureerde, individuele onderhoude in Engels, Afrikaans en Sesotho gebruik om ’n omvattende beeld van ’n deelnemer se ervaring en persepsies van pasiëntbestuur tydens bragiterapie behandeling te verkry. Om die opinies van vroue oor die breë spektrum van ouderdomsgroepe te verkry, het die navorser pasiënte doelgerig as deelnemers geselekteer uit elk van die volgende drie ouderdomsgroepe: 30-45 jaar; 46-60 jaar en 61 jaar en ouer. Elke ouderdomsgroep het ten minste een privaat en een plaaslike onkologie pasiënt ingesluit. Gehospitaliseerde pasiënte is ook in die studie steekproef ingesluit. Die grootte van die studie steekproef is bepaal deur datasaturasie. Saturasie is bereik nadat onderhoude met agt-en-twinitg deelnemers gevoer is. Die onderhoudvoerder was ʼn veeltalige vroulike maatskaplike werker. Die ope-vrae vraelys in Engels, Afrikaans en Sesotho is deur die navorser saamgestel en die voorafbepaalde vrae is deur die onderhoudvoerder gebruik tydens die onderhoude. Oopvrae (met ondersoekende vrae) is aan die deelnemers by die Departement Onkologie, Universitas Annex, Bloemfontein, gevra na hul derde bragiterapie behandeling. Die volgorde van die vrae was so saamgestel dat dit die pasiënt se bestuur in die afdeling simuleer (nuwe pasiëntkliniek tot bragiterapie behandeling). Onderhoude is op band opgeneem en getranskribeer voor kwaliatiewe ontleding deur die navorser. Begrip en erkenning van die pasiënt se onvervulde behoeftes was die grondslag vir die ontwikkeling van die voorgestelde riglyne. Gemeenskaplike en unieke ervaringe van die 28 deelnemers is tydens analisering van die data geïdentifiseer. Vier temas met onderafdelings is geïdentifiseer: (1) ʼn behoefte aan inligting, (2) die pasiënt se houding teenoor die behandeling, (3) sielkundige ervaring- en (4) fisiese ervaringe. In fase twee is die omvang van die voorgestelde riglyne geformuleer deur (1) die integrasie van die pasiënt ervaring van fase een, gekombineer met (2) ’n literatuursoektog en (3) die kennis en ervaring van die navorser. Die voorgestelde riglyne spreek logistieke aangeleenthede van die praktykomgewing en die kollektiewe en eksklusiewe rolle en verantwoordelikhede van lede van die multidissiplinêre span by die nuwe pasiëntkliniek en die bragiterapie-eenheid van die departement aan. Die voorgestelde riglyne is met die vloei van die pasiëntbestuur in die Departement Onkologie belyn. In fase drie van die navorsingstudie is die voorgestelde riglyne geëvalueer deur lede van die multidissiplinêre span van die Departement Onkologie wat op ʼn gereelde basis interaksie het met hierdie groep pasiënte. Twintig lede van die multidissiplinêre span wat werksaam is by die bragiterapie-eenheid van die Departement Onkologie, Bloemfontein, met ten minste ʼn jaar se ervaring van dienslewering by die bragiterapieeenheid is doelgerig geselekteer om aan die fokusgroeponderhoude deel te neem. Fokusgroepe bestaan gewoonlik uit ses tot tien deelnemers en daarom is die twintig geselekteerde deelnemers verdeel in twee fokusgroepe. Elke fokusgroep is saamgestel sodat die groepe vergelykbaar was ten opsigte van professionele kategorie en jare ervaring. Mediese fisici is uitgesluit aangesien hulle nie direk betrokke is by die bestuur of sorg van pasiënte by hierdie eenheid nie. Die twee fokusgroeponderhoude het op dieselfde dag plaasgevind. Die omgewing was bekend en maklik bereikbaar vir die deelnemers. Die fokusgroeponderhoude het plaasgevind in Engels om alle deelnemers te akkommodeer. Die studie-promoter het die funksies van ʼn groepfasiliteerder verrig, terwyl die mede-promoter opgetree het as assistant-fasiliteerder tydens die fokusgroeponderhoude. Die besprekingsgids vir die fokusgroeponderhoude was die lys voorgestelde riglyne. Die fokusgroeponderhoude is gelei deur die ondershoudskedule waartydens algemene en spesifieke, oop-vrae gevra is. Die besprekings wat gevolg het na elke afdeling tydens elke fokusgroep, is deur die assistent-fasiliteerder opgesom met instemming van die fokusgroepe. ʼn Geleentheid is aan die fokusgroep-deelnemers gegee om bykomende inligting tot die voorgestelde riglyne by te voeg. Die voorgestelde riglyne is aanvaar as duidelik, bondig en gestruktureer en geformuleer op ʼn beskrywende en verstaanbare wyse sodat dit maklik toegepas kan word deur al die dissiplines werksaam by die nuwe pasiëntkliniek en die bragiterapie-eenheid. ʼn Totaal van ses addisionele riglyne is voorgestel, twaalf riglyne is gewysig en vier riglyne is uitgelaat. Die woorde “gedeelde verantwoordelikhede” is verander na kollektiewe verantwoordelikhede en die rolle en verantwoordelikhede van die multidissiplinêre span is aan ʼn spesifieke lid of lede toegewys. In fase vier van die navorsingstudie is die gewysigde riglyne geëvalueer deur hoofde of aangewese verteenwoordigers van staats- en privaat bragiterapie-eenhede in Suid- Afrika. Die fase is onderneem om hul menings oor die toepaslikheid en uitvoerbaarheid van die riglyne te verkry. Elektroniese pos onderhoude is in Engels met sewe hoofde of aangewese verteenwoordigers gehou. Die uitleg en formaat van die riglyne is deur al die deelnemers goedgekeur, aangesien bevind is dat dit goed gegroepeer was met goed gedefinieerde mandate. Verder is die riglyne gesien as prakties uitvoerbaar deur bragiterapie-eenhede, omdat die uitleg en formaat logies, duidelik en bondig is. Sewentien addisionele riglyne is voorgestel, twee riglyne is gewysig en een riglyn is uitgelaat. Die terugvoer het die navorser gehelp om die voorgestelde riglyne verder te verfyn voordat dit finaal in fase vyf van die navorsing aangebied word. Die finale riglyne soos aangebied in fase vyf van hierdie navorsingstudie bied ’n raamwerk wat duidelik die kollektiewe en eksklusiewe rolle en verantwoordelikhede van lede van multidissiplinêre spanne definieer vir implementering by onderskeidelik die nuwe pasiëntkliniek en bragiterapie-eenheid. Verder spreek die riglyne die praktykomgewing van bragiterapie-eenhede aan om sodoende ’n veilige omgewing vir die pasiënt te verseker. Alhoewel individuele eenhede se aktiwiteite mag wissel en beperkings op hulpbronne die volledige implementering van die riglyne mag verhoed, kan die riglyne met verdere verfyning en deur te fokus op dit wat reeds in die praktyk plaasvind, geïmplementeer word. Die navorser kom dus tot die gevolgtrekking dat die doelwitte van die studie bereik is en dat die riglyne ’n betekenisvolle verskil sal maak wat betref die pasiënt se ervaring van pasiëntbestuur by bragiterapie-eenhede in die land. | af |
| dc.identifier.uri | http://hdl.handle.net/11660/1247 | |
| dc.language.iso | en | en_ZA |
| dc.publisher | University of the Free State | en_ZA |
| dc.rights.holder | University of the Free State | en_ZA |
| dc.subject | Radioisotope brachytherapy | en_ZA |
| dc.subject | Cervix uteri -- Cancer | en_ZA |
| dc.subject | Cervix uteri -- Cancer -- Patients | en_ZA |
| dc.subject | Oncology | en_ZA |
| dc.subject | Brachytherapy | en_ZA |
| dc.subject | Thesis (Ph.D. (Oncology))--University of the Free State, 2014 | en_ZA |
| dc.subject | Quality patient management | en_ZA |
| dc.subject | Phenomenology | en_ZA |
| dc.subject | Multidisciplinary team | en_ZA |
| dc.subject | Patientcentred care | en_ZA |
| dc.subject | High dose rate | en_ZA |
| dc.subject | Cervical cancer | en_ZA |
| dc.title | Brachytherapy for cervical cancer : guidelines to facilitate quality patient management in a multidisciplinary environment | en_ZA |
| dc.type | Thesis | en_ZA |