Cancer has increasingly become a global concern in recent years, with studies showing that the prevalence of cancer is on the rise (Torre et al., 2015). Many approaches and strategies have been researched on ways of curbing the increase in prevalence and ameliorate the patients’ symptoms. These approaches have largely focused on improving the patients’ welfare through better preventive measures, treatment modalities, and managed care. Cervical cancer, for example, has been regarded as a menace in females especially of the reproductive age. There has, however, been a breakthrough in the prevention and, management of cervical cancer following the discovery of the HPV (human papillomavirus) vaccine (Torre et al., 2017). Research is currently underway to find better alternatives to the existing management approaches for cancers. These initiatives are compelled by the need to improve the health benefits of gynecological cancer patients and patients of other cancer forms. Despite the endearing support and consideration for the patients, there is one aspect of the patient welfare that has for a long time been overlooked – the psychosocial needs and support for cancer patients. It should be noted that a large part of the research and cancer initiatives are dedicated to treating and managing cancer itself. There are however other underlying factors that affect the cancer patients that need to be addressed in equal measure. Distress is one of the presenting factors affecting patients. A study by O’Connor et al., (2017) sought to determine the prevalence of distress among gynecological cancer patients, the presenting problems of the patients, and how the health care practitioners (HCP) perceive the distress screening approaches. The study involved a cross-sectional evaluation of patients and interviewing of HCP in the health care facility. The distress thermometer (DT) was used to quantitatively scale the distress levels among the patients involved. According to the study, there is a high prevalence of distress among gynecological cancer patients. This necessitates the upregulation of incorporation of distress screening and referral programs into patient care management. This paper aims to analyze the prevalence of distress among cancer patients, the problems of the patients, HCP’s perception of the distress screening interventions and the applicability of the study findings to clinical care for enhanced patient benefits.
The study by O’Conor et al., (2017) aimed to answer the following study questions: what is the prevalence of distress in gynecological cancer patients? What are the specific problems affecting the patients? What is the HCPs’ perception of the screening and referral methods for distress in patients? To answer these questions, the researchers obtained qualitative and quantitative data from patients and staff at the King Edward Memorial Hospital in Western Australia. Quantitative data was obtained by performing a cross-sectional study that involved 62 female participants. The data from the participant was obtained using a distress thermometer (DT) paired with a Problem List. The DT contained a scale of range 0 -10 of single items, while the PL had 39 items in five categorizes. The qualitative study data was obtained by interviewing six oncology HCPs. The study findings showed that there is a high prevalence of distress (60%) in female patients with gynecological cancers. Fear, fatigue, nervousness, and sleep disorders were among the most common problems in the participating population group. HCPs and patients positively perceived the distress screening guidelines as a way of helping to improve patient welfare and HCP-patient interactions. Distress screening is beneficial both to the patients and the HCPs. The research questions were formulated on the basis of the surging prevalence of cancer globally, which prompts the need to evaluate other associated psychosocial and economic problems that the patients face. Distress does not only affect the patient, but also the HCPs as they relate with the patients during the treatment and management process. A higher prevalence of distress among the patients might negatively affect the treatment process by inhibiting practitioner-patient interaction. HCP contribution to the integration of distress screening approaches in cancer patient management is also imperative. A negative perception of these approaches could greatly impede its adoption because the HCPs are at the fore of the adoption and integration of distress screening in health care. The study questions have thus formed a basis for evidence-based practice in cancer patient management.
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The study used a mixed-method design; in which quantitative data was obtained using the DT and PL in a cross-sectional study, while qualitative data were obtained by interviewing HCP in the health care facility. The mixed-study design is a research method that integrates qualitative and quantitative data in a single study. This approach is particularly applicable in research that aims at obtaining data to guide evidence-based practice in a clinical setting (Wisdom & Cresswell, 2013). The research focuses on collecting both types of data on the same platform without the need to split the research into two studies. This makes the research more efficient, less costly and saves time. The method, however, requires intensive data analysis to correlate and interpret the data obtained. O’Conor et al., (2017) utilized the mixed method research design because the research objectives could be effectively met by simultaneously collecting and analyzing quantitative and qualitative data.
Sixty-two participants took part in the cross-sectional study, while 6 participants were interviewed. The 62 participants were women 18-years or older, diagnosed with gynecological cancer and could be able to understand the DT and PL without unnecessary help. Females below 18 years, those that could not obtain consent on their own, or those that could not read and interpret the DT and PL on their own were excluded from selection. Six HCP were interviewed, i.e., two social workers, three nurses, and one psychotherapist (O’Connor et al., 2017. The sample size included in the study was inadequate in light of the research questions and objectives of the study. Determining the most important problems for cancer patients requires a larger sample size (a minimum of 100 participants). Only six oncology staff were interviewed. This number is inadequate given the number of oncology HCP spread out across a region or nation. Finding and conclusions drawn from such as a small number of participants might not be reflective of the entire patient population or HCPs. Ethical consideration involved was ensuring that only consented participants were included in the study.
Both quantitative and qualitative data were collected. Quantitative data was collected using the DT and PL, in which the participants were required to respond to the items listed in the data collection tool. The DT was scored from 0 -10, which 0 depicting no distress and 10 being high distress. The PL had a list of 39 problems which were grouped into five categories. The participants were to respond with “yes” or “no” to the listed items. Another set of qualitative data was obtained by interviewing the participating oncology staff. The study does not explicitly state what questions were included in the interview. But it can be construed that the HCPs were asked about what their thoughts were on patient distress screening, possible challenges, and if the intervention would be beneficial for both the patients and HCPs. The data was collected by a research officer who was in contact with the study participants.
The study was conducted in a busy health care facility. The busy environment made difficult to keep track of distress referral. Also, some patients could not be approached to be included in the study because it was difficult to keep track of all the patient visiting the gynecology wing of the facility. The study also left some potential participants out because there was no one to provide consent during some research day. These factors contributed to the small sample size used in the study, thus bringing the credibility of the results into question.
According to the study findings, 21 participants scored 7-10 on the DT, 20 scored 4-6, and the other 21 participants scored 0-3. On the PL assessment, three-quarters of the problems identified were physical and emotional – 207 and 147 respectively; while spiritual problems were the least. When categorized by age, participants aged 40 years and below scored the highest on the DT (7-10) while only 3 participants had the same high scores. There were no significant variations by age in the problems faced by the patients. It also emerged that distress screening interventions would be beneficial both for the patients and the HCPs. The HCPs positively perceived distress screening but cited challenges such as time constraints (O’Connor et al., 2017). The findings support the research questions because they depict the prevalence of distress among cancer patients, and provide insight into the HCP’s perception on the applicability of distress screening in health care.
In conclusion, the study highlights the significance of incorporating distress screening for cancer patients in patient care and management. There is a high prevalence of distress among the patients compounded by physical, emotional, practical, familial, and spiritual problems. It is therefore imperative to implement a practice change in health care to incorporate distress screening, besides the conventional cancer treatment and management intervention. There are more issues besides the physiological cancer symptoms that the patients present. The study points out that adopting distress screening and management is beneficial both to the patients and HCPs. Better management and service provision for cancer patients can, therefore, be realized by implementing change in patient management and adopting distress screening.
References
O'Connor, M., Tanner, P. B., Miller, L., Watts, K. J., & Musiello, T. (2017). Detecting Distress: Introducing Routine Screening in a Gynecologic Cancer Setting. Clinical journal of oncology nursing , 21 (1), 79-85.
Torre, L. A., Bray, F., Siegel, R. L., Ferlay, J., Lortet‐Tieulent, J., & Jemal, A. (2015). Global cancer statistics, 2012. CA: a cancer journal for clinicians , 65 (2), 87-108.
Torre, L. A., Islami, F., Siegel, R. L., Ward, E. M., & Jemal, A. (2017). Global cancer in women: burden and trends.
Wisdom, J., & Creswell, J. W. (2013). Mixed methods: integrating quantitative and qualitative data collection and analysis while studying patient-centered medical home models. Rockville: Agency for Healthcare Research and Quality .
