Patients' experiences and perceptions of an outpatient systemic anti-cancer therapy service - Implementing a new pre-assessment care pathway for lung cancer patients

Abstract

The demand for outpatient systemic anti-cancer therapy (SACT) services has increased by 15% in the period 2011–2018. An ageing population, improving cancer survival rates and the ongoing introduction of new and more complex SACT have contributed to the increased demand. Treatment capacity and achieving cancer waiting time targets have also affected the demand for outpatient services. It had become apparent that, in a large regional cancer centre, the current care pathway was no longer person-centred or fit for purpose for lung cancer patients receiving SACT, as they required a greater amount of clinical time in the treatment area than scheduled and involvement from the medical team. A pre-assessment care pathway was identified as a possible alternative and would also provide a person-centred approach.

Lung cancer has remained the most common cancer in Scotland with approximately 5,331 new cases in 2018, 85% of these cases occur in the over-65 years age group and survival rates remain poor. These patients are vulnerable, often present at an advanced stage of their disease and experience distressing symptoms. Many patients have pre-existing long-term medical conditions that often affect their general health, which may determine their fitness and tolerance for treatment.

A comprehensive review of the literature identified a number of key benefits to a pre-assessment care pathway, such as improved patient experience; improved self-management of disease and treatment-related symptoms, and improved efficiency of resource and capacity. The aim of my study was to explore the patients’ experiences and perceptions of an outpatient SACT service and whether implementing a new pre-assessment care pathway enables person-centred care for a group of lung cancer patients. Using qualitative methodology, semi-structured interviews facilitated an in-depth inquiry with 32 lung cancer patients undergoing SACT. Thematic analysis using Braun and Clark’s framework facilitated analysis of the data to help construct initial codes into themes and then into three overarching themes: consequence of lung cancer diagnosis, care delivery: SACT pre-assessment and phone assessment, and symptoms of lung cancer and side effects from SACT.

The findings have provided insight into the benefits of a SACT pre-assessment care pathway. These have indicated that this provided person-centred and tailored assessment for lung cancer patients, which enabled participants to feel better informed about their decision-making. Findings further indicated being better informed improved compliance with the treatment and management of side effects, positively impacting on the quality of life for these patients. This study provides healthcare professionals with new knowledge of the SACT assessment process which would improve clinical practice and care provision for these patients. From the findings, there is potential for other patient groups undergoing SACT, including gynaecological, breast or colon cancer, to benefit from a pre-assessment care pathway.