Symptom clusters in cancer patients: An Italian survey to validate and describe unwarranted clinical variation, inequality in access to healthcare, knowledge, and risk of malpractice: Italian national survey on symptom clusters

Silvia Beloni; Cristina Arrigoni; Federica Dellafiore; Orejeta Diamanti; Alessio Piredda; Rosario Caruso

doi:10.23750/abm.v92iS2.11331

Symptom clusters in cancer patients: An Italian survey to validate and describe unwarranted clinical variation, inequality in access to healthcare, knowledge, and risk of malpractice

Italian national survey on symptom clusters

Authors

Silvia Beloni Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
Cristina Arrigoni Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
Federica Dellafiore Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
Orejeta Diamanti Research Nursing Centre, IRCCS Istituto Oncologico Veneto, Padova, Italy
Alessio Piredda Italian Association of Cancer Nurses, European Institute of Oncology, Milan, Italy
Rosario Caruso Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy http://orcid.org/0000-0002-7736-6209

DOI: https://doi.org/10.23750/abm.v92iS2.11331

Keywords:

care, cancer symptoms, inequities, oncology nursing, survey, symptoms science management

Abstract

Background and aims: The perceptions of professionals involved in cancer care regarding the importance of their symptoms-specific knowledge, unwarranted clinical variation (UCV), and inequalities in access to healthcare are still underdescribed. This study aims to confirm the construct validity of a previously initially developed questionnaire and describe nurses' perceptions about the relevance of their knowledge referred to cancer symptoms management, the UCV, the inequalities in access to healthcare, and malpractice risk.

Method: A cross-sectional pan-national study was conducted using a convenience sample, collecting data through a previously initially validated questionnaire. Construct validity was corroborated through confirmatory factor analysis, and descriptive statistics were employed for summarizing the questionnaire's scores. The scores between the nurses working in accredited cancer centers and nurses employed in general hospitals were inferentially compared.

Results: The sample comprised 810 nurses, 480 were nurses working in accredited cancer centers, and 330 were nurses working in general hospitals. The questionnaire showed adequate construct validity and reliability. Nurses perceived the cluster of psychosocial symptoms with a greater risk of UCV and inequalities in access to cancer services than the cluster of physical symptoms.

Discussion and conclusions: A paradigm shift aimed at integrating psychosocial cancer symptoms in the care paths emerged as pivotal for improving Italy's cancer care.

References

Miaskowski C, Barsevick A, Berger A, Casagrande R, Grady PA, Jacobsen P, et al. Advancing symptom science through symptom cluster research: Expert panel proceedings and recommendations. Vol. 109, Journal of the National Cancer Institute. 2017.

Mroz EA, Rocco JW. The challenges of tumor genetic diversity. Vol. 123, Cancer. 2017. p. 917–27.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.

Cleeland CS. Symptom burden: multiple symptoms and their impact as patient-reported outcomes. J Natl Cancer Inst Monogr. 2007;(37):16–21.

Kwekkeboom KL. Cancer Symptom Cluster Management. Vol. 32, Seminars in Oncology Nursing. 2016. p. 373–82.

Fan G. Symptom Clusters in Cancer Patients: A Review of the Literature. Curr Oncol. 2007;14(5):173–9.

Thomas BC, Waller A, Malhi RL, Fung T, Carlson LE, Groff SL, et al. A longitudinal analysis of symptom clusters in cancer patients and their socio-demographic predictors. J Pain Symptom Manage. 2014;47(3):566–78.

Kim HJ, Barsevick AM, Beck SL, Dudley W. Clinical subgroups of a psychoneurologic symptom cluster in women receiving treatment for breast cancer: A secondary analysis. Oncol Nurs Forum. 2012;39(1):E20-30.

Kirkova J, Aktas A, Walsh D, Davis MP. Cancer symptom clusters: Clinical and research methodology. J Palliat Med. 2011;14(10):1149–66.

Caruso R, Belloni S, Dellafiore F, Biagioli V, Piredda A, Arrigoni C. A bottom-up approach to prioritize the scientific activities of Italian Association of Cancer Nurses (AIIAO): Questionnaire validation and pilot study. Recenti Prog Med. 2019;110(10):480–9.

Cashion AK, Gill J, Hawes R, Henderson WA, Saligan L. National Institutes of Health Symptom Science Model sheds light on patient symptoms. Nurs Outlook. 2016;64(5):499–506.

Harrison R, Manias E, Mears S, Heslop D, Hinchcliff R, Hay L. Addressing unwarranted clinical variation: A rapid review of current evidence. J Eval Clin Pract. 2019;25(1):53–65.

European Commission. Report on inequalities in access to healthcare across the EU released - Employment, Social Affairs & Inclusion - European Commission [Internet]. European Union. 2018 [cited 2020 Jul 1]. Available from: https://ec.europa.eu/social/main.jsp?langId=en&catId=89&newsId=9238&furtherNews=yes

Arnold M, Rutherford M, Bardot A, Ferlay J, Al. E. Progress in Cancer Survival, Mortality, and Incidence in Seven High-Income Countries 1995-2014 (ICBP SURVMARK-2): A Population-Based Study. Artic Lancet Oncol. 2019;20:1493–505.

Espina C, Soerjomataram I, Forman D, Martín-Moreno JM. Cancer prevention policy in the EU: Best practices are now well recognised; no reason for countries to lag behind. J Cancer Policy. 2018;18:40–51.

Lugtenberg M, Burgers JS, Westert GP. Effects of evidence-based clinical practice guidelines on quality of care: a systematic review. Qual Saf Heal Care. 2009;18(5):385–92.

De Paoli P, Ciliberto G, Ferrarini M, Pelicci PG, Dellabona P, De Lorenzo F, et al. Alliance Against Cancer, the network of Italian cancer centers bridging research and care. J Transl Med. 2015;13(1):360.

Kwekkeboom K, Zhang Y, Campbell T, Coe CL, Costanzo E, Serlin RC, et al. Randomized controlled trial of a brief cognitive-behavioral strategies intervention for the pain, fatigue, and sleep disturbance symptom cluster in advanced cancer. Psychooncology. 2018;27(12):2761–9.

Bonkowski SL, De Gagne JC, Cade MB, Bulla SA. Evaluation of a pain management education program and operational guideline on nursing practice, attitudes, and pain management. J Contin Educ Nurs. 2018;49(4):178–85.

Faithfull S, Samuel C, Lemanska A, Warnock C, Greenfield D. Self-reported competence in long term care provision for adult cancer survivors: A cross sectional survey of nursing and allied health care professionals. Int J Nurs Stud. 2016;53:85–94.

Sweeney CF, LeMahieu A, Fryer GE. Nurse practitioner malpractice data: Informing nursing education. J Prof Nurs. 2017;33(4):271–5.

Borras JM, Albreht T, Audisio R, Briers E, Casali P, Esperou H, et al. Policy statement on multidisciplinary cancer care. Eur J Cancer. 2014;50(3):475–80.

Heyes SM, Bond MJ. Pathways to psychological wellbeing for patients with bladder cancer and their partners-in-care. Eur J Oncol Nurs. 2020;46:101757.

Biagioli V, Belloni S, Albanesi B, Piredda A, Caruso R. Comment on "The experience on coronavirus disease 2019 and cancer from an oncology hub institution in Milan, Lombardy Region" and reflections from the Italian Association of Oncology Nurses. Eur J Cancer. 2020;135:8–10.

Caruso R, Di Pasquale C, Lichosik D, Dellafiore F, Pittella F. Report on the 2013 European Multidisciplinary Cancer Congress - ECC 17, Amsterdam, 27 September-1 October 2013: Nursing highlights. Ecancermedicalscience. 2013;7(1).

Van Harten WH. Comprehensive cancer centres based on a network: the OECI point of view. Ecancermedicalscience [Internet]. 2014;11(8):ed43. Available from: www.ecancer.org

Signorelli C, Odone A, Oradini-Alacreu A, Pelissero G. Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary. Health Policy (New York). 2020;124(1):69–74.

Signorelli C, Fara GM, Odone A, Zangrandi A. The reform of the Italian Constitution and its possible impact on public health and the National Health Service. Health Policy (New York). 2017;121(1):90–1.

Atella V, Belotti F, Bojke C, Castelli A, Grašič K, Kopinska J, et al. How health policy shapes healthcare sector productivity? Evidence from Italy and UK. Health Policy (New York). 2019;123(1):27–36.

Althubaiti A. Information bias in health research: Definition, pitfalls, and adjustment methods. J Multidiscip Healthc. 2016;9:211–7.

Flora DB, Flake JK. The purpose and practice of exploratory and confirmatory factor analysis in psychological research: Decisions for scale development and validation. Can J Behav Sci. 2017;49(2):78–88.