Searching for a professional identity: a qualitative study of the oncology nurses role in a multidisciplinary breast-unit team.
Keywords:
case manager; specialist nurses role; clinical decision-making; person-centred care; interprofessional care; qualitative study; content analysis.Abstract
Background and Aims. Interprofessional collaboration concept in healthcare implies and evoke enhanced nurses’ involvement and role consideration. Our research aimed to investigate: 1) the impact of nursing within a multidisciplinary team of breast-unit practice; 2) healthcare team and patients' perceptions of key-features of the interprofessional care pathway. Methods. A qualitative exploratory approach was adopted. Researchers were involved in the activities of the Breast Unit: department meetings, review of unit guidelines, observation of professional practice and documents. In-depth interviews were conducted with 14 patients and a representative group of 15 healthcare professionals from the unit. Qualitative content analysis was chosen to infer data from interviews’ transcripts. Results. The analysis’ critical themes showed a very marginal nursing presence and the unfulfilled role of the Case Manager, especially in organizing the patient's journey and facilitating team communication. Furthermore, the lack of shared decision-making, team communication problems and limited inter-professional collaboration indicated the mono-professional management of the breast unit and a devaluation of specialist nurses role in managing patient care. Conclusion. The supportive roles of the oncology specialist nurse and case manager are still struggling within the cancer care pathways and multidisciplinary team. Although healthcare organizations attempt to develop and expand these roles, nurses must assess, identify challenges and barriers to navigate through such complex systems. Therefore, the implementation of interprofessional collaboration and a person-centred model of care can also take place through greater socio-cultural awareness and the recognition by health professionals and patients of the specialist nurses role.
Keywords: advanced nursing role; case manager; clinical decision-making; person-centred care; interprofessional care; qualitative study; content analysis.
References
2. Bookey-Bassett S, Markle-Reid M, Mckey CA, Akhtar-Danesh N. Understanding interprofessional collaboration in the context of chronic disease management for older adults living in communities: a concept analysis. J Adv Nurs. 2017;73(1):71-84. https://doi.org/10.1111/jan.13162
3. Moilanen T, Leino-Kilpi H, Koskela I, et al. Healthcare professionals’ perceptions of the pre-requisites and realisation of interprofessional collaboration in cancer care. Eur J Cancer Care (Engl). 2020;29(1):e13197. https://doi.org/ 10.1111/ecc.13197
4. Fox A, Reeves S. Interprofessional collaborative patient-centred care: a critical exploration of two related discourses. J Interprof Care. 2015;29(2):113-118. https://doi.org/10.3109/13561820.2014.954284
5. Petri L. Concept analysis of interdisciplinary collaboration: Concept analysis of interdisciplinary collaboration. Nurs Forum. 2010;45(2):73-82. https://doi.org/10.1111/j.1744-6198.2010.00167.x
6. Constand MK, MacDermid JC, Dal Bello-Haas V, Law M. Scoping review of patient-centered care approaches in healthcare. BMC Health Serv Res. 2014;14(1):271.
https://doi.org/10.1186/1472-6963-14-271
7. Sidani S, Fox M. Patient-centered care: clarification of its specific elements to facilitate interprofessional care. J Interprof Care. 2014;28(2):134-141. https://doi.org/10.3109/13561820.2013.862519
8. Cardoso, F., Cataliotti, L., Costa, A., Knox, S., Marotti, L., Rutgers, E. & Beishon, M. European Breast Cancer Conference manifesto on breast centres/units. Europ J Cancer. 2017; 72:244-250.
9. Knox S. The European patient advocacy perspective on specialist breast units and accreditation. Breast. 2015;24(3):287-289. https://doi.org/10.1016/j.breast.2015.01.013
10. Wilson ARM, Marotti L, Bianchi S, et al. The requirements of a specialist Breast Centre. Eur J Cancer. 2013;49(17):3579-3587. https://doi.org/10.1016/j.ejca.2013.07.017
11. Aarhus R, Tjørnhøj‐ Thomsen T, Tarp B, Vedsted P & Andersen RS. (2019). Coordinating objects of care: Exploring the role of case managers as brokers in cancer patient pathways. Eur J Cancer. 2019; e13017. doi.org/10.1111/ecc.13017
12. Tariman JD, Szubski KL. The evolving role of the nurse during the cancer treatment decision-making process: a literature review. Clin J Oncol Nurs. 2015;19(5):548-556. https://doi.org/10.1188/15.CJON.548-556
13. Leary A, White J, Yarnell L. The work left undone. Understanding the challenge of providing holistic lung cancer nursing care in the UK. Eur J Oncol Nurs. 2014;18(1):23-28. https://doi.org/10.1016/j.ejon.2013.10.002
14. Eicher M, Kadmon I, Claassen S, Marquard S, Pennery E, Wengstrom Y & Fenlon D. Training breast care nurses throughout Europe: the EONS postbasic curriculum for breast cancer nursing. Eur J Cancer. 2012;48(9):1257-1262. https://doi.org/ 10.1016/j.ejca.2011.07.011
15. O’Rourke DJ, Thompson GN, McMillan DE. Ethical and moral considerations of (patient) centredness in nursing and healthcare: Navigating uncharted waters. Nurs Inq. 2019;26(3):e12284. https://doi.org/10.1111/nin.12284
16. Goldman J, MacMillan K, Kitto S, Wu R, Silver I, Reeves S. Bedside nurses’ roles in discharge collaboration in general internal medicine: Disconnected, disempowered and devalued? Nurs Inq. 2018;25(3):e12236. https://doi.org/10.1111/nin.12236
17. Joo J. Y. & Liu M. F. Effectiveness of Nurse-Led Case Management in Cancer Care: Systematic Review. Clin Nurs Res. 2019;28(8):968-991. https://doi.org/10.1177/21054773818773285
18. Thoma JE, Waite MA. Experiences of nurse case managers within a central discharge planning role of collaboration between physicians, patients and other healthcare professionals: A sociocultural qualitative study. J Clin Nurs. 2018;27(5-6):1198-1208. https://doi.org/10.1111/jocn.14166
19. Sena B & Liani S. The role of relational routines in hindering transdisciplinary collaboration: the case of the setting up of a team in an Italian Breast Unit. J Int Care. 2020;34(2):251-258.
20. Cosentino C, Bettuzzi M, Campioli G, Di Marco V, Giacopuzzi G, Marinoni I, ... & Artioli G. Individual and social variables and their effect on Case/Care Manager Job Satisfaction: an exploratory study. Acta Biomed. 2017;88(Suppl 3), 59. https://doi.org/10.23750/abm.v88i3-S.6615
21. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107-115.. https://doi.org/10.1111/j.1365-2648.2007.04569.x
22. Krippendorff, K.Content analysis: An introduction to its methodology. (Fourth Ed). Sage publications; 2018.
23. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105-112.. https://doi.org/10.1016/j.nedt.2003.10.001
24. Finfgeld-Connett D. Use of content analysis to conduct knowledge-building and theory-generating qualitative systematic reviews. Qual Res. 2014;14(3):341-352.https://doi.org/10.1177%2F1468794113481790
25. Schreier, M. Qualitative Content Analysis in Practice. Sage publishing; 2012.
26. Rolfe G. Validity, trustworthiness and rigour: quality and the idea of qualitative research. J Adv Nurs. 2006;53(3):304-310. https://doi.org/10.1111/j.1365-2648.2006.03727.x
27. Epstein RM, Street RL Jr. The values and value of patient-centered care. Ann Fam Med. 2011;9(2):100-103. https://doi.org/10.1370/afm.1239
28. Kitson A, Marshall A, Bassett K, Zeitz K. What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing: Core elements of patient-centred care. J Adv Nurs. 2013;69(1):4-15. https://doi.org/10.1111/j.1365-2648.2012.06064.x
29. Truccolo I, Mazzocut M, Cipolat Mis C, et al. Patients and caregivers’ unmet information needs in the field of patient education: results from an Italian multicenter exploratory survey. Support Care Cancer. 2019;27(6):2023-2030. https://doi.org/10.1007/s00520-018-4439-z
30. Savelberg W, Boersma LJ, Smidt M, Goossens MFJ, Hermanns R, van der Weijden T. Does lack of deeper understanding of shared decision making explains the suboptimal performance on crucial parts of it? An example from breast cancer care. Eur J Oncol Nurs. 2019;38:92-97. https://doi.org/10.1016/j.ejon.2018.12.004
31. Zucca A, Sanson-Fisher R, Waller A, Carey M. Patient-centred care: making cancer treatment centres accountable. Support Care Cancer. 2014;22(7):1989-1997. https://doi.org/10.1007/s00520-014-2221-4
32. D’Amour D, Oandasan I. Interprofessionality as the field of interprofessional practice and interprofessional education: an emerging concept. J Interprof Care. 2005;19 Suppl 1(sup1):8-20. https://doi.org/10.1080/13561820500081604
33. Bilodeau K, Dubois S, Pepin J. Interprofessional patient-centred practice in oncology teams: utopia or reality? J Interprof Care. 2015;29(2):106-112.
34. Mortari L. & Saiani L. Gestures and thoughts of caring: A theory of caring from the voices of nurses. McGraw-Hill Education; 2014.
35. Propp KM, Apker J, Zabava Ford WS, Wallace N, Serbenski M, Hofmeister N. Meeting the complex needs of the health care team: identification of nurse-team communication practices perceived to enhance patient outcomes. Qual Health Res. 2010;20(1):15-28. https://doi.org/10.3109/13561820.2014.942838
36. Wittenberg-Lyles E, Goldsmith J & Ferrell B. Oncology nurse communication barriers to patient-centered care. Clin j oncol nurs. 2012;17(2). https://doi.org/ 10.1188/13.CJON.152-158.
37. Bachmann C, Abramovitch H, Barbu CG, et al. A European consensus on learning objectives for a core communication curriculum in health care professions. Patient Educ Couns. 2013;93(1):18-26. https://doi.org/10.1016/j.pec.2012.10.016
38. Henoch I, Danielson E, Strang S, Browall M & Melin-Johansson C. Training intervention for health care staff in the provision of existential support to patients with cancer: a randomized, controlled study. J Pain Symptom Manage. 2013;46(6): 785-794. https://doi.org/10.1016/j.jpainsymman.2013.01.013
39. Chen Y-C, Chang Y-J, Tsou Y-C, Chen M-C, Pai Y-C. Effectiveness of nurse case management compared with usual care in cancer patients at a single medical center in
Taiwan: a quasi-experimental study. BMC Health Serv Res. 2013;13(1):202 https://doi.org/10.1186/1472-6963-13-202
40. Wallace I, Barratt H, Harvey S, Raine R. The impact of Clinical Nurse Specialists on the decision making process in cancer multidisciplinary team meetings: A qualitative study. Eur J Oncol Nurs. 2019;43(101674):101674. https://doi.org/10.1016/j.ejon.2019.101674
41. Autelitano C, Bertocchi E, Artioli G, Alquati S, Tanzi S. The Specialist Palliative Care Nurses' in an Italian Hospital: role, competences, and activities. Acta Biomed. 2021 Mar 31;92(S2):e2021006. doi: 10.23750/abm.v92iS2.11360. PMID: 33855987.
42. Rose P, Yates P. Person centred nursing care in radiation oncology: a case study. Eur J Oncol Nurs. 2013;17(5):554-562. https://doi.org/10.1016/j.ejon.2013.02.001
43. McMullen L. Oncology nurse navigators and the continuum of cancer care. Semin Oncol Nurs. 2013;29(2):105-117. https://doi.org/10.1016/j.soncn.2013.02.005
44. Sena B. Professionalization without autonomy: the Italian case of building the nursing profession. P&P. 2017;7(3):e1900-e1900.
45. Epstein RM, Duberstein PR, Fenton JJ, et al. Effect of a patient-centered communication intervention on oncologist-patient communication, quality of life, and health care utilization in advanced cancer: The VOICE randomized clinical trial: The VOICE randomized clinical trial. JAMA Oncol. 2017;3(1):92-100.https://doi.org/10.1001/jamaoncol.2016.4373
46. Kesson E. M., Allardice G. M., George W. D., Burns H. J., & Morrison D. S. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ. 2012;344:e2718. doi:10.1136/bmj.e2718
Downloads
Published
Issue
Section
License
Copyright (c) 2021 Enrico De Luca, Barbara Sena
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
