Research in action

EONS is pleased to present short reports from researchers undertaking current research. Click on each section to read more about the researcher and their research.

My current research project topics include:

Implementing walkarounds to improve safety outcomes for cancer patients

Objective: To analyze the changes in safety culture for patients following the implementation of a program of Patient Safety Rounds (RS) at three Cancer centers 2015-2017.

Method: Study pretest-posttest intervention in inpatient units of the three Oncology Hospitals. Displays estimated 300 doctors and nurses care field of oncology inpatient units (booking fees included) for α=β= 5%. A total 36 patients were included, using a purposive sampling of typical cases: oncology, hematology and radiotherapy.

Data collection: the meetings will be made quarterly way covering all nursing shifts. She prior to the completion of the RS, a questionnaire will be passed to professionals and members of management and participate in assessing the patient safety culture. The instrument used is the questionnaire Hospital Survey on Patient Safety of the Agency for Care Research and Quality (AHRQ) in its Spanish version. The first measure is before initiating RS and the second after a year of being implemented measures change (RS).

Data analysis: descriptive and inferential, uni and bivariate analyzes were performed. In the case of data obtained from patient’s interviews, descriptive content analysis will be performed in pairs.

Clinical Importance:

The present study seeks to implant and evaluate new mechanisms for improving the care process, based as an angular element of care the safety of the patient and family.

Research Impact:

The oncological process is characterized by its complexity, both in the application of oncological treatment and in the process of holistic cancer care, accompanied by moments of great physical, psychological and social fragility that endanger the safety of the person. Therefore, Patient Safety Rounds can be a tool that allows management to improve the culture and results referred to Patient Safety in the cancer process.

My current research project topics include:

The research protocol is entitled “Explore the effectiveness of topical lemon candy, and honey in patients with thyroid cancer after treatment with radioactive iodine131I”

The aim is to explore the effectiveness of topical lemon candy and honey in patients with thyroid cancer after radioiodine therapy. The radioactive iodine (RAIT) is used as a treatment for people who have been diagnosed with thyroid cancer after total thyroidectomy. Although reasonably safe, RAIT is not always without side effects. Sialadenitis is the most common side effect with RAIT, with an incidence rate ranging from 24% to 67% treatment. The condition causes pain and swelling leading to oral discomfort. Another side effect of therapy that is related to salivary gland damage is dry mouth (xerostomia). Dry mouth incidence rates following RAIT can range from 11% to 44%. Sialadenitis and dry mouth causes pain, difficulty in swallowing, speech and taste changes. Persistency of these toxicities can negatively affect patients’ quality-of-life.

The study sample will be 120 patients after thyroidectomy due to thyroid cancer and will undergo treatment with 131I at the Oncological Centre of the Bank of Cyprus. The recruitment process will be done with the predefined selection and exclusion criteria. The patients will be divided into four groups. The control group will include individuals who receive the standard treatment (with lemon candies) While patients remaining three groups will follow intervention protocols. Various statistical methodologies used for the analysis of the subjective and objective effects after repeated measurements. Looking at the subjective and objective effects and repeated measures will be adopted various statistical methodologies. The recommended intervention protocol should improve the management of side effects caused by 131I. The methodological approach chosen for the intervention therapy, consider the ideal starting time and frequency in order to obtain the best results to minimize or protect the effects on salivary glands

My current research project topics include:

I am currently developing a project which will examine the support that can be given to adolescents and young adults with cancer by their partners. Previous research, findings suggest that the partners of young people play a vital role in supporting them both whilst they are having cancer treatment and when this is completed (Davies 2015). Whilst it was evident that young people would often seek help from their parents, family members and professional staff, this was often concerned with pragmatic elements of their experience during treatment. The young people looked to their partners for emotional support and discussion concerned with their everyday lives particularly when thinking about ‘after cancer’. Subsequently, sometimes their discussions were different to those that they had with others who were involved in their lives. The study will result in the development of a tool to help partners support each other and therefore impact on their shared experience.

My other current work involves testing a model of agency in decision making throughout the cancer experience developed as part of previous research findings (Davies 2015). I am hoping to develop collaborative links in terms of this work following the award of a European Oncology Nursing Society travel award to be undertaken in May 2017 at the University of New South Wales, Sydney, Australia. The model is important as it will enable a better understanding of choice and control in decision making during the cancer journey.

Reference:
Davies, J. 2015. The fluctuation of agency in teenagers and young adults with cancer. Unpublished PhD, Cardiff University.

The role of complementary and alternative medicine (CAM) in symptom management

The effect of the use of thyme honey in minimizing radiation-induced oral mucositis in head and neck cancer patients: A randomized controlled trial.

Purpose: Radiation-induced oral mucositis is one of the main side effects during and after the treatment of head and neck cancer patients. The study was designed to provide evidence on the effectiveness of thyme honey on oral mucositis management.

Methods: This was a randomised controlled trial (RCT) with 72 head and neck cancer patients who were divided either to the intervention group (thyme honey rinses) or to the control group (saline rinses). Oral mucositis was assessed according to the Radiation Therapy Oncology Group (RTOC criteria), and assessments were performed weekly starting at the 4th week of the radiotherapy for seven weeks and repeated once 6 months later. Additionally, the Oral Mucositis Weekly Questionnaire (OMWQ) was given at 4th week of radiotherapy, 1 month after the completion of radiotherapy and 6 months later. The ClinicalTrials.gov Identifier for this study is NCT01465308. This paper reports on the findings regarding thyme honey’s effectiveness on oral mucositis.

Results: Generalized estimating equations revealed that patients in the intervention group were graded lower in the objective assessment of oral mucositis (p < 0,001), maintained their body weight (p < 0,001) and showed an improvement in their global health (p=0.001) compared to the control group. Quality of life of the patients in the same group was also statistically significantly higher than that of the patients of the control group (p < 0,001).

Conclusion: The study provided evidence on the positive effect of thyme honey on the management of radiation induced oral mucositis and quality of life in head and neck cancer patients.

Reference:
Charalambous M et al., 2018. European Journal of Oncology Nursing 34 89-97

Earlier profiles

My current research project topics include:

  • Development & Evaluation of a clinical patient reported outcome measure for female sexual difficulties after cervical / endometrial cancer treatment
  • Development of a brief CBT / psycho-educational training intervention for breast clinical nurse specialists to assist women experiencing sexual consequences of breast cancer & its treatment
  • Survey of women affected by breast cancer and health professionals regarding the identification and clinical management of sexual difficulties associated with breast cancer treatment
  • Survey of men / couples and health professionals regarding access to erectile / sexual dysfunction management / services in the UK after prostate cancer treatment

Clinical Importance:

Sexual difficulties after treatment for cancer are common but frequently not adequately assessed or managed even in higher risk patient sub-groups such as those affected by breast or pelvic malignancies. Health professionals remain under confident and thus reluctant to discuss sexual consequences of treatment and thus need targeted training and service resources to improve the clinical identification and management of this neglected aspect of cancer survivorship.

Research Impact:

These studies are designed to develop and pilot test clinical assessment instruments (PROMS) to improve / support patient-health professional communication. They also develop and pilot test HCP training initiatives and service interventions that can improve access to specialist information and management to assist patients / couples in their sexual recovery after cancer. As a cancer nurse, psychosexual therapist and clinical researcher Isabel is in an ideal position to directly influence the development of local guidelines and services based on clinical and research evidence.

My research involves both patients and relatives in palliative care. In my PhD I emphasized relatives’ experiences of guilt and shame in palliative care. Feelings that are common and hard to live with. The situation of being a relative is complex, something that health professionals should be aware of. Acknowledgement of experiences of guilt and shame can help relatives in their adaption to the situation as a whole and maybe also give useful tools to support relatives during bereavement.

To gain more insight into palliative care I have continued to study patients’ and relatives’ experiences through interviews and used both hermeneutics and classic Grounded Theory (GT). In a GT, living in uncertainty of a death foretold emerged as the main concern for patients in palliative care. How they deal with this can be important knowledge in educational settings when teaching about how to encounter patients in this situation.

Further I am involved in adapting the Dignity Care Intervention (DCI) to Swedish care settings. This includes studies, and supervision of a doctoral student. This project will facilitate the work to improve dignity among persons with palliative care needs.

The overarching aim of my thesis is to describe the psychological consequences of oesophageal cancer following diagnosis and treatment. Oesophageal cancer patients represent a particularly vulnerable patient group due to the poor prognosis (overall survival <15% in Europe) and the demanding curative treatment pathway including extensive surgery in combination with oncological treatment. In addition to a severe treatment, many patients experience a challenging and lasting rehabilitation process including complications, eating difficulties, pain and fatigue. Even though it is well known that these patients suffer a difficult time from diagnosis and up to several years post-treatment due to the changed physical condition, the psychological consequences of the disease and treatment have been poorly investigated. My ambition is that my thesis might contribute to a better understanding of the psychological suffering among oesophageal cancer patients by describing the trajectory and predictors of psychological distress. I hope that the results from my PhD-project will influence a rehabilitation action plan for this patient group including an extended strategy for improving the psychological well-being in oesophageal cancer survivors.

I am Head Nurse at an Infectious Diseases Unit of a University Hospital in Athens. The research protocol entitled “Symptom clusters of patients’ with colorectal cancer: study of the experience and its determinants” will be contacted in purpose to complete my dissertation in Nursing Department, School of Health Sciences, National and Kapodistrian University of Athens.

The aim is to identify Symptom Clusters (SC) in patients with colorectal cancer undergoing chemotherapy and explore the correlation of the severity of their symptoms with personality traits and the immune response of patients. Many studies have tried to model SC using diverse statistical methods. Two different approaches will be used to identify SC : 1) the use of a quantitative standardised scale , the MD Anderson Symptom ?nventory to collect data of the severity of patients' symptoms and statistical analysis and 2) a semi-structured interview and interpretative phenomenological analysis of patients' lived experience of multiple concurrent symptoms. Revised Life Orientation Test and the 15 item Systems of Beliefs Inventory scale will be used to measure optimism and spirituality. Patients' immune response will be accessed by blood tests : CRP, Neutrophil Lymphocyte Ratio (NLR) and cytokines TNFa, IL-8, IL-10 and IL-25 in serum. The sample will be 50 patients with colorectal cancer at any stage, undergoing 3rd cycle of chemotherapy. The data collection will be cross sectional.

Growing evidence suggests that pain, fatigue, sleep disturbance and depression may be associated with cytokine-induced sickness behavior. If cytokines levels in serum are correlated with symptom severity and NLR, NLR will possibly be a useful biomarker that can be a routine blood test of patients with colorectal cancer without significant cost.

This research protocol will potentially contribute to the development of sensitive and specific biomarkers that correlate with subjective reports of symptoms and QOL. These biomarkers could be used to identify patients at risk for more severe symptoms and poorer QOL. Also, the qualitative approach to model symptom clusters can clarify relations between symptoms that contribute to the development of non-pharmacological interventions (e.g. cognitive behavioral).

For the last decades I worked as a oncology nurse. In 2011, I completed the master Evidence Based Practice. At the moment I am working as nurse practitioner in training, with a focus on melanoma, targeted - and immunotherapy. Besides that, I am a PhD student. My research is about targeted - and immunotherapy treatment in cancer patients.

Cancer treatments become more and more personalised, based on tumor characteristics. This approach will lead to an improved patient selection which makes long-lasting treatment possible. Patients on targeted and immunotherapy treatment are faced with toxicities due to these treatments and due to disease-related complaints, together summarised as symptoms.

Even if experienced symptoms are mild in nature, they may cause a high level of symptom burden, which decreases wellbeing and thereby are a threat to the quality of treatment. Patients are faced with uncertainties caused by symptom burden. Uncertainty influences patients behavior, like treatment adherence and effective use of self-management strategies.

By using patient reported outcome measurement tools in daily practice early recognition of symptom prevalence and intensity is realised. Also, insight into the effect of interventions performed is accomplished. This insight provides a more personalised patient education, support with management of adverse events (AEs) and self-management.

This approach is needed to make personalised, (long-lasting) cancer treatment with targeted - and immunotherapy successful.

The aim of this study (2017-2020) is to investigate how community nurses can reduce the burden on the relatives of patients diagnosed with cancer, heart failure or chronic obstructive pulmonary disease (COPD) in the last months of their lives.

In many countries patients prefer to spend their last phase of life and to die at home. Then relatives play an important role - by just being there for their loved ones but also as the caregiver, managing and monitoring the patient’s symptoms and treatment. On average relatives spend 25 hours per week on informal care during the last months of life. They are at a risk of overburden, which both increases their physical and psychological problems and the risk of acute hospital admission of the patient for which they are caring.

Although some work has been done on possible methods to assess caregiver needs, nurses are still primarily focused upon the needs of the patient and pay minimal attention to the caregiver. However, nurses do have opportunities to include care for the relatives when diagnosing patient problems and planning for outcomes and interventions.

Based on the existing literature and the experiences of nurses and relatives, we will develop a training programme to improve community nurses’ diagnostic skills and study its effectiveness on reducing the caregiver burden in a cluster randomised trial. We hope this study will contribute to a better quality of nursing care and a better quality of life at the end of life, for patients and for their relatives.


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