Aims: To examine how patients received, understood, and acted on healthcare professional communication about their oral chemotherapeutic regimen throughout their treatment.
Design: A longitudinal ethnographic study.
Methods: Over 60 hr of observational data were recorded, in the form of field notes and audio-recordings from interactions among nine oncology doctors, six oncology nurses, eight patients, and 11 family members over a period of 6 months in outpatient departments in one hospital in Northern Ireland. Sixteen semi-structured interviews with patients and three focus groups with healthcare professionals were also carried out. This study took place from October 2013-June 2016. Data were thematically analysed.
Results: Three themes where identified from the data. These were initiating concordance through first communication about oral chemotherapy; which focused on initial communication during oncology consultations about oral chemotherapy, sustained communication of managing chemotherapy side effects; which was about how communication processes supported timely and effective side effect management and un-sustained communication of oral chemotherapy medication-taking practice; when patients and healthcare professionals failed to communicate effectively about chemotherapy medication-taking.
Conclusion: The two most important factors in ensuring the optimal management of oral chemotherapeutic medicines are early recognition and appropriate response to side effects and the maintenance of safe and effective medication administration. This study found that oncology doctors and nurses engaged in sustained communication about the side effects of chemotherapy but did not focus their communication on safe administration after the first consultation.
Impact: Based on this evidence, we recommend that healthcare professionals who provide oral chemotherapy for home administration should review their processes and procedures. Healthcare professionals need to ensure that they embed frequent communication for the duration of treatment between themselves and patients, including open discussion and advice, about side effects and medication administration.
目的: 研究在整个治疗过程中患者如何接受、理解和执行关于口服化疗方案的专业医疗沟通。 设计: 纵向民族志研究 方法: 以现场笔记和音频记录的形式,记录了北爱尔兰一家医院门诊部9名肿瘤医生、6名肿瘤护士、8名患者和11名家庭成员6个月内的互动,共记录了超过60小时的观察数据。对患者进行了16次半结构化访谈,并对医疗卫生专业人员进行了3次焦点小组访谈。这项研究于2013年10月至2016年6月进行,并对数据进行了专题分析。 结果: 由数据得出的三个主题。以下为关于口服化疗的初次沟通的最初共同点;主要集中为肿瘤会诊时关于口服化疗的初步沟通和关于化疗副作用处理的持续性沟通;有助于进行及时有效的副作用处理的沟通以及口服化疗用药的非持续性沟通;患者和医护人员就化疗药物的服用未能进行的有效沟通。 结论: 确保口服化疗药物最佳用药的两个最重要因素是对副作用的早期判断和适当反应,以及维持安全有效的用药。本研究发现,肿瘤医生和护士在初次会诊后就化疗副作用进行了持续的沟通,但并未将沟通重点放在安全用药上。 影响: 基于此证据,我们建议提供口服化疗家庭用药的专业医疗卫生机构应审查其程序。专业医疗卫生机构应确保治疗期间与患者进行频繁沟通,包括公开讨论、提出建议,以及关于副作用和用药的沟通交流。.
Keywords: cancer; communication; ethnography; medication-taking; nursing; oncology; oral chemotherapy; patient participation; patient safety; qualitative research.
© 2020 John Wiley & Sons Ltd.