Personalising Head and Neck Cancer Survivorship: Intervention with the Head and Neck Cancer Patients Concerns Inventory in Routine Head and Neck Cancer Outpatient Visits



Ghazali, N
(2018) Personalising Head and Neck Cancer Survivorship: Intervention with the Head and Neck Cancer Patients Concerns Inventory in Routine Head and Neck Cancer Outpatient Visits. Doctor of Medicine thesis, University of Liverpool.

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Abstract

The Head and Neck Patients Concerns Inventory (HN-PCI) is a self-completed holistic tool that helps patients to disclose items of concern they wish to discuss. The MD study was designed to evaluate the roll-out of HN-PCI in subjects who were unfamiliar with it. The primary aim of the study was to evaluate HN-PCI can help patients self-disclose concerns. The secondary aims were to: (1) categorise HN-PCI items into domains; (2) develop a thematic content analysis; (5) examine associations between concerns and distress; (4) examine associations between clinicopathological factors with HN-PCI consultations; (5) determine if HN-PCI intervention changes consultations and the outcomes of consultations. Method: The MD work was divided into 3 sections and undertaken in the following order: (1) Pilot study; (2) Domain generation; and (3) Main study. Sections (1) and (2) were undertaken designed to support the Main study. In the Main study, patients were recruited prospectively to a non-randomised study design composed of 3 blocks. Block 1 constituted normal practice i.e. control group, Block 2 constituted patients exposed to HN-PCI but doctors were not i.e. control in attention, and Block 3 was the HN-PCI intervention group. The primary outcome measures were the number of concern and selected and/or discussed. The secondary outcome measures were patient satisfaction with consultation, consultation length, distress level and clinical outputs. i.e. clinical decision or action taken related to the consultation. Result: In the Pilot study, a content thematic framework was developed. Five domains were generated: (A) Physical and functional; (B) Psychological/emotional and spiritual well-being; (C) Social care/Social well-being; (D) Treatment-related; and (E) Other. In the Main study, 365 patients were recruited, producing a matching number of audiorecorded consultation i.e. Block 1: 136 patients; Block 2: 78 patients; and Block 3: 111 patients. Introduction of HN-PCI generated a trend towards an increased number of concerns discussed when compared with control consultations. A broader range of expressed concerns was addressed in HN-PCI intervention group. More items within the Psychological/emotional and Spiritual well-being Domain were discussed in HN-PCI intervention groups. In the HN-PCI intervention groups, doctors were fair to moderately more likely to take on the patient’s agenda for discussion by addressing the items selected. These were achieved with a trend towards longer consultations. Consultations with HN-PCI were significantly associated with certain clinicopathological factors. The HN-PCI intervention group showed higher number of medical outputs when compared with control group, suggesting that HN-PCI may facilitate collaborative decision-making. Patients with HN-PCI intervention showed a trend towards lower levels of distress post-consultation and reported significantly higher scores of satisfaction. This study also demonstrated that the HN-PCI was able to indirectly predict patients who experienced significant distress based on the number of items selected. Conclusions HN-PCI was able to help patients disclose a wider range of concerns in cohorts unfamiliar with the tool. Its use is associated with changes in the content of consultations, suggesting a more patient-concern focused consultation. This is possible to create a personalised, patient-centred HNV visit using the HN-PCI. However, there remain service-based barriers to fully realizing the HN-PCI tool in personalising HNC patient’s survivorship trajectory.

Item Type: Thesis (Doctor of Medicine)
Divisions: Faculty of Health and Life Sciences > Faculty of Health and Life Sciences
Depositing User: Symplectic Admin
Date Deposited: 21 Aug 2018 10:21
Last Modified: 02 Apr 2021 08:13
DOI: 10.17638/03020175
Supervisors:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3020175