title: Patient and carer needs following a cancer-related hospital admission: the importance of referral to the district nursing service.
abstract: BACKGROUND
  Despite 30 years of research attention, discharge planning and district nurse (DN) referral remain problematic and few cancer-related publications exist. With shorter hospitalizations, discharged cancer patients and their carers may experience unmet needs for assessment, information and support. Although DN referral might enable patient/carer needs to be met, the DN role lacks clarity.
  
  
  OBJECTIVE
  To investigate the needs of people with cancer, and their lay carers during discharge from hospital to home, and identify the role of DNs in meeting these needs.
  
  
  METHODS
  In this qualitative study, 71 pre- and postdischarge interviews were performed with cancer patients and (where possible) their carers. Predischarge interviews focused on expectations and postdischarge interviews on experiences of discharge and aftercare. Interview tapes were transcribed and analysed thematically.
  
  
  RESULTS
  Interviewees anticipated few aftercare needs during predischarge interviews but described met and unmet needs during postdischarge interviews. Unmet needs of those referred and not referred to the district nursing service were similar. Patients and carers had unmet needs for psychological support related to nutrition. Carers, especially those not resident with and not related to patients, had informational needs. Even very elderly, ill and isolated patients felt that other people had greater needs than their own and many thought that DNs only performed physical tasks.
  
  
  CONCLUSIONS
  All cancer patients discharged from hospital might be referred to a DN for ongoing assessment of needs. However, to ensure optimal results, the DN role needs to be clarified and public perceptions altered. Further research on psychological aspects of nutrition and the needs of carers not resident with/not related to patients is necessary.
authors.affiliation: School of Nursing, Midwifery and Health Visiting, University of Manchester, Manchester, UK. kkwilson@man.ac.uk
authors.forename: Kate
authors.initials: K
authors.lastname: Wilson
authors.forename: Brian
authors.initials: B
authors.lastname: Pateman
authors.forename: Kinta
authors.initials: K
authors.lastname: Beaver
authors.forename: Karen A
authors.initials: KA
authors.lastname: Luker
mesh_terms: D000328:Adult; D000359:Aftercare / Q000458:organization & administration; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003152:Community Health Nursing / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007587:Job Description; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology; D024802:Nurse's Role; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D010351:Patient Discharge / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards*; D011795:Surveys and Questionnaires