title: Evaluating the impact of a cancer supportive care project in the community: patient and professional configurations of need.
abstract: Advances in cancer care and treatment have created a new and somewhat anomalous category of patients with a diagnosis of non-curative disease who still have a considerable period of life remaining. During much of this time they may remain relatively well, without manifest need for clinical care. The responses of patients to this challenging situation are largely unknown. However, it has been assumed that because they confront a difficult experience they will need, or can benefit from, professional intervention. The implementation of pre-emptive support measures is anticipated to improve patients' resilience in coping with their illness and approaching death. This study aimed to investigate the impact of the keyworker role in a 3-year cancer supportive community care project to identify and provide for the needs of patients with a diagnosis of non-curative cancer. It was a qualitative study incorporating face-to-face interviews and focus groups with 19 healthcare professionals and 25 patients and carers from an urban East Midlands locality and a thematic analysis of qualitative interview and focus group transcripts. The project was positively evaluated by patients, carers and professionals. However, the findings raised questions about the different configuration of 'need' within the lay and professional perspectives and how this should most appropriately be addressed. In contrast to widespread professional assumptions about patients' need for counselling, many patients preferred to turn to their friends and families for support, and to adopt a stance of emotional and personal self-reliance as a strategy for coping with their predicament. The study highlights the continuing orientation of services around professional, rather than patient, agendas and the momentum towards increasing specialisation of professional roles and the medicalisation of everyday life that flows from this.
authors.affiliation: School of Nursing, University of Nottingham, Queen's Medical Centre, Nottingham, UK. kristian.pollock@nottingham.ac.uk
authors.forename: Kristian
authors.initials: K
authors.lastname: Pollock
authors.forename: Eleanor
authors.initials: E
authors.lastname: Wilson
authors.forename: Davina
authors.initials: D
authors.lastname: Porock
authors.forename: Karen
authors.initials: K
authors.lastname: Cox
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services; D005260:Female; D017144:Focus Groups; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D010166:Palliative Care; D010361:Patients / Q000523:psychology*; D036301:Qualitative Research; D013222:State Medicine; D006113:United Kingdom