title: Development and pilot evaluation of a complex intervention to improve experienced continuity of care in patients with cancer.
abstract: High experienced continuity of care in patients with cancer is associated with lower needs for care, better quality of life and better psychological outcomes. We developed and evaluated an intervention to improve experienced continuity. The intervention, consisted of (1) a 17-item patient-completed continuity assessment; (2) feedback to clinical nurse specialists and action to address the needs identified. Multidisciplinary team meetings and oncology outpatient clinics were observed, and patients and staff were interviewed. After qualitative work and reliability testing, the intervention was evaluated in a feasibility trial. Sixty-one patients provided data for analysis. No statistically significant differences were found in patients' experienced continuity between the trial arms, but important trends were seen in measures of needs for care in favour of those receiving the intervention. Feeding back findings from the continuity assessment to clinicians reduced patients' needs for care. Our results indicate that an intervention to target patients' experiences of continuity can reduce their subsequent needs for care. However, overcoming barriers to organisational change and addressing some patients' hesitation to report their continuity difficulties must be considered when implementing such an intervention. A phase III trial targeting patients with inadequate experienced continuity of care is recommended.
authors.affiliation: Department of Mental Health Sciences, Royal Free and University College Medical School, Royal Free Campus, London, UK. m.king@medsch.ucl.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: King
authors.forename: L
authors.initials: L
authors.lastname: Jones
authors.forename: O
authors.initials: O
authors.lastname: McCarthy
authors.forename: M
authors.initials: M
authors.lastname: Rogers
authors.forename: A
authors.initials: A
authors.lastname: Richardson
authors.forename: R
authors.initials: R
authors.lastname: Williams
authors.forename: A
authors.initials: A
authors.lastname: Tookman
authors.forename: I
authors.initials: I
authors.lastname: Nazareth
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000523:psychology / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000523:psychology / Q000628:therapy*; D003266:Continuity of Patient Care; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D008175:Lung Neoplasms / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D000078329:Workforce