Abstract
I was interested to read the results of the research undertaken by Briggs et al. exploring the concerns, coping and electronic holistic needs assessment (eHNA) experience of UK breast cancer survivors. As an oncology specialist nurse and more recently as the CEO of Age UK Camden, I was encouraged that this research was taking place. Although there has been a plethora of breast cancer research, it remains important to continue this area of study as diagnosis and treatment pathways change. In addition, although the number of men diagnosed with breast cancer is remaining stable, the number of women being diagnosed with breast cancer is increasing, with a further 2% rise projected in the UK between 2014–2035 to 210 cases per 100,000 females by 2035 (Cancer Research UK, 2018) resulting in a larger cohort of patients on an already overstretched service. The need to provide the very best care within the resource constraints has never been more important.
This research, while focusing on those diagnosed with a breast cancer, will have a relevance beyond this patient group. As new resources and platforms for information gathering, sharing and analysis are developed, this type of research is important in order to understand more fully how they impact on patient and staff behaviour, as well as the capability and usability of the tool itself. The Kings Fund have often been at the forefront of supporting the use of technology; however, they noted that ‘technology has the potential to deliver significant savings for the NHS but the service does not have a strong track record in implementing it at scale and needs to get better at assessing the benefits, feasibility and challenges of implementing new technology’ (Castle-Clarke, 2018).
The scope of the research question seemed broad, and I wonder whether it should have been agreed or stated that the primary focus was on the patient use/experience of the eHNA tool, with secondary information being gathered on the concerns and coping issues raised. It was this aspect of the research that was of most interest to me and I would imagine to many others working in this field of nursing. I note that the use/implementation of the eHNA tool itself was not in question, which I found interesting, and not fully explained or evidenced as to why this position was taken within the discussion.
The stages of disease ranged from 1 to 3 with some unknown. The difference in stage may have affected the impact the diagnosis had on the study participants. Although I note all had surgery, the treatment package offered/given may also have differed significantly with the addition of medication, chemotherapy and/or radiotherapy for some (National Institute for Health and Care Excellence (NICE), 2018). In addition, the prognosis for those included in the study will have been a point of difference. This raises the question as to whether the staging and subsequent treatment pathway would have had an effect on the results.
I was pleased to see that the study group ages ranged from 46–60 to 80+. Breast cancer risk increases with age, with over 80% being diagnosed over the age of 50 (Breast Cancer Care, 2018). Any resources of this type therefore need to be user friendly and effective for the older age group if they are to have a significant effect on the majority of breast cancer patients. This remains the case for tools that are facilitated primarily or solely by staff, as the effectiveness will often be affected by the interaction between the three components of nurse, patient and technology. Sharing the screen and working through questions/information together is commonplace in many health and social contexts, building trust and a sense of shared collaboration. Often resources of this type have significant benefits for some older people, enabling them to access information (receiving and sharing) – which they would otherwise be prohibited from doing, such as when they have compromised hearing or sight – with the ability to have it in written format with a range of font sizes. However, the format and user experience are important to consider in order to optimise inclusivity. Age UK (Davidson, 2018) undertook a review of digital inclusion in older people in the UK and identified a gap in research evidence as to how digital technology interfaces need to be modified to improve the older user experience.
It was interesting that the timing of the use of the tool and how it is introduced may have affected how patients felt about it. As the researchers suggest, it may be external factors that hindered its success rather than the tool itself. Resources such as these can often enhance practice, but only if the nurse using it is a skilled communicator, knowledgeable of their subject matter, and competent and confident with the resource itself.
There were some issues raised that may warrant further study. I was particularly interested that some patients expressed the fact that some concerns seem worse if they have to write them down. Does a tool such as this add to the distress which results in less disclosure? The study does not address the possible impact of the tool on a patient’s long-term quality of life. For example, if its use resulted in a lack of disclosure on certain issues such as mental health, was there an impact on the severity and length of the patient’s compromised wellbeing due to a delayed assessment and intervention?
As the researchers identify, the conclusions are limited because the research was based at one hospital. However, the results are relevant within the confines of the study and will inform further work going forward. This is the type of research that nurses should be undertaking in order to inform our own practice and ensure that collectively our patients have access to the best resources that are implemented and used in the best way.