What do patients think about telephone aftercare?

Abstract

BACKGROUND
The National Cancer Survivorship Initiative Vision in the UK calls for a shift from the traditional medical model of hospital follow-up for people with cancer to developing alternative strategies that demonstrate real patient benefit and promote self management. Telephone aftercare is one such alternative approach. We have conducted randomised controlled trials (RCT) to demonstrate that telephone aftercare by specialist nurses is beneficial in breast and colorectal cancer, shifting the focus from searching for signs of recurrent disease to meeting the information and support needs of patients using a structured telephone intervention. While RCTs provide evidence of effectiveness, integrating qualitative research into RCTs allows in-depth analysis of how complex interventions work and the perceived impact.
METHODS
Interviews were conducted with 28 patients with breast cancer, 26 patients with colorectal cancer and five specialist nurses; all had either received or delivered telephone aftercare. Content analysis was used to analyse interview data.
RESULTS
All patients found telephone aftercare to be a positive experience, comparing favourably with hospital follow-up. The structured intervention was well received and patients felt confident that all relevant questions had been asked and answered and nothing had been “missed”. Patients reported telephone aftercare as convenient, economical and more “normal” than attending hospital outpatient clinics, providing continuity of care and carer. Specialist nurses reported the high level of skill, knowledge and confidence required to deliver the intervention. Specialist nurses perceived that, unlike hospital outpatient care, telephone aftercare met individual needs and enabled patients to self-manage when discharged from hospital follow-up.
CONCLUSIONS
The addition of qualitative methods to RCT’s of complex interventions advances our understanding of how interventions work. Useful insights were gained into how the intervention could be implemented into everyday clinical practice. Moreover these studies demonstrated that meeting psycho-social needs is essential to help patients who have survived a cancer diagnosis and treatment to self-manage.