Introduction
Materials and methods
Design
Inclusion criteria
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Living in a rural area of Scotland (as defined by residential postcode)
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Diagnosed and living with breast cancer
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Could communicate in English
Sampling and recruitment strategy
Data collection
Emotional needs: For example, fear of the cancer spreading, feeling sad and anxious or depressed or worried about the people close to them |
Care process: For example, being treated like a person and not just a number as they went through their diagnosis and treatment |
Information: For example, about the treatment and the benefits and side effects of the treatment and about recurrence |
Talking to others: For example, talking to other patients affected by breast cancer |
Data analysis
Results
Sample characteristics
Percentage (n) | ||
---|---|---|
Gender | ||
Female | 100 (44) | |
Postcode area (description) | ||
IV | Inverness-shire, Ross-shire, Sutherland, Island of Skye | 54.5 (24) |
PA | Argyll and Bute, Islands of Mull, Iona, Tiree, Coll | 13.6 (6) |
K | Caithness and Orkney Islands | 11.4 (5) |
PH | South-Western Highlands, including Islands of Eigg, Rum and Canna | 9.1 (4) |
ZE | Shetland Islands | 6.8 (3) |
HS | Outer Hebrides | 4.5 (2) |
Age (mean [SD]) | ||
At survey | 59.1 [10.0] | |
At diagnosis | 52.2 [9.5] | |
Relationship status | ||
Married/civil partnership and living with husband/wife/partner | 75.0 (33) | |
Separated or divorced | 13.6 (6) | |
Single | 6.8 (3) | |
Widowed/partner died | 4.5 (2) | |
Employment status | ||
Paid employment or self-employed | 43.2 (19) | |
Retired from paid work | 36.4 (16) | |
In full-time education/employment training | 6.8 (3) | |
Permanently unable to work because of long-term sickness or disability | 6.8 (3) | |
Looking after home or family | 4.5 (2) | |
Doing something else | 2.3 (1) | |
Currently receiving medical treatment for breast cancer | ||
Yes | 43.2 (19) | |
No | 56.8 (25) | |
Currently receiving medical treatment not related to breast cancer | ||
Yes | 54.5 (24) | |
No | 45.5 (20) | |
Time since diagnosis | ||
≤18 months | 11.4 (5) | |
18 months to 5 years | 36.4 (16) | |
>5 years | 52.3 (23) | |
Breast cancer treatment (at any time) | ||
Surgery | 100 (44) | |
Chemotherapy | 63.6 (28) | |
Radiotherapy | 52.3 (23) | |
Hormone therapy | 72.7 (32) | |
Biological therapy | 13.6 (6) | |
Complementary therapy | 6.8 (3) | |
Breast cancer treatment (at time of survey) | ||
Surgery | 0 (0) | |
Chemotherapy | 2.3 (1) | |
Radiotherapy | 2.3 (1) | |
Hormone therapy | 43.2 (19) | |
Biological therapy | 0 (0) | |
Complementary therapy | 2.3 (1) |
Supportive Care Needs Survey results
Rank | Item | Moderate/high need, % (n) | Domain |
---|---|---|---|
1 | Being informed about cancer which is under control or diminishing (i.e. remission) | 31.8 (14) | Health system and information |
2 | Fears about the cancer spreading | 27.3 (12) | Psychological |
3 | Being adequately informed about the benefits and side effects of treatments before you choose to have them | 25.0 (11) | Health system and information |
3 | Concerns about the worries of those close to you | 25.0 (11) | Psychological |
5 | Having access to professional counselling (e.g. psychologist, social worker, counsellor, nurse specialist) if you, family or friends need it | 22.7 (10) | Health system and information |
5 | Not being able to do the things you used to do | 22.7 (10) | Physical and daily living |
7 | Being given written information about the important aspects of your care | 20.5 (9) | Health system and information |
7 | Being treated like a person and not just another case | 20.5 (9) | Health system and information |
7 | Having one member of hospital staff with whom you can talk to about all aspects of your condition, treatment and follow-up | 20.5 (9) | Health system and information |
10 | Uncertainty about the future | 20.5 (9) | Psychological |
10 | Keeping a positive outlook | 20.5 (9) | Psychological |
12 | Being given information (written, diagrams, drawings) about aspects of managing your illness and side effects at home | 18.2 (8) | Health system and information |
12 | Being informed about your test results as soon as feasible | 18.2 (8) | Health system and information |
12 | Pain | 18.2 (8) | Physical and daily living |
15 | Being informed about things you can do to help yourself to get well | 15.9 (7) | Health system and information |
15 | Worry that the results of treatment are beyond your control | 15.9 (7) | Psychological |
15 | Work around the home | 15.9 (7) | Physical and daily living |
18 | Being given explanations of those tests for which you would like explanations | 13.6 (6) | Health system and information |
18 | Feelings about death and dying | 13.6 (6) | Psychological |
18 | Learning to feel in control of your situation | 13.6 (6) | Psychological |
18 | Anxiety | 13.6 (6) | Psychological |
18 | Reassurance by medical staff that the way you feel is normal | 13.6 (6) | Patient care and support |
18 | Hospital staff attending promptly to your physical needs | 13.6 (6) | Patient care and support |
18 | Hospital staff acknowledging, and showing sensitivity to, your feelings and emotional needs | 13.6 (6) | Patient care and support |
25 | Feelings of sadness | 11.4 (5) | Psychological |
26 | Being treated in a hospital or clinic that is as physically pleasant as possible | 9.1 (4) | Health system and information |
26 | Feeling down or depressed | 9.1 (4) | Psychological |
26 | More choice about which cancer specialists you see | 9.1 (4) | Patient care and support |
26 | Lack of energy/tiredness | 9.1 (4) | Physical and daily living |
26 | Changes in sexual feelings | 9.1 (4) | Sexuality |
26 | Changes in your sexual relationships | 9.1 (4) | Sexuality |
32 | Feeling unwell a lot of the time | 6.8 (3) | Physical and daily living |
32 | More choice about which hospital you attend | 6.8 (3) | Patient care and support |
34 | To be given information about sexual relationships | 4.5 (2) | Sexuality |
Moderate to high need, % (n) | ||||
---|---|---|---|---|
Time since diagnosis | ||||
Domain | Total | ≤5 years | >5 years | Significancea
|
Health systems and information |
43.2 (19) |
66.7 (14) |
21.7 (5) |
0.003
|
Psychological | 43.2 (19) | 57.1 (12) | 30.4 (7) | 0.074 |
Physical and daily living | 29.5 (13) | 28.6 (6) | 30.4 (7) | 0.892 |
Patient care and support | 25.0 (11) | 28.6 (6) | 21.7 (5) | 0.601 |
Sexuality‡
| 9.1 (4) | 9.5 (2) | 8.7 (2) | 0.924 |
Interview findings
Information about treatment and side effects |
Overview of care |
Fears about cancer |
Impact on family |
Distance from support |
Information
You’re just thrown in there… it’s just like nobody prepares you… it should be written down; what the side effects are, what they are for, what its actually for, none of that information was actually given.
With the chemotherapy and radiotherapy I felt I hadn’t been given enough information or support when I started taking the Tamoxifen”… {I was} told to persevere with the Tamoxifen for 6 months… {I had} dreadful hot flushes and sweating… {My GP} said, “Oh well you know you have to take it”.
Overview of care
What would have been very helpful would have been if there was one point of contact…I felt as though they were drip-feeding me information… {I was} having to chase… appointments… sometimes I had to phone 4 different people… If they gave you some timelines for treatment and they explained it to you.
It’s a bit of a production line going in for chemo… waiting for your drugs to arrive, the drugs didn’t arrive but nobody actually comes to tell you what’s going on, you’re sitting there for 2 or 3 h waiting on…I was starting to get annoyed because some of my friends had come and, and gone out and had all theirs…I just want it over with cause I know that it’s going to make me feel so rubbish.
Fear of recurrence
Impact on family
{there were} massive difficulties for my husband and myself. It changed the relationship and it was very difficult. I carried on for a long time. I tried to protect everyone but I felt powerless. It had an effect on me.
They arranged like to be done in 1 day—like all those appointments at the hospitals…. so I wasn’t there for weeks trying to get appointments… {name of nurse}, the Breast Care Nurse at the Western didn’t want me away from home for months because of the kids so she tried to fit everything in so that I would go up 1 day, get seen by all the {three} hospitals stay overnight and home the next day.
Distance from support
We have no mobile phone signal and it costs £60 in a taxi to get the ferry. And then if it’s cancelled because of the weather… The logistics are bad. If you have radiotherapy you have to live on the mainland and you are away from all of your support.
Discussion
Implications for services
Limitations
Recommendations for policy and practice
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Address lack of or inadequate information about treatment and side effects. This information should be specifically tailored to the experience and needs of the patient. That is, provide individualised rather than general information.
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Fit appointments around the needs of the patient to minimise disruption to work or family routines. That is, fit treatment around the needs of the patient and not the needs of the service.
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Address lack of care coordination from the point of diagnosis to long-term follow-up. Patients need to have a total overview of their care and be able to visualise where they are on the care pathway. That is, give a total overview of their care from start to finish.
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Address lack of support to manage fear of recurrence.
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Address lack of support to manage the impact of cancer on the family.
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Consider a greater role for generalist health professionals to address support care needs of rural women with breast cancer.
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Consider a greater role for health technologies. Telemedicine can transcend geographical distance and permit women living in rural areas to share experiences and learn from and teach each other and should be encouraged for the provision of information and support to women in rural settings, where such services may be especially beneficial [26].