Showing papers in "European Journal of Cancer Care in 1996"

Helping Cancer PatientsTo Disclose Their Concerns

Abstract: Health professionals are reluctant to enquire actively about cancer patients' concerns and feelings. They fear that probing will damage patients psychologically and believe they have had insufficient training in the relevant interviewing skills. In considering how their interviewing skills might be improved, the key question is which interviewing behaviours promote patient disclosure and which inhibit it. To test our predictions about the utility of specific interviewing behaviours, we asked 206 health professionals, who were attending workshops on communication and counselling skills, to interview a simulated patient before and after the workshop to establish the patient's current problems. They were given 20 min to do this and the interviews were tape-recorded and transcribed to permit detailed assessment by trained raters using an utterance by utterance analysis. This permitted the form, function, content and emotional level of each utterance to be rated. Correlation coefficients were calculated between specific interviewing behaviours and patient disclosure of significant information. Significant information was defined as any information disclosed by patients about their perceptions of their illness or prognosis or any adverse physical, psychological or social sequelae of their cancer and treatment. Spearman correlation coefficients were calculated between specific interviewing behaviours and patient disclosure. The use of these behaviours by those 41 (20%) of interviewers who achieved most disclosure was compared with those 41 (20%) who obtained least disclosure. Patient disclosure of significant information was promoted by the use of open directive questions, focusing on and clarifying psychological aspects, empathic statements, summarising and making educated guesses. The use of leading questions, focusing on and clarifying physical aspects, moving into advice and reassurance mode inhibited patient disclosure. Inhibitory behaviours were used 2-3 times more frequently before training than facilitative ones. Training of health professionals involved in cancer care should, therefore, ensure they acquire these positive skills and relinquish the inhibitory behaviours.

A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals.

Abstract: Interest in fatigue research has grown since the finding that fatigue/tiredness is the most frequently reported symptom of cancer and its treatment. But even though several authors have tried to conceptualize fatigue (Piper & Rieger, 1989; Cimprich, 1992; Gibson & Edwards, 1985; Winningham, 1994; Irvine et al. 1994; Grandjean, 1970; et al.), its mechanisms are still poorly understood. The aim of this study was two-fold: i) to explore fatigue in cancer patients, inductively, and ii) to compare fatigue/tiredness experiences of healthy individuals with those of cancer patients to identify cancer-specific fatigue/tiredness and related concepts. A qualitative research strategy was adopted using a grounded-theory approach. The prospective study took place in the Oncology Department of the Kantonsspital St Gallen (Switzerland) with samples of 20 cancer patients and 20 healthy individuals. Unstructured, tape-recorded interviews were conducted to collect data. Transcripts of the interviews were analysed using content analysis and constant comparison. Although different themes emerged between the two groups, both fitted a classification system that categorized expression of fatigue/tiredness as physical, affective or cognitive. Physical signs were more frequent than affective and cognitive signs in both groups. For the cancer patients, fatigue involved decreased physical performance, extreme, unusual tiredness, weakness and an unusual need for rest, which was distinctly different for healthy persons. Affective and cognitive distress were also more prominent in cancer patients. Interestingly, the concept of malaise was not identified by either sample and not understood as an expression of fatigue by this German-speaking population. Linguistic differences in the description of fatigue/tiredness between healthy and ill individuals revealed different perceptions of the phenomenon. A step-like theory, involving nociception, perception and expression of tiredness, was put forward tentatively to explain the production of fatigue/tiredness. The emerging concepts break tiredness/fatigue into expressions of physical, affective and cognitive tiredness/fatigue. The experience is different between healthy individuals and cancer patients. The generalization of data needs precaution but the results of the study identify and clarify ideas that might form an important basis for further, controlled studies.

The role of information in patients' adaptation to chemotherapy and radiotherapy: a review of the literature.

Abstract: This paper reviews the literature concerning the role of information in facilitating patients' adaptation to chemotherapy and radiotherapy. The relationship between information and patient self-efficacy is examined, and the information requirements of cancer patients receiving treatment are reviewed. Finally, studies evaluating informational interventions for patients receiving either chemotherapy or radiotherapy are critiqued before recommendations for practice are formulated.

The experience of fatigue and other symptoms in patients receiving chemotherapy

Abstract: Fatigue has been recognized as the most frequently reported symptom of cancer and cancer therapy. There is a lack of research on such aspects as the pattern of fatigue which accompanies treatment, its exacerbating and relieving factors, the different mechanisms of fatigue and its relationship with the factors purported to be related to the fatigue experience. It has been suggested that cancer patients may be those best placed to reveal the likely causes of fatigue. As part of a larger study examining the pattern of fatigue in cancer patients who were undergoing a course of chemotherapy treatment, patients' perceptions of fatigue and tiredness and the nature, pattern and causes of fatigue in relation to cancer and its treatment were obtained. In addition to a diary, interviews were conducted at two time points, at the beginning and end of a cycle of chemotherapy, with over 100 cancer patients. Just under 90% of the sample reported fatigue at some point during a cycle of chemotherapy. The majority of the sample did not consider tiredness and fatigue to constitute the same feelings. Subjects attributed their fatigue to a combination of factors but most frequently mentioned treatment, changes in sleep patterns and other symptoms. Implications for practice and research are outlined.

Coping with the cancer experience. I. Developing an education and support programme for cancer patients and their significant others.

Abstract: As reported, cancer patients and their significant others need information promoting their understanding of events throughout the illness, and support in mobilizing coping strategies when they consider the situational demands to exceed their personal resources. In the present study the provision of information was merged into the field of education and combined with emotional support to facilitate efforts to cope with the cancer experience. A patient education programme entitled Learning to live with cancer was developed (part I) and evaluated (part II). Cancer patients and their significant others (n = 127) participated in group sessions. Open interviews organized around experiences of increased knowledge and understanding, decreased confusion and anxiety, and enhanced coping capacity related to participation in the programme were conducted with the participants. The interviews were analysed using the Grounded Theory approach. The findings indicate that supportive education, sensitively responsive to expressed learning needs and learning capability, has the power to promote proper understanding and facilitate coping efforts. Becoming familiar with facts and feelings reinforced confidence in evolving appropriate coping strategies for living with cancer.

An audit of palliative care in dementia.

Abstract: A retrospective case note audit was conducted in order to determine the most prevalent symptoms in terminal dementia and to assess the palliation given. Seventeen case notes were audited. Pain and dyspnoea were the most common symptoms. The palliation and treatment of constipation and oral candidiasis was within current accepted practice. Palliation of other symptoms were inadequate compared to current accepted practice. There appears to be a reluctance to prescribe opiate analgesia, and when this was prescribed the doses were not modified to achieve full pain or symptomatic relief. Many patients were unable to take medication orally, but syringe drivers were not used. The conclusions include the need for education of both nursing and medical staff as to the current principles of palliative care.

The good and bad death perceptions of health professionals working in palliative care

Abstract: The development of palliative care originated from shortcomings in mainstream health services. Palliative care aims to cater for both the psycho-social needs of dying patients and the allieviation of their physical symptoms. This is reflected by the good and bad death perceptions of palliative care workers, though increasing signs of institutionalization in palliative care have challenged the idealization of a good death. This study aimed to investigate the health professionals' perception of both a good and a bad death and their perception of patients' awareness context. Seventy questionnaires were distributed to nurses and social workers. The 50 returned questionnaires revealed that health professionals perceived a good death as controlling the patients' physical symptoms and psychologically preparing them, whilst a bad death was perceived as the inability to control pain and deal with any psychological distress. Factor analysis identified three main factors (lack of patient distress, patient control and staff's supporting role perceptions) in the perception of a good death whereas four main factors (the negative effect of death on the family, a patient's non-acceptance of death, not dealing with patients' fears and the age of a dying person) were identified with the perception of a bad death. Overall, health professionals perceived themselves to be open and sensitive in communicating with patients although over half felt poorly supported by other staff.

Clinical incidence of lymphoedema in breast cancer patients in Jönköping County, Sweden.

Abstract: The clinical incidence of lymphoedema of the arm in breast cancer patients was studied before and after general mammography screening in the country of jonkoping, Sweden. There was a significant decrease of incidence of lymphoedema from 15% in 1983 to 8% in 1988. Clinical and pathological therapy data have been analysed in relation to lymphoedema. Significant factors contributing to lymphoedema were the number of lymph nodes examined and the number of pathologically positive lymph nodes. A higher proportion of patients receiving post-operative radiotherapy to the axilla developed lymphoedema, compared with those with surgery alone. A comparison between the two groups is impossible due to the fact that post-operative radiotherapy was prescribed only to patients with pathologically positive lymph nodes.

Fatigue in cancer: a phenomenological perspective

Abstract: Fatigue is a frequently encountered symptom in cancer populations. This study aimed to describe the experience of fatigue from the perspective of cancer patients who had recently completed a course of chemotherapy. A phenomenological method was used. The themes which emerged from the data indicated both a shared and individual experience of fatigue. These incorporated: the nature of fatigue; the causes, consequences, strategies for coping with fatigue; and the trajectory of the fatigue experience. Issues arising from the nature of phenomenological inquiry and the research were also elicited from this study. An understanding of the fatigue experience for this population and the use of phenomenology have implications for the nursing profession's knowledge base and for clinical practice.

Well-being, general health and coping ability: 1-year follow-up of patients treated for colorectal and gastric cancer

Abstract: The aims of this paper were to describe the patients' perceived well-being, general health, symptoms and coping ability 1 year after surgery and to compare the results with the same as recorded before and 6 weeks after surgery and with those of healthy individuals. The investigation was carried out in a surgical unit at the Karolinska Hospital in Stockholm, Sweden during 1992 and 1993. Sixty-nine patients (34 men, 35 women) with diagnoses of colorectal or gastric cancer participated in the study. Two randomly selected samples of healthy individuals were available for comparisons and were used as reference subjects. Main measurements were the Health Index (HI) and the General Health Rating Index (GHRI). The HI measured the change in well-being before and after surgery. There were few and small differences in the patients' sense of well-being 1 year after surgery compared with before. There was no significant difference between the total HI scores before and 1 year after surgery but the HI subscale scores for energy, bowel function and mobility had improved. The patients living alone rated their well-being as inferior in comparison with those who lived with relatives. Furthermore, the cancer patients perceived their well-being as inferior to that of healthy individuals. One year after surgery the patients had not returned to a state of normal health. Social and marital status apparently affected the patients' sense of well-being.

The experience and impact of contacting a cancer information service.

Abstract: Our objective was to review the quality of service delivered by a national cancer information service–the British Association of Cancer United Patients (BACUP)–and to consider the implications for future policy and practice. We used a sample of callers over a 10-day period, responding to a structured postal questionnaire. The sample included patients, relatives, friends, and general public who called the service with any concern relating to cancer. Of the 406 invited to take part, 282 responded (69%). The questionnaire was designed to evaluate the callers' perceptions of the information they received, their perceptions of the nurse's communication skills, the emotional impact of the call, and their overall satisfaction with the service. The results indicate that over 90% of callers evaluated the information they received and the nurse's communication skills positively, and there was no difference between the two major groups of callers, i.e. patients and relatives/friends. Both groups reported that the call had a positive emotional impact on them and that they were satisfied with the service. Emotional impact was predicted by quality of information for patients and nurse's communication skills for friends/relatives; overall satisfaction was predicted by nurse's communication skills for patients and both measures for relatives/friends. We conclude that the telephone is an effective medium for conveying information about cancer, and BACUP is meeting its needs. The needs of patients and relatives/friends are different–principally information for patients and support for relatives/friends–and it may be possible to improve training still further by focusing on those differences. The main challenge for cancer information services is to meet the ever-increasing demand.

Measuring quality of life in oncology: is it worthwhile? I. Meaning, purposes and controversies.

Abstract: This is the first of a two-part paper on quality of life in cancer patients. This part examines some of the fundamental issues in health-related quality of life measurement with particular attention being given to cancer medicine, thus helping to focus the direction and methodological rigour required in future investigations. Relevant topics are discussed to illustrate the importance of quality of life measures in cancer care. A perspective on the meaning of "outcome' and "quality of life' are presented to demonstrate the controversies that exist in the field. It is concluded that despite methodological limitations, quality of life measures have a potential role in advancing cancer care.

Palliative care teaching and today's general practitioners—is it adequate?

Abstract: Although only 25% of patients die at home, more than 90% of the terminally ill patient's last year of life is at home under the care of their own general practitioner (GP). In the United Kingdom, doctors training for general practice undergo a 3-year training with 2 years in hospital posts and a year in general practice. This questionnaire study of 33 GPs who had recently completed their vocational training was carried out to ascertain the teaching given on palliative care during the general practice component of training. Very few GPs (15%) had received tutorials on palliative care from within their practice. Less than a third felt they had received adequate teaching on pain and symptom control and fewer than 10% perceived the teaching on psychological support to be adequate. Compared to previous studies, the knowledge of specific therapeutics in palliative care had improved, but several were uncertain of basic principles such as the maximum dose of oral opiates which could be prescribed. The majority (85%) wished to have a placement in a hospice as part of their vocational training. This survey suggests that today's GPs would be very receptive to more focused teaching on palliative care encompassing both symptom control and psychological care during their GP training and would also welcome the opportunity of a hospice placement.

Advances in supportive care.

Abstract: A range of distressing symptoms, such as nausea and vomiting, dyspnoea and pain, which invariably impair quality of life, may develop in cancer patients as a result of their disease and treatment. The sideeffects of cancer treatments place additional burdens on the patient. Patients indicate that they find nausea and vomiting and fatigue to be the most &stressing symptoms. The burden of &stressing symptoms and the side-effects of cancer treatments may lbe so great for some patients that they make a decision not to continue with treatment. Developing better methods of managing these complaints is critical for improving both quallty of life and treatment outcome. Over the past two decades there have been dramatic advances in supportive care. The most significant advances have occurred in the general approach to symptom management and in the development of new pharmacological agents. Advances have also occurred in non-pharmacological approaches to supportive care and it is now acknowledged that interventions such as patient education and complementary therapies have an important role to play in ameliorating distressing symptoms.

Group cognitive behavioural therapy interventions with cancer patients: a review of the literature.

Abstract: At present there is considerable evidence that suggests cancer patients, once diagnosed, experience significant and long-term psychosocial problems. Several studies have evaluated group interventions, but only a few have used group cognitive behavioural therapy (GCBT) with cancer patients. The following paper represents a review of the literature of GCBT, illustrating the key findings from these studies.

What do cancer patients identify as supportive and unsupportive behaviour of nurses? A pilot study.

Abstract: Social support has been claimed to have positive effects on a variety of outcomes, including physical health, mental well-being and social functioning, and yet, its nature, meaning and measurement are still being debated in the literature. This pilot study set out to identify, within the theoretical framework of the social support literature, supportive and unsupportive nurse behaviours as perceived of by eight hospitalized patients diagnosed with a haematological malignancy. The findings of the semi-structured interviews appear to suggest that emotionally supportive behaviour patterns are the most frequently identified helpful nurse interactions reported by individuals with cancer, followed by informationally supportive behaviour. The most frequently identified unsupportive nurse behaviours were those perceived of as being devoid of an emotional component. Tentative conclusions for practice are drawn from these findings and considerations for future research are presented. In accordance with work by Dunkel-Schetter (1984) the terms supportive and unsupportive are operationalized throughout this paper as the more familiar terms helpful and unhelpful.

Measuring quality of life in oncology: is it worthwhile? II. Experiences from the treatment of cancer.

Abstract: This is the second part of the paper on quality of life in cancer patients which appeared in this journal (Montazeri et al, 1996a) In this part experiences from the treatment of cancer are given and relevant literature is reviewed Several topics have been covered, including new directions and methods in assessing quality of life It is argued that in a chronic condition, adding life to years instead of years to life is an important task Adding years to life may prolong survival, but whether this is to the benefit of patients is debatable Considering patients' views, their values and preferences may improve the quality of care and at the same time, reduce the psychological distress and physical discomfort in patients with cancer It is concluded that quality of life measures have considerable potential in this challenging issue

Who has the power? Some problems and issues affecting the nursing care of dying patients

Abstract: Nurses play a central role in the care of dying people, yet they may find themselves marginalized, devalued or in conflict with other health professionals. This paper examines a number of problems and issues related to nursing power and control in the workplace. The factors we consider are: • the relative effects of personal and structural influences; • the ‘medicalization’ of dying; • the demands and challenges of interdisciplinary work; • ethical issues raised by euthanasia and AIDS; • patients' rights to make informed decisions about their care; • philosophies and policies of health care.

Ethical and practical problems of early anti-cancer drug trials: a review of the literature.

Abstract: Early clinical trials for new anti-cancer drug treatments typically use patients with cancer as research subjects. This paper identifies some of the ethical and practical concerns that arise from the recruitment of a vulnerable group of patients and their exposure to a drug of unknown risk or benefit. This review discusses the ethical principles related to recruitment and informed consent in cancer trials, and indicates that there is a lack of consensus concerning the requirements, process and practice of informed consent. It is suggested that, as yet, little is known about patients' decision making framework in this situation, and the need for further work that concentrates on the patient's point of view is highlighted. The paper concludes by discussing some of the difficulties associated with obtaining patients' opinions, and suggests that the use of a qualitative approach may overcome some of these problems.

The development, implementation and evaluation of guidelines for the management of breast cancer related lymphoedema.

Abstract: A project was funded by the UK's Department of Health to develop national guidelines for breast cancer related lymphoedema using a Consensus Strategy. This involved the organization of a consensus conference with a multidisciplinary panel of experts, an extensive literature review, the production of clinical guidelines and the implementation of the guidelines at three pilot sites (breast unit, hospice and community). The EORTC QLQ-30, MOS SF-36 and a standard assessment form were used to evaluate patient outcome. Diaries and semi-structured interviews were used to elicit data on practitioner compliance and practical issues of implementing change using clinical practice guidelines. Results showed stable or improved scores in all categories of physical, social and emotional functioning and a stable or measured decrease in limb volume for 75% of the sample. Qualitative data obtained from practitioners demonstrated high levels of compliance from practitioners and patients and offers useful recommendations. This project highlights the importance of raising awareness of lymphoedema through the development and utilization of research-based, patient-centred guidelines.

Radiation mucositis: a new approach to prevention and treatment

Abstract: Mucosal reactions in patients receiving radiation treatment for head and neck cancer are regarded as unavoidable side-effects. The degree of mucositis experienced is determined by the treatment dose, radiation field size and fractionation schedules prescribed for individual patients. This article reviews a double-blind placebo-controlled trial of an antibiotic pastille which was aimed at reducing the more extreme effects of radiation mucositis. It identifies the role of oral care and hygiene, oral assessment and nursing support within a clinical trial setting. The results showed that the active pastille had a beneficial effect on the degree of mucositis experienced. Patients had a reduction in their weight loss in the active arm of the trial and the amount of yeast bacteria present in the oral cavity of those patients also diminished. It is worth noting that those patients in the placebo arm of the trial received both physical and psychological support from the nursing staff which may not have been available as frequently if they had not been in the trial.

Audit in palliative care: does practice change?

Abstract: This study aimed to document current palliative care initiatives, identify any reported changes in working practice as a result of audit, and determine the opinions of palliative care staff towards audit. All 31 established palliative care services within the former North West Thames Regional Health Authority were sent a brief postal questionnaire on previous and current audit activities. Of the 28 units who responded, most (78%, n = 21) were currently involved in audit with a further 7% (n = 2) planning to implement audit in the near future. Changes as a result of audit included implementation of standards, for example response to referrals; improvements in documentation, for example revision of case notes; and changes to unit practice, such as converting to multidisciplinary care plans. The respondents viewed the main advantage of carrying out any audit project as the improvement or maintenance of the quality of patient care. The principal disadvantage expressed was the time-consuming nature of audit. An audit with a clear aim and thorough design can provide valuable evidence upon which new policies or strategies in palliative care can be based. By educating and training staff in audit and illustrating the benefits, any concerns about carrying out audit could be addressed.

A descriptive study of a cancer support group

Abstract: Six cancer support groups in the West of Scotland were studied. All 31 patients attending these groups were interviewed. The majority of participants were married females, middle class, 50-65 years old and were long-time survivors. Fifty-two per cent stated that they were very satisfied with the support they received. A high proportion of patients reported that they did not receive any counselling during their treatment from their cancer specialists (90%) or at present from a professional counsellor (84%). the general perceived health and 'global quality of life' among participants were found to be moderately good or good. Concerns of patients were studied and they reported optimistic changes. Needs assessment indicated that most patients (52%) require symptom relief and family support. Most patient (32%) reported that they had no problem at that time while the rest identified difficulties in home duties, shopping and transportation, and financial problems. The study suggests there is value in encouraging cancer patients and their relatives to take part in existing cancer support groups.

Paclitaxel (Taxol®) — a guide to administration

Abstract: The introduction of a new chemotherapeutic agent has implications for nursing care. Paclitaxel (Taxol) chemotherapy is now being used throughout Europe for treatment of patients with ovarian cancer who have previously failed a platinum-containing chemotherapy regimen, and in many countries to treat metastatic breast cancer. Nurses need to be equipped to care for these patients receiving Paclitaxel. This paper introduces nurses to Paclitaxel, the history of its development, its mechanism of action, potential side-effects and administration. Paclitaxel's side-effects include hypersensitivity reactions, neutropaenia, peripheral neuropathy, asymptomatic bradycardia, alopecia, malaise, myalgias and arthralgias. Administration guidelines will be discussed because Paclitaxel leaches plasticizer from polyvinyl chloride (PVC) intravenous-giving sets normally used to administer chemotherapy, hence an alternative delivery system is required.

Clinical supervision: a plea for 'pit head time' in cancer nursing.

Abstract: The concept of clinical supervision has received considerable attention in the nursing literature of late, enjoying favour not only with many practitioners and managers, but academics and policy makers alike. The following paper considers the utility of clinical supervision within the cancer nursing setting, concentrating particularly on the development of self-awareness and the facilitation of responsive, reflective, therapeutic relationships. The paper is predicated on the belief that clinical supervision not only provides a valuable means of peer review and support, for nurses both in the pre- and post-registration spheres, but that structured process of systematic supervision sustains the necessary environment for the protection and enhancement of quality nursing interventions (Butterworth, 1992). The potential of clinical supervision, as regards the wider development of nursing as a practice discipline, is illustrated by the incorporation of an extensive literature review which explores the theoretical and practical imperatives pertaining to the notion of clinical supervision, not only in relation to the individual, but to cancer nursing and nursing per se.

Hereditary breast cancer

Abstract: An overview is provided of the genetics of hereditary breast cancer, as well as the clinical aspects and the management of this disease. In September 1994 a new breast cancer gene, BRCA 2, was located and BRCA 1, discovered in 1990, was sequenced (Miki et al., 1994; Wooster et al., 1994). The implications of these discoveries are immense. Tests are now available to women who have a family history of breast cancer that can determine if they carry one of these defective genes. The genetic nurse specialist can play a huge role in counselling women who wish to have predictive testing and in advising them about screening and risk.

Interventions for fatigue.

Abstract: Fatigue is the most frequently reported symptom of cancer and cancer treatment, which can significantly impair the patient's quality of life. It may also interfere with cancer therapy compliance and even limit the amount of treatment that a patient receives. There is little information on, and research into, the mechanisms of fatigue and the relationships between its multiple causes, patterns and the many factors that may improve or worsen the condition. The management of fatigue, therefore, represents a major nursing challenge. The nurse's role in combating cancer-related fatigue spans the treatment continuum from prevention to research. It includes: patient assessment to identify those at high risk and to evaluate potential causes of fatigue; and the implementation of interventions to manage the fatigue, such as patient and family education, self-care activities and treatment of specific problems. Continued research on the multiple aspects of cancer-related fatigue, together with multifaceted projects such as the fatigue initiative, will lead to improved oncology nursing care of patients with cancerrelated fatigue.

The basis of cancer fatigue: where does it come from?

Abstract: Fatigue is a common complaint that many of us experience at one time or another, and which is normally relieved by a good night's sleep. For the cancer patient this is not often the case. Several studies have focused on the causes and objective and subjective manifestations of fatigue. The aetiology may be physiological, psychological or pathological. The frequency and severity of the symptoms depend on the cause of the fatigue. Because of the complexity of the situation, a comprehensive knowledge of the possible causes and contributing factors permits a more thorough assessment by the nurse. This leads to a precise nursing diagnosis which allows a nursing strategy to be tailored to the individual patient.

A study to explore the role of a community oncology nurse specialist.

Abstract: Cancer patients are increasingly being cared for in the community. However, the role of the community oncology nurse specialist (CONS) remains a rare appointment in the United Kingdom. There is little research evidence to substantiate the view that this is a worthwhile and effective role. This study aimed to explore the role of one CONS using a qualitative case study approach. The sample consisted of the CONS, seven patients, no relatives and five community nurses. Semi-structured interviews were used to elicit the view of these participants. In addition, documents containing details of the CONS's work to date were reviewed. A number of the CONS's role components were identified by the different respondent groups. Five themes were identified within the data collected: functions of the CONS, communication between the CONS and other health care professionals, structural and organizational factors, characteristics of the service and benefits to patients and their families. Furthermore, all respondent groups were positive about the service offered by the CONS, and felt that the role was valuable. Some negative features were identified and these were concerned with organizational aspects of the service. The findings suggest the need for further research and evaluation in this area.

Patient advocacy: a role for nurses?

Abstract: There is much controversy surrounding the issue of nurses in the role of patient advocate. Cancer patients are vulnerable due to their diagnoses, the anxiety that it generates, the nature of the disease and subsequent treatment and may diminished autonomy as a result. It is questionable whether the nurse is able to promote the best interest of the patient in this situation. Models of advocacy and the nurse-patient relationship are discussed. The main arguments for taking on the role of patient advocate include: reference to long periods of time spent with patient and the chance to build a relationship; on duty to care and the duty to do no harm. Criticisms of the appropriateness of advocacy role for nurses include: inability for the patient to choose his or her nurse; promotion of self interests; charges of paternalism; challenges from other health care professionals and multiple and/or conflicting obligations. It is concluded that perhaps the most ethical way of caring is by empowering patients and promoting self-advocacy. This concept needs to be further explored.