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Too Much Cancer Care?: Nurses' Perspectives on the Unnecessary Use of Oncology Services
Moriah E Ellen1, Saritte Perlman, Ruth Shach
1Author Affiliations: Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Department of Health Systems Management, Ben-Gurion University of the Negev (Dr Ellen and Ms Perlman), Beersheba, Israel; Institute for Health Policy, Management and Evaluation, University of Toronto (Dr Ellen), Ontario, Canada; McMaster Health Forum, McMaster University (Dr Ellen), Hamilton, Ontario, Canada; and Department of Psychology, Saint Louis University (Ms Shach), Missouri.
Background:
"Unnecessary use of health services" refers to care that does not add value for patients and can lead to physical, emotional, and economical harm. High rates of overuse have been reported within oncology, and patients experience its consequences.
Objective:
The aim of this study was to explore perceptions and experiences of oncology nurses regarding unnecessary use of oncology services.
Methods:
In-depth, semistructured interviews were conducted with a convenience sample of 20 oncology nurses currently practicing in Israel. Interviews were recorded, transcribed, and analyzed thematically.
Results:
Themes included perceptions of unnecessary use of health services in cancer (causes and effects of unnecessary use, current and proposed solutions) and negative effects of unnecessary cancer care on patients, families, providers, and the system, including decreased quality of life, increased suffering, and emotional effects on patients and families. Causes were seen on provider, family, and patient levels, such as difficulty for providers to "give up," lack of registered nurses' authority, and family and patient demands. Multidisciplinary care provision, nurses' role, and the patient-provider relationship were seen as existing facilitators minimizing unnecessary use. Future improvement can be achieved by strengthening relationships, providing support to healthcare providers, and improving communication.
Conclusions:
Nurses perceive unnecessary use of health services as a result of multiple, interlinked and complex causes, but few targeted interventions exist. Future research should explore quantifying unnecessary use to determine an accurate representation of the issue.
Implications For Practice:
Solutions should include engaging patients and families, involving nurses, and fostering multidisciplinary collaborative teamwork to positively affect care and treatment decision-making processes.
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