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Factors Influencing Evidence-Informed Symptom Management in Outpatient Malignant Hematology: A Qualitative
Kylie Teggart1, Denise Bryant-Lukosius1,2, Sarah E Neil-Sztramko3,4
1School of Nursing, McMaster University, Hamilton, Ontario, Canada.
Aims:
To describe patients' and oncology nurses' experiences with symptom management care, and influential barriers and facilitators to enhancing evidence-informed symptom management in an outpatient malignant hematology unit.
Design:
A qualitative descriptive study embedded within an experience-based co-design approach.
Methods:
Patients with hematologic malignancies, registered nurses and nurse practitioners were interviewed. A qualitative content analysis approach was used, informed in part by the Consolidated Framework for Implementation Research (CFIR).
Results:
Twenty-seven people participated (15 patients, 12 nurses). Symptom management was focused on medical management, with limited non-pharmacological strategies or patient education provided. The outpatient environment, staff and service model impacted patients' symptoms and experiences. CFIR factors influencing evidence-informed symptom management delivery were mission alignment, the relative priority of symptom management versus procedures and treatment, symptom management guideline compatibility, nursing knowledge and access to information, and symptom management roles.
Conclusion:
Patients with hematologic malignancies receiving outpatient care experience a high symptom burden. Opportunities exist to enhance symptom management through evidence-informed oncology nursing practice.
Implications For The Profession And/Or Patient Care:
Organizational and unit-based strategies are needed to empower oncology nurses to work to their full scope when providing symptom management care. Implementing guideline-informed symptom management protocols may optimize the range of interventions offered and reduce suffering.
Impact:
A local Steering Group will use these findings to collaboratively identify the top priorities and strategies for improving symptom management.
Reporting Method:
Reported in line with the Standards for Reporting Qualitative Research and Guidance for Reporting Involvement of Patients and the Public.
Patient Or Public Contribution:
A Steering Group of patients, caregivers, oncology clinicians and organizational leaders informed all study phases. Their contributions included reviewing protocols and data collection tools, supporting recruitment and interpreting findings to ensure the research addressed relevant issues and could be meaningfully used to inform improvement priorities through experience-based co-design.
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