Home and Community Care Digest
Methods: This qualitative study took place within a larger study in Toronto, Canada, in which children aged 2 to 16 were randomized into two groups, the first receiving home chemotherapy for six months, and the second receiving hospital-based treatment for six months. Both groups then received treatment in the opposite setting for the remaining half of the year. In this current study, 33 health professionals who administered the chemotherapy program from both the hospital and home sectors, including nurses, pediatric oncologists, managers, lab technicians, and pharmacy staff. Participants were interviewed about their views concerning (1) benefits they perceived for participating families; (2) service delivery and administration of the program; (3) impact on health professionals.
Findings: Health professionals felt the program reduced disruption in the daily lives of families and decreased psychological distress among child patients. Concerning future administration of the program, health professionals called for greater consistency of home-based personnel, improved continuity between hospital and home, including similar skills and qualifications among home-based nurses. Better communication between health professionals in all settings was another important recommendation. A serious problem for home-based patients concerned visits to community labs for pre-chemotherapy blood work: technicians lacked experience working with children generally, and pediatric oncology patients specifically. Program administration in the home setting also involved increased paperwork, thereby increasing perceived workload for some. Some hospital physicians were also concerned about legal liability surrounding the prescription of chemotherapy drugs to home-based patients who were not being examined by the physicians themselves.
Conclusions: In general, health professionals in both settings were satisfied with the home chemotherapy program and support its continuation, subject to minor changes. In order to provide seamless health care across delivery settings, good communication between all participating health care professionals is key. Enhanced, centralized communication between all parties may have also satisfied concerns by hospital-based staff who did not see home-based patients regularly. In addition, consistency in training, qualifications and competency of health care delivery staff in all settings is necessary. More orientation and skills training supports may be required to address this issue.
Reference: Stevens, B., McKeever, P., Booth, M., Greenberg, M., Daub, S., Gafni, A., Gammon, J., Yamada, J., Beamer, M. "Home chemotherapy for children with cancer: perspectives from health care professionals". Health and Social Care in the Community, March 2004; 12 (2), 142-148.
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