Professional Documents
Culture Documents
Park 2016
Park 2016
Park 2016
DOI: 10.1111/ecc.12592
ORIGINAL ARTICLE
K.A. Park MPH, RN1,2|Y.J. Oh MSN, RN1,2 |K.M. Kim MSN, RN2 |S.Y. Eum MSN,
RN2 |M.H. Cho MPH, RN2 |Y.H. Son RN2 |S.H. Park MSN, RN2 |K.M. Woo MSN,
RN2 |Y.S. Lee MD1 |S. Kim PhD, RN3 |H.-S. Chang PhD, MD1 |C.S. Park PhD, MD1
1
Thyroid Cancer Center,Gangnam
Severance Hospital,Yonsei University Health
The purpose of this study was to develop and evaluate a navigation program for pa-
System, Seoul, Korea tients with thyroid cancer. The navigation program was developed following an analy-
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Division of Nursing, Gangnam Severance sis of the unmet needs of patients who underwent surgery for thyroid cancer.
Hospital, Yonsei University Health System,
Seoul, Korea Ninety-nine patients in the control group received usual care, and 95 in the navigation
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Department of Clinical Nursing Science group were managed with a navigation program during the perioperative period. The
& Mo Im Kim Nursing Research Institute,
effectiveness of the navigation program was assessed by administering a question-
Yonsei University College of Nursing, Seoul,
Korea naire to both groups. Overall satisfaction scores were significantly higher in the navi-
gation than in the control group (p=.025), as were satisfaction scores on the continuity
Correspondence of information (p<.001), the continuity of management (p=.002), the continuity of
Yong Sang Lee, Department of Surgery,
Gangnam Severance Hospital, Thyroid relationships with healthcare providers (p<.001), and patient empowerment (p<.001).
Cancer Center, Yonsei University Health The newly developed navigation program for patients with thyroid cancer was effec-
System, Seoul, Korea.
Email: medilys@yuhs.ac tive in raising satisfaction levels and in actively managing the disease during the perio-
Sanghee Kim, Department of Clinical perative period.
Nursing Science & Mo Im Kim Nursing
Research Institute, Yonsei University College KEYWORDS
of Nursing, Seoul, Korea.
Email: sangheekim@yuhs.ac
navigation program, perioperative care, satisfaction, thyroid cancer
1| INTRODUCTION Several recent studies of thyroid cancer care have focused on dis-
charge education after surgery (van der Meulen, de Leeuw, Gamel, &
The incidence of thyroid cancer has been increasing throughout the Hafsteinsdottir, 2013; Kim & Kim, 2011; Pieper etal., 2006), which is
world (Chen, Jemal, & Ward, 2009; Kent etal., 2007; Leenhardt & mainly intended to improve patient quality of life (Almeida, Vartanian,
Grosclaude, 2011). In Korea, the incidence of thyroid cancer increased & Kowalski, 2009; Huang, Lee, Chien, Liu, & Tai, 2004; Husson etal.,
24.2% per year in both sexes from 1999 to 2010, with thyroid cancer, 2011). Those studies, however, did not evaluate effective care during
which was the fourth most common cancer type in 2006, becoming the perioperative period. In most hospitals, care is not sufficient to
the most common type of cancer in 2009 (Jung etal., 2013). Although satisfy patients. Despite the use of various educational methods in
the causes of this increase have not been determined, increases in pa- hospitals, many patients still have questions and feel anxiety about
tients undergoing generalized health examinations and developments upcoming surgery (Kim etal., 2013; Roberts, Lepore, & Urken, 2008;
in ultrasonography and fine-needle aspiration biopsy have contributed Seok etal., 2013). Moreover, disagreements among the medical staffs
to earlier detection of thyroid cancer (Aschebrook-Kilfoy, Ward, Sabra, of different departments can lead to patients receiving inconsistent
& Devesa, 2011; Brown, de Souza, & Cohen, 2011). information, which can cause patient dissatisfaction and confusion.
As the number of patients undergoing surgery for thyroid cancer Because of the importance for providers to maintain continuity of
increases, so does their need to receive proper perioperative care. care across the health care setting, the thyroid cancer treatment
Patients require sufficient time for medical consultations and for edu- team, which includes doctors and nurses, should maintain a consistent
cation about upcoming surgery. quality of care for patients and their families during the perioperative
Eur J Cancer Care 2016; 16 wileyonlinelibrary.com/journal/ecc 2016 John Wiley & Sons Ltd | 1
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2 PARK etal.
period. Patient navigation programs can support patients with educa- group was managed with the newly developed navigation program
tional needs and emotional problems. during the perioperative period, whereas the control group received
Patient navigation has been used and evaluated in a various dis- usual care. To verify the efficacy of the navigation program, all patients
eases (Dohan & Schrag, 2005; Hendren etal., 2012). Navigation pro- were administered a questionnaire at the post-surgical follow-up visit
grams are universally regarded as positive and have been modified to the outpatient clinic (Fig.1). Both groups were post-tested after
continuously. However, navigation programs do not fit a strict con- perioperative care.
ceptual framework. Patient navigation programs require continuous
development and evaluation to provide timely care, ensure patient
2.2|Navigation program
satisfaction, and improve patients quality of life (Wells etal., 2008).
The purpose of this study was to explore the educational needs The navigation program was developed to improve continuity of in-
of thyroid cancer patients, develop a navigation program in a sys- formation, continuity of management, continuity of relationships, and
tematic way, and evaluate the program statistically. In evaluating the to empower patients (Table1). At their first visit to the outpatient de-
navigation program, we focused on patient satisfaction with surgery, partment prior to surgery, patients received a booklet of information
which can be evaluated by a questionnaire. We hypothesized that the about the perioperative period, face-to-face education and Internet
navigation program would improve patient satisfaction with thyroid guidance. An assigned nurse consulted with patients by telephone
cancer surgery. during the period of waiting for surgery. Upon admission to the hospi-
tal for the surgery, patients received face-to-face education from the
inpatient nurses, using the booklets provided.
2| METHODS
The educational methods included a booklet, a phone consulta-
tion, face-to-face education and websites. The booklets contained
2.1|Design
information about pre-operative preparation and post-operative man-
This study consisted of methodological research to develop the navi- agement, which included a treatment plan, a plan for managing com-
gation program, followed by a casecontrol study to evaluate the ef- plications, doses of medications and an introduction to the Internet
fectiveness of the program. community. The phone counselling service included pre-
surgical
First, the navigation program was developed following an analy- checkups, responses to questions and emotional support. The website
sis of patients unfulfilled needs. The navigation program was applied consisted of professional opinion columns, online booklets, a story of
during the perioperative period, from the first outpatient visit to dis- a patients experiences and a Q & A board. The website was managed
charge after surgery. and updated by the designated medical staff.
Second, the navigation program was evaluated by a casecontrol The educator program was designed to provide accurate and con-
study using non-equivalent control group methods. Patients were sistent education for nurses. Nurses who worked in outpatient care,
classified into a navigation group and a control group. The navigation inpatient care, telephone counselling and surgery for thyroid cancer
patients received special training for the navigation program (Fig.1).
The contents of the navigation program were reviewed by thyroid
cancer specialist teams composed of four medical specialists and seven
nurses. The navigation program was approved by the hospital man-
agement, and the nursing manager examined the overall process to
determine if the navigation program was being carried out as designed.
2.3|Data collection
This study was approved by the Institutional Review Board of the
Yonsei University Gangnam Severance Hospital. Inclusion criteria
F I G U R E 1 Structure of the navigation program with description included age 18years and diagnosis of thyroid cancer. Participants
of each process were patients whom the nurses met in the outpatient clinic after
Continuity of information Booklets The education booklets cover all information, from before surgery to management after surgery
Patients were encouraged to read these booklets
Continuity of management Educator program Nurses completed the education program to provide consistent education for patients
Continuity of relationship Telephone counseling The patient was provided the assigned nurses phone number and assigned nurse provided counseling
Empowerment of patients Website Internet community answered questions and provided emotional support
PARK etal. |
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on the importance of making medical consulting services more acces- navigation program should undergo continuous development and
sible (Rasmussen, Wellard, & Nankervis, 2001). The improved satis- improvement by medical staff. Doctors and nurses must work coop-
faction score for empowerment suggests that the navigation program eratively to ensure that the navigation program has been properly
may lead patients to better prepare, both physically and psychologi- developed. Further research is also necessary to evaluate navigation
cally, for treatments. programs, as they are likely to improve patient satisfaction and the
Patient navigation programs were originally developed to as- quality of patient care.
sist with cancer care delivery and to assess underserved patients The number of thyroid cancer patients worldwide is increasing,
(Freeman, Muth, & Kerner, 1995; Vargas, Ryan, Jackson, Rodriquez, & suggesting the need for a proper navigation program, which should be
Freeman, 2008). Current professional navigation programs were de- continuously developed and improved. Although patients can easily
signed to provide continuous care to patients diagnosed with cancer access information using the Internet, some of information may be in-
(Doll etal., 2007). Professional cancer patient navigators help newly correct. Thus, and it is important for medical teams to provide correct
diagnosed patients, patients undergoing treatment and follow-up, information to patients.
and patients who survived after a diagnosis of cancer (Fillion etal., Furthermore, the long-term effectiveness of the navigational
2009). After discharge, patients require sufficient information about program should be evaluated. Future studies should focus on the
side effects and unmet needs (Pieper etal., 2006). Patient naviga- development and evaluation of a navigation program for radioiodine
tion involves all stages of cancer care, but little has been reported therapy, as many thyroid cancer patients receive radioiodine therapy
about the outcomes and efficacy of patient navigation during cancer after surgery.
treatment (Guadagnolo, Dohan, & Raich, 2011; Ko etal., 2014). This
study analysed a navigation program adapted for the perioperative
AC KNOW L ED G EM ENT
period in thyroid cancer patients. An assigned nurse played the role of
navigator, to relieve patient anxiety before surgery. Also, systematic The authors especially thank the nurses who work in the outpatient
education was provided during the patients hospitalization. In gen- department (Thyroid Cancer Center), inpatient department (52, 73,
eral, cancer patients need to be properly educated from the time of and 74 wards).
diagnosis to post-surgical discharge, enabling them to manage their
health for the rest of their lives. Providing these patients with system-
atic education about thyroid cancer and treatment plans is essential. CO NFL I C T O F I NT ER ES T
Some patients expressed dissatisfaction with their education None.
booklets and the navigation program, as both focused solely on con-
ventional surgery. In the future, it will be necessary to develop addi-
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