Patient Satisfaction for Breast Cancer in Primary Care in the UK - Research Paper Example

Patient satisfaction for breast cancer in primary care in the UK Introduction Breast cancer is one of the most severe forms of cancer and is making great headlines around the globe. Breast tissues are the region of origin of this disease, the milk supply unit that are connected to the milk ducts inner lining (Worster, 1995, p.1314). Mostly women are affected through this form of cancer but it does not necessarily mean that it cannot occur in males. In the recent years there has been a large amount of male cases facing breast cancer (Karnon et al, 2007, p. 479). Treatment of this form of cancer is now possible. The treatment of breast cancer depends upon the complexity of case. If the cancer is determined in the earlier stage then various methods of treatment are applied in order to cure it. Usually treatment of breast cancers includes the usage of radiations, drugs, surgery, hormonal therapy, immunotherapy and chemotherapy (Fogg, 2011, p.136). Aims The focal point of discussion would be to check out the implications of breast cancer cure in UK. ‎How much patient satisfaction level can be seen in this sector and is the world really winning the ‎cancer war. Combination of statistical data with essential factual information will be the ‎backbone of this research work. ‎ Objectives The study mainly aims to examine the primary care satisfaction for breast cancer in UK. In this regard, the core objectives of the research study are as follow To analyse the current status of breast cancer and its prevalence in UK To examine the current test and treatment procedure provided to the breast cancer patient in UK To analyse the pattern of breast patient primary care by identifying the breast cancer care process To identify the new interventions and introduction of new treatment options for the breast cancer treatment in UK To identify the problem areas within the primary care process for the breast cancer patient To present some workable suggestions and recommendations to help clinicians and patients towards achieving better level of primary care for breast cancer patient in UK Background The patient’s satisfaction rate in UK is quite impressive. The statistics of all the four quarters of 2011 depict a pretty clear picture that around 99% patients rated healthcare facilities as excellent. When it comes to breast cancer patient care, the case becomes very sensitive because breast cancer has evolved as most commonly diagnosed cancer among women in UK. In 2002, 41,000 women were diagnosed with breast cancer whereas 13,000 deaths from breast cancer were also reported in UK. However, there is gradual decline in the mortality due to breast cancer over the last few years due to development of some new therapy options. The prevalence of breast cancer among 30% of women in UK is alarming sign for the healthcare professionals and the general public due to which there have been several awareness campaigns also introduced by the government and healthcare agencies to make people aware about the people however, the quality and procedure of the primary health for the breast cancer patients always remain an important area of concern for the people. There have been several research studies conducted to examine the quality of primary care for breast cancer patient in UK. These researchers (e.g Wolstenholme et al, 1998, p. 277; Worster et al, 1995, p1314; Fogg, 2000, p. 136) have conducted detailed assessment of patient care by selecting breast cancer patients treated in different hospitals. This research paper aims to survey the research work conducted around the topic in order to come towards a logical conclusion towards the primary care for breast cancer patient in UK. The literature has been analysed and examined to attain the core objectives of the research and several important discoveries have been made as a result of the literature survey. The identification of the weak areas within the patient care has been attempted to compliment through the formulation of some suggestions and recommendations. Summary Breast cancer patient care is an important and critical area of research within UK healthcare system. The paper aims to examine the primary care for breast cancer in UK through the review and detailed survey of the research studies conducted around the topic. The recent literature has been examined to understand the issue in detail and come towards a logical conclusion towards the assessment of primary patient care for breast cancer in UK. Chapter 2 Literature Review Introduction This chapter provides the literature review and discusses several research about the breast cancer and its primary care provided to the patients in the UK. The review focuses on the understanding and examines the issue which is one of the most highly occurring diseases in humans. The following literature review talks about all the theoretical and substantial aspects to breast cancer. The chapter unfolds the current knowledge of the issue by describing what is breast cancer and what is the treatment that is introduced and researched for primary patients. The basic knowledge about breast cancer and how it affects the majority of women, shown in statistics, will help to further understand the problem posed by breast cancer. The primary care and the types of primary care, the patient satisfaction with the usage of those primary care methods and the recommendations given for the improvement of the primary care methods in order to fully satisfy the patients is discussed in this chapter developing a keen understanding. What is breast cancer? Cancer is the disease which exists when cells in the body abnormally form more cells and become uncontrollable. In breast cancer, the cancer is developed in the tissues that make up the breasts (Olson, 2002, p. 32). These cancer cells tend to form a mass which is called a tumor and these may also attack the nearby tissues, though all tumors are not cancers. There can be two main types of breast cancers: Ductal carcinoma which is the common type in which the cancer begins in ducts and grows in the tissues. The other type is Lobular carcinoma in which the cancer begins in lobules and grows into tissues. 1 in 10 breast cancers would be of the second type (Michell, 2010, p. 102). The treatment available for breast cancer is determined by many factors which include the tumor stage, type, characteristics, the patient’s general health and the medical conditions that may be involved for the treatment. This part of the treatment is to stage the cancer after which a treatment plan will be ready by the oncologist and physicians (Lacroix, 2006, p. 1033). This treatment plan involves the need for surgery to remove the cancer using one or a combination of the following radiation therapy, chemotherapy hormone therapy. The other treatment options given by the doctors are for severe or last stage breast cancers which involve high-dose chemotherapies with bone marrow transplantation and immunotherapy (Pasqualini, 2002, p. 84). The statistics show that in the UK there are about 50,000 people who are diagnosed with breast caner every year which is 1 person in every 10 minutes and over 12,000 people die of breast cancer every year. Moreover, breast cancer is the second largest cancer that can cause death, lung cancer being first. In the UK, approximately 550,000 people living today have had a diagnosis of breast cancer. Breast cancer is the most commonly diagnosed cancer in women under 35 years of age. However, since the Breast Cancer Awareness Month first started in the UK in 1993, the average age of the women diagnosed with cancer was 50-54 (Parkin et al, 2005, p. 80). Primary care and breast cancer Primary health care is the sufficient health care which is based on the practical, scientifically and socially acceptable policies that are made universally understandable. It is the care provided at the cost of the community to families and individuals with their full participation. The primary care should consist of all the services which play a role in health that could be needed as the ‘primary’ treatment to patients such as biology, health services and environment (Greenhalgh, 2008, p.28). Breast cancer has become increasingly common in women, and rare in men, the primary care played an important role in encouraging women and saving them from getting into severe stages of cancer. These primary care teams have worked in providing women the encouragement to utilize the services of screening, provision of information and advice and reassurance at all stages. Research from Cancer Research Centre UK shows that self examination has not been seen as an effective method of screening and should not be included in the primary screening procedure. It is the primary care teams’ responsibility to initiate a case for women to make them more ‘breast aware’. Primary care becomes important because the earlier breast cancer is diagnosed, the better will be the survival rates. This means that the morality rate from breast cancer could also be controlled from the effective services of primary health care (Goldhirsch et al, 2005, p. 1581). Breast screening by mammography is the most appropriate method of diagnosing breast cancer in the early stages. Most of the cancers that are detected through screening would have good prognosis. The breast screening by mammography is the only method which has been valued in rigorous randomized trials. Not in all cases, but the morality has been reduced mostly by screening controls of breast cancer rather than unscreened controls adopted. All the randomized trials have shown an overall reduction of 28% in morality from breast cancer (Grunfeld, Mant, Yudkin, 1996, p. 402). There are many benefits of breast screening. It is most often recommended because it leads to the improved prognosis of those cases that are detected by screening, there could be a less radical treatment for those cases and there will be reassurance for those cases that have negative test results (Vainio, Bianchini, 2002, p. 122). Women may be hesitant to attend the breast screening, thus it is the role of the primary care teams to provide them awareness and through their attitudes influence them to understand the effectiveness of the screening method. Doctors should have an influential and positive attitude towards encouraging primary care patients by relaying importance and advantages. Patient satisfaction a UK perspective In most of the clinics in UK, after treatment there are routine follow-up practices for the breast cancer patients. These follow-ups are aimed to assess the patient satisfaction by detecting any cancer recurrences and by providing the patient continuous psychological support. Although, the research from cancer specialists tells little about the views that the patients have for these follow-ups but the number of patients that show up in the clinics proves that it does increase patient satisfaction. The follow-up is 18 months in which the women receive routine care from their own practitioner. The patient satisfaction was assessed by questionnaires supplied to the women. Patients had reported more satisfaction from the general practice group than the hospital outpatient departments(Watson, Haviland, 1999, p. 1711). A national audit, National Mastectomy ans Breast Reconstruction Audit reported that patients who undergo breast reconstruction surgery have been immensely satisfied by the quality of care. Eighty percent of women said they were treated with respect and dignity in the hospitals while 90% report that the care they received was excellent or very good. A large number of women were satisfied with the competence of their surgeon and the professionals in the team. These figures are extracted from the patient’s responses shown in the National Mastectomy and Breast Reconstruction Audit (Miller, 2012, p. 279). Women have also reported the post-surgery attributes including their self-confidence and social setting being positive and satisfactory. The above results are taken from hospitals where the patients are surveyed after every treatment and the feedback over the last year have showed that 99.6% of the patients were satisfied with the treatment that they received. Excellence in hospitals is achieved with the help of the reports and the findings provided by the patients. They believe that the patient survey is the best tool for identifying the areas of improvement. These hospitals provide primary care and are sufficient in the patient satisfaction in the UK and thus, their reports and treatments play a vital role in finding out how primary care works in UK. When we are talking about the primary care and its findings, the reports have not shown much good results. There are a number of patients who have to be diagnosed every day in the primary care clinics. The increased number of patients eventually led to the failure of the clinics to look after every patient individually. There are many problems that arise in primary care some of the problems include multiple checks of patients in one time, lack of proper advices, lack of provision of information etc. Improving breast cancer satisfaction in UK primary care services It is very important to understand the satisfaction levels of breast cancer patients receiving primary care. There are many ways in which improvements can be made to fight the war against a cancer the top method that can increase patient satisfaction is multidisciplinary care. The reports from Health Services Research in 2006 have proved that patient satisfaction has increased where oncologists co-manage their care with other specialists. It is important to assess surveys finding because as the increasing number of cases has been diagnosed, it has been found that many physicians and oncologists co-manage their practices with other specialists and are to treat the breast cancer patients independently. They might often not carry out the treatment themselves and pass them on to other providers. According to the Health Behavior News Service, 2011, this has been an important reason why patients were unsatisfied with the primary care services(Bouleuc, Dolbeaul, 2005, p. 351) Researchers from the Cancer Research Centre UK found out that patients’ satisfaction could increase when there is an understanding relationship between the physician and the patient. Thus, the physician should make sure that he is not only advising or providing information, but also actively co-managing the decision making, this would improve the patient satisfaction rates. In some aspects, the patients expect to be guided, choosing the type of surgery decisions about radiation, treatment of depression. Other ways that could be adopted to improve primary care are increased visits, counseling and also the provision of cultural sensitive care. Summary This chapter discussed a number of important aspects related to the breast cancer. It analyzed how common and important primary care is for the hundreds of patients who need treatment Screening is the best method that the patients have to initially undergo to be able to seek further treatment. Screening can help many patients to detect their cancer and stop it from spreading. Patient satisfaction with the professionals have often been seen and observed but with the provision of primary care services, there have been issues arising regarding the patient’s satisfaction. Measures for improvement have also been described to improve the services and satisfaction of the patients. ‎Chapter 3‎ Research Methodology Introduction ‎ The chapter aims to present the methodological framework established to conduct the research ‎study. The chapter discusses the selected research approaches and explains the sources of data ‎collection and its procedure ‎ Conducting a Critical Literature Review ‎ A literature review is a qualitative research approach in which a body of text is examined and ‎reviewed according to its critical points, theoretical framework and findings in order to made ‎conclusion regarding a specific issue under study (Hart, 1998, p144). There are different types of ‎reviews including traditional or narrative literature review, systematic literature review, Meta-‎analysis and meta-synthesis (Marchevsky, 2000, p32). The current research employs the approach ‎of critical literature review that proposes the use of Non-statistical technique, Integrates, ‎evaluates and interprets findings of multiple qualitative research studies in order to find out the ‎common core elements and themes ‎(Wood and Kerr, 2010, p14). ‎Sources of information ‎ There is variety of sources accessed for collecting information for the research study. Different ‎academic databases, medical research journals, health science informative portals and magazines ‎have been accessed to sort out the relevant information and literature conducted around the ‎topic. The major sources of information include:‎ • Pub Medical Journal ‎ • Science Direct,‎ • Department of Health Website ‎ • ERIC • Proquest ‎ ‎ Inclusion & Exclusion criteria ‎ Before initiating the collection of information, an inclusion and exclusion criteria has been set up ‎to sort out the material accordingly. It was decided that only the articles date from 2007-2012 ‎would be included in the study. All the selected articles must be published in English language ‎and should be focused upon patient satisfaction and breast cancer care in UK.‎ In addition, articles published before 2007 would not be accessed for this research study. The ‎articles published in any language other than English would also be excluded from the study ‎whereas the articles focused upon issues other than breast cancer and patient satisfaction in UK ‎would also be not included in thereview. ‎ Search strategy ‎ Specific key words were usedbreast cancer UK, Department of Health UK breast cancer, Patient ‎satisfaction UK, breast cancer UK statistics, breast cancer UK patient care, breast cancer primary ‎care issue and breast cancer patient care improvement UK; were used to search material and ‎articles from the selected databases and search engines ‎ Data Extraction Twenty five articles were selected to conduct the literature review and analysis in order to ‎examine the issue under study. The data and information from these articles has been extracted ‎after going through a process of extraction that allows finalizing the selected 25 articles for the ‎research study. The process of article search and selection is described below Key Words/Database EBSCOHOST Pub Med Science Direct DOH ProQuest and Others Total Breast cancer UK Statistics, Primary care, Patient Satisfaction 150 125 115 60 100 550 Removed Duplicate 125 90 85 45 30 375 Full Text Only 90 30 70 50 25 265 Inclusion and Excursion Criteria 50 15 35 20 15 135 From Reading 8 5 4 5 3 25 Quality Assessment Factors Score Breast cancer + patient ‎satisfaction ‎ 1 Breast cancer + patient ‎satisfaction + England 1 Breast cancer + primary care 1 Sample size 1 (If an articles scored 4 point =A, 3 point =B, 2 point =C‎ and 1 point =D‎) The following table shows the quality assessment conducted of all the 25 articles selected for the reseatch study along with their respective scores and grades Number Year Actors Score Grade 1 2011 DOH 3 B 2 2011 Wales Assembly 2 C 3 2009 NHS 2 C 4 2009 NICE 4 A 5 2011 BHGI 4 A 6 2011 Lodge M, Corbex 4 A 7 2008 Greenhalgh 4 A 8 2007 Karnon et al 4 A 9 2010 Michell 4 A 10 2012 Millar 4 A 11 2011 Coleman et al 3 B 12 2008 O’Shaughnessy,et al 3 B 13 2006 Eicher 3 B 14 2011 Beaumont and Leadbeater 3 B 15 2007 Rubenstein and Pugh 2 C 16 2010 Bouleuc et al 3 B 17 2011 Fogg 4 A 18 2010 Goldhirsch 3 B 19 2010 Grunfeld et al 4 A 20 2007 Karnon et al 4 A 21 2009 Parkin 2 C 22 2010 Pasqualini 3 B 23 2007 Vainio 3 B 24 2009 Watson and Haviland 3 B 25 2011 Coleman et al 4 A Chapter 4- Result, Dissection, Conclusion and Recommendation Introduction The chapter presents the finding of the research study. The selected articles have been analyzed and the conclusions made by the researchers have been examined to find out their implication to the UK primary care setting for breast cancer patients. On the basis of these recommendations and conclusion, the chapter presets some suggestions for the improvement of the situation. Result Unit of analysis Articles No Yr Actor Title of Articles Journal Grade 1 2007‎ Rubenstein and Pugh ‎ Strategies for Promoting Organizational and Practice Change by Advancing Implementation ‎Research J Gen Intern Med ‎ B 2 2007 Karnon et al Health care costs for the treatment of breast cancer recurrent events: estimates from a UK-based ‎patient-level analysis British Journal of cancer A 3 2008 Greenhalgh‎ Primary Health Care: Theory and Practice‎ John Wiley &Sons A 4 2012 Millar Year Book of Plastic and Aesthetic Surgery ‎ Elsevier Health Sciences ‎ A Themes: Community care and Breast cancer patient satisfaction ‎ Discussion Rubenstein ‎and Pugh (2007) in their article “Strategies for Promoting Organizational and Practice Change by Advancing Implementation Research” talk about the gap between the implementation and development of the research aims. The article mainly discusses the gap between the techniques of producing high quality clinical care and what more effective methods are to implement the evidence into practice as prompted by the interest of what the public actually receives. The purpose of the article is to present recommendations that are aimed for establishing a better relationship between the implementation research and its development. By fulfilling the recommendations, it is more likely that the patients are able to gain more satisfaction according to their interests and they can help in the development of efficient practices. The article recommendations are based on the research conference which was hosted by VA for VA and non-VA health services researchers. This is in a wide aspect where all the research implementations are covered keeping in mind the breast cancer care in the UK and the patient satisfaction. The author writes how these recommendations can be helpful to accomplish the care in this field where doctors are trying their best to achieve the best statistics for patient satisfaction. These recommendations will assist the health care organizations, medical journals, researchers and the academic medical institutions to advance the field of implementation science. This will eventually increase the effect on the clinical services and impact on the health services research on the health care of the public. Through these implementations and research recommendations, the author talks about the organizational change and quality of care that will be accessible. The article talks about the increasing rate of breast cancer in women in the UK and the fact that even though there are many improved screening programs to detect the disease, it still poses a very high burden on the health care services. The author talks about many ways in which awareness is spread, new therapies have been introduced, quality care is provided, screening by mammography is introduced and how it has helped in transforming the care of the patients with breast cancer. In this study, keen importance has been given to discuss the current issues for the diagnosis and management of breast cancer. Karnon et al (2007) in their article “Health care costs for the treatment of breast cancer recurrent events: estimates from a UK-based patient-level analysis” is an article which is written on the cost pressures that the patients have to suffer due to the treatment of breast cancer. Since breast cancer is the highly diagnosed disease, and health care centers are doing their best in providing each patient with the proper treatment, it is important to analyze the cost pressures that the patients might be facing. As new interventions are being made, the author writes that their cost effectiveness needs to be demonstrated according to the cost of the treatment of the recurrent events. This is a study which is based on the analysis of the data covered through those women who suffered breast cancer recurrent events between 1991 and 2004 and were treated. This article descriptively analyzes the cost pressures on the patients who suffer from recurrence events and the cost pressures on those who have to pay for the time period but do not suffer any recurrent events. Breast cancer patients tend to give an annual cost for 5 years to remain alive without any further recurrence. No evidence has shown any changes or variations in these costs. These cost estimates that are made in this study inform the magnitude of resource consequences of breast cancer recurrent events, and they are also regarded to inform cost effectiveness analyses, which have a great role in allocating health care resources. The research shows that more cost effective treatments and new therapies are important to increase the patient satisfaction in UK. Conclusion The research paper basically focuses upon the issue of patient care for the breast cancer in UK. In this regard the main focus is given to the examination of the quality of primary health care needed for breast cancer in the ‎UK. The articles reviewed for the study mainly talk about several primary health care treatments that are currently available for ‎the UK patients as breast cancer is very commonly diagnosed there and primary care seems to be ‎the most important step in the treatment. It ensures that the patient is given the best and the ‎fastest treatment for the stage in which the cancer exists. It is unveiled that the importance of ‎health care for breast cancer patients in her language of experience that she gained as a medical ‎journalist. Her book focuses on many aspects and treatments that should be provided and those ‎that are recommended. The study discovers that the social scientist and experts commonly believe that if more patients have to be seen satisfied with their treatment, it ‎is important that they receive the quality care which gives them hope, fast treatment and proper ‎guidance. Breast cancer patients and their families need initial support of the doctor whom they ‎rely upon. Thus, it is important that the health care provided is high quality because without ‎quality, no patient will be satisfied. Furthermore, the book talks about the theories given in the ‎health studies for immediate health care needed for the breast cancer patients and along with that ‎it focuses on the implementation. The practice is as important as the theory ‎and through many recent examples she explains how and where we need to correct ourselves in ‎providing patient satisfactory primary care. ‎The more effective treatment for breast cancer according to the author is the development ‎of new techniques to diagnose and the use of the sophisticated drugs. However, in the ‎application of these techniques, there are contentious topics such as risk factors, professional ‎performance and quality assurance that are thoroughly explored by a multidisciplinary experts’ ‎team. This expert multidisciplinary team helps in providing satisfactory care to the patients by ‎contributing actively in the management decisions and making sure that the health care for the ‎patients is efficiently managed. Managing the techniques and resources would result in increased ‎patient satisfaction and will contribute in the breast cancer treatment in the UK. ‎ Recommendation There are some recommendations also formulated for the UK healthcare system with the intention to assist the supervisors in providing improved primary care to the patients of breast cancer across the country. It is found that the current practice requires induction of latest technologies and enhances nursing care for the patients. The government need to fund the implication of new technology for the treatment of the patients with breast care. Moreover, the clinicians and nursing staff should be provided with training to deal with the patients in more effective manner. The medical and moral suppost of the medical staff possesses great importance for the patients because the behavior of the staff draw bery strong impacts upon the minds of the patients and eventually their progress level in fighting with the disease is also improved. It implies that medical staff training is also an important area of consider while thinking about improving the quality of primary care for breast cancer in UK and to attain great level of satisfaction of the patients it is important to emphasize on technology and medical staff training. Reference Wales. 1995. A Policy Framework for Commissioning Cancer Services: A Report by the Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales (1995). Available from: http://www.doh.gov.uk/cancer/pdfs/calman-hine.pdf Advanced breast cancer. Diagnosis and treatment. NHS 2009 Beaumont, T. and Leadbeater, M. 2011. “Treatment and care of patients with metastatic breast cancer”. Nursing Standard 26 (40). 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