1. Joint working between NHS and commercial sector to promote self-administration of subcutaneous systemic anticancer therapy (SACT) in breast cancer patients: A patients’ perspective.
- Author
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Hei Wan Wendy Ng, Dodhia, Vikash, Alves, Carla, Wojtas, Malgorzata, Miles, David, Guppy, Amy, James, Sarah, Harrold, Karen, Adisa, Aolat, Tome, Tapiwa, Lyner, Zarina, Bennett, Jonathan, and Majid, Rizwan
- Subjects
THERAPEUTIC use of antineoplastic agents ,PRIVATE sector ,PATIENT satisfaction ,CONFERENCES & conventions ,NATIONAL health services ,SELF medication ,PATIENTS' attitudes ,INTERPROFESSIONAL relations ,QUALITY of life ,BREAST tumors ,SUBCUTANEOUS injections ,HEALTH promotion - Abstract
Objective: Trastuzumab (T) is a humanized monoclonal antibody used in the treatment of HER2-positive breast cancer and is available as a subcutaneous (SC) formulation thereby allowing short and convenient administration. A lack of trained nurses to administer T at home and/or train patients at home to self-administer, together with challenges in maintaining cold-chain delivery have impeded the uptake of home administration. In order to support patients’ ability to self-administer T at home, we have implemented an educational programme that includes nurse-led training, education material, support apps and follow-up telephone clinics. Home delivery of pre-filled syringes was enabled in collaboration with commercial providers for aseptic and logistic. The aim of this pilot study was to evaluate the utility of this programme from the patients’ perspective and to assess patient satisfaction and its impact on quality of life (QOL). Methods: A previously validated Self-Injection Assessment Questionnaire (SIAQ) was modified to assess patient satisfaction, perceptions and the impact of the programme. Patients, who had agreed to enrol on the ‘self-administration’ scheme, were asked to complete the questionnaire at baseline, at the third training session and at the second self-administered dose. Results: All 14 patients offered the questionnaire responded to all questions. The median age was 58 years old, (age range 43–76): 11(79%) were Caucasian, 2(14%) were Asian and one (7%) was African/ Caribbean. The average distance from their home address to the hospital was 10.1 miles (range 4–19). Following completion of the 1:1 nurse training, there was a significant improvement in patient confidence to self-administer sc. T (p = 0.03). No differences in ‘feeling in control of their treatment’ or ‘satisfaction of attending hospital appointments’ were noted. Of the 11 patients who reached the self-administration stage, 10 pts (91%) reported that they felt ‘very confident’ and 8 pts (82%) reported that it was ‘very easy’ to give themselves the injection. All patients were ‘very satisfied’ with self-administration and felt that the 1:1 nurse training programme helped them to be more confident. 10 pts (91%) found the App and written information useful as well as the pre- and post-administration telephone clinics. All patients reported that the self-administration programme had a positive impact on their QOL by reducing the number of hospital visits. In the first 4 months of self-administration, each patient reduced their hospital attendance by an average of eight appointments (median = 8) equating to 10 h of time that would have been spent at hospital. Conclusion: The subcutaneous T self-administration programme was well received by patients. The nurse training sessions and supportive materials enabled patients to feel more confident about self-administration with no reported incidents or adverse events. This led to fewer hospital visits and improved QOL. This programme was critically dependent on the services of a commercial compounder and homecare provider, emphasizing the importance of joint working between the NHS and the commercial sector. Evaluation of this programme will continue. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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