Pauline Humphrey

Development and refinement of patient care recommendations in brachytherapy for locally advanced cervical cancer using nominal group technique workshops

Abstract Purpose Patient experiences of brachytherapy for locally advanced cervical cancer (LACC) are widely variable, with reports of difficult and traumatic experiences and aspects of care requiring improvement. The aim of this study was to develop patient care recommendations and consult with key stakeholders to review, refine and prioritise recommendations. Methods Phase 1: Patient care recommendations were developed from qualitative exploratory study data. Phase 2: Service users and providers with recent experience of brachytherapy for LACC were recruited to online nominal group technique (NGT) workshops. Four NGT stages were followed: (1) initial voting and silent generation; (2) round robin; (3) clarification; and (4) prioritisation. Voting data were summed across the workshops, deriving inter-group scores. Qualitative data were analysed through content analysis. Results Phase 1: Fifty-one patient care recommendations were developed. Phase 2: Thirteen participants took part in three online NGT workshops, with a combination of service users and providers. Initial recommendations were voted on; four new recommendations were added; minor changes were made and second voting was undertaken. Recommendations were positively received with 25 recommendations scoring maximum points from all participants. An importance score above 90% was given to 46 recommendations. The remaining recommendations received scores between 74 and 90%. Conclusions NGT workshops facilitated collaboration between key stakeholders, discussing, refining and prioritising patient care recommendations, leading to verification of achievable and relevant recommendations. These provide a foundation for future development of guidelines and subsequent implementation into clinical practice, aiming to improve consistency of care and patient experiences of brachytherapy for LACC.

Brachytherapy for locally advanced cervical cancer: A survey of UK provision of care and support

Gynaecological brachytherapy can cause anxiety, distress and discomfort. It is not known how variation in delivery impacts women's experiences. To inform future research an online survey was carried out to identify variations in brachytherapy and support available to women receiving treatment for locally advanced cervical cancer (LACC). An online survey was sent to 44 UK brachytherapy centres using the Qualtrics® survey platform. It included questions about brachytherapy scheduling, inpatient/day case treatment, anaesthetic/analgesia, non-pharmacological support and health professionals' opinions regarding holistic care. A mixture of closed questions with pre-specified options and open questions were employed. Descriptive statistics were generated to identify variance in UK practice. Free text responses were analysed using inductive content analysis. Responses were received from 39/43 eligible centres (91% response rate). Brachytherapy was predominantly given on an inpatient basis at 65% and day case at 35% of centres. Eleven scheduling regimes were reported with typical duration of brachytherapy ranging from three to 52 h. The main categories identified in response to what worked well were: 'consistency of staff'; 'good information provision' and 'experienced/skilled/senior staff'. The main categories identified as needing improvement were: 'training of different staff groups' and 'follow up and support' with many suggestions for service improvements. The survey provided a comprehensive overview of brachytherapy services for LACC demonstrating wide variability in scheduling regimes, duration of treatment and holistic care. The findings support the need to explore women's experiences with a range of treatment regimes and anaesthesia and analgesia techniques to inform improvements to future clinical care.

Patient Experiences of Brachytherapy for Locally Advanced Cervical Cancer: Hearing the Patient Voice Through Qualitative Interviews

Brachytherapy for gynecological cancer is reported to cause pain, anxiety, and distress with no clear guidance for optimizing patient experiences. The aim of this study was to explore patient experiences of brachytherapy and views on improvement. Semistructured interviews were undertaken with patients who had received brachytherapy for locally advanced cervical cancer. Two cohorts were recruited: cohort 1 had recently had brachytherapy, and cohort 2 was a year post brachytherapy. Four recruitment sites were selected, where brachytherapy is given in different ways, some with short day case procedures and others having 1 or 2 overnight stays with applicators in place. Consecutive patients were invited to interview. Participants were asked to retell their brachytherapy story, with views on their care and ideas for improvement. Interviews were audio recorded, transcribed, and data analyzed following Braun and Clarke's method for reflexive thematic analysis. Thirty-five interviews were conducted (20 in cohort 1 and 15 in cohort 2). Participant's ages ranged from 28 to 87 years. The interview duration ranged from 22 to 78 minutes. Difficult and traumatic experiences were reported, including periods of severe pain and perceptions of poor care. However, some participants described positive experiences and what went well. Three themes were developed: (1) how the patient got through it, (2) unpleasantness, discomfort, and the aftermath, and (3) emotional consequences and trauma. Some aspects of medium and long duration brachytherapy were found to be more problematic compared with short duration brachytherapy. Exploring experiences at 1-year post brachytherapy has provided insights into the long-lasting impact of brachytherapy experiences. Hearing the patient voice has demonstrated that further work is needed to improve patient care in modern brachytherapy techniques using different regimens and durations, to minimize difficult and traumatic patient experiences. Study insights will inform future work to develop clinical care recommendations.