A systematic review of the effectiveness of patient‐initiated follow‐up after cancer

BackgroundCurrent follow‐up models in cancer are seen to be unsustainable and inflexible, and there is growing interest in alternative models, such as patient‐initiated follow‐up (PIFU). It is therefore important to understand whether PIFU is acceptable to patients and healthcare professionals (HCPs).MethodsStandard systematic review methodology aimed at limiting bias was used for study identification (to January 2022), selection and data extraction. Thematic synthesis was undertaken for qualitative data, and survey findings were tabulated and described.ResultsNine qualitative studies and 22 surveys were included, mainly in breast and endometrial cancer. Women treated for breast or endometrial cancer and HCPs were mostly supportive of PIFU. Facilitators for PIFU included convenience, control over own health and avoidance of anxiety‐inducing clinic appointments. Barriers included loss of reassurance from scheduled visits and lack of confidence in self‐management. HCPs were supportive of PIFU but concerned about resistance to change, unsuitability of PIFU for some patients and costs.ConclusionPIFU is viewed mostly positively by women treated for breast or endometrial cancer, and by HCPs, but further evidence is needed from a wider range of cancers, men, and more representative samples.A protocol was registered with PROSPERO (CRD42020181412).

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“…A protocol was registered with PROSPERO (CRD42020181412). 16 Reporting of the systematic review has been informed by ENTREQ guidelines. 17…”

Section: Methodsmentioning

confidence: 99%

Systematic review of patients’ and healthcare professionals’ views on patient‐initiated follow‐up in treated cancer patients

et al. 2023

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Using the Behaviour Change Wheel to identify barriers and targeted strategies to improve adherence in randomised clinical trials: The example of MEL-SELF trial of patient-led surveillance for melanoma

Ackermann,

Hersch,

Janda

et al. 2024

Contemporary Clinical Trials

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Characteristics and outcomes of patients with heart failure with preserved ejection fraction referred to a community specialist nurse-led clinic

Tavares,

Kanaganayagam,

Lampridou

et al. 2024

British Journal of Cardiac Nursing

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Background/Aims Heart failure with preserved ejection fraction remains relatively poorly understood, despite its increasing prevalence. It is unclear how most clinical services are adapting to changes in caseload and management. This study aimed to describe the characteristics and outcomes of patients with heart failure with preserved ejection fraction who were referred to a community heart failure specialist nurse-led clinic, and to evaluate the clinical interventions implemented during patients’ reviews. Methods A longitudinal cohort design was used. Baseline characteristics and 6-month data on heart failure specialist nurse interventions, morbidity and mortality were collected for all patients (n=80) referred and allocated to the community heart failure specialist nurse-led clinic between November 2022 and June 2023. Data were collected from the service's electronic medical record system and analysed with descriptive statistics using SPSS version 28. Results A total of 696 referrals were made of patients with confirmed or suspected heart failure, of whom 80 were allocated to heart failure specialist nurse caseloads. The mean age of the sample was 82 years (±8.85 years), with each patient having a median of three comorbidities. At the end of 6-month period, 37.5% were discharged and 38.8% were on a patient-initiated follow-up pathway, with a median of four contacts. Interventions received at the specialist clinic included management of comorbid conditions. Prescribing focused on diuretic titration and sodium-glucose cotransporter-2 inhibitors initiation. Of the 65 hospital admissions recorded, 45 (69.2%) were unrelated to heart failure, while 20 (30.8%) were related to heart failure. Conclusions The community heart failure specialist nurse-led clinic resulted in the initiation or adjustment of key therapies in heart failure with preserved ejection fraction. Heart failure specialist nurses can autonomously implement advanced interventions in heart failure with preserved ejection fraction, despite patients’ complexity. Some aspects of care require improvement, such as comprehensive geriatric assessments, multimorbidity management and involvement of cardiac rehabilitation and palliative care teams.

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A systematic review of the effectiveness of patient‐initiated follow‐up after cancer

Cited by 3 publications

References 41 publications

Systematic review of patients’ and healthcare professionals’ views on patient‐initiated follow‐up in treated cancer patients

Systematic review of patients’ and healthcare professionals’ views on patient‐initiated follow‐up in treated cancer patients

Using the Behaviour Change Wheel to identify barriers and targeted strategies to improve adherence in randomised clinical trials: The example of MEL-SELF trial of patient-led surveillance for melanoma

Characteristics and outcomes of patients with heart failure with preserved ejection fraction referred to a community specialist nurse-led clinic

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