Experience of nursing support from the perspective of patients with cancer in mainland China
Yongxia Song, Xiaoqing Lv and Jingjing Liu contributed equally to this work.
Abstract
This study was conducted to understand patients’ experiences of nursing support, to identify gaps between patients’ expected needs and the nursing support they received, and to explore reasons for such disparity. A qualitative study with a phenomenological approach was used. A purposive sample of 22 patients with different types of cancer was recruited and interviewed using semistructured guidelines. The data were analyzed using phenomenological analytic methods. Several needs regarding nursing support were expressed, including informational, psychological, clinical, care coordination and communication needs, and there were some unmet or partially-met needs. Reasons for the disparities covered both patient- and nurse-related factors, including patients’ lack of awareness regarding how to acquire professional assistance and reluctance to express their needs, and nurses’ lack of active communication with patients, inability to provide specific support, and limited resources for coordination. The expectations of nursing support did not always correspond with the actual delivery of nursing care. A tailored intervention is warranted to meet patients’ expectations, which might contribute to quality-of-care improvements.
Introduction
Cancer is a major public health problem and a leading cause of death worldwide, with 8.2 million deaths in 2012 (Siegel et al., 2015). The most common fatal cancers each year are lung, liver, stomach, colorectal, and female breast cancers (Ferlay et al., 2014). Because patients with cancer face difficulties in managing their daily activities or experience emotional problems or other related issues (Gray et al., 2002), understanding their needs and their actual acquisition of professional support delivered by nurses is important. Several types of social and psychological support needs were found among patients with cancer during their cancer journey, such as the need for information about disease diagnosis, tests, and results; psychological/emotional support; symptom management; and palliative care in the terminal stage (Sanson-Fisher et al., 2000; Tamburini et al., 2003; Liao et al., 2007; Laird & Fallon, 2009; Remmers et al., 2010; Schmitz et al., 2012).
Although nurses are expected to have an understanding of cancer patients’ identified needs and have the ability to fulfill those needs, their provision of professional support is sometimes lacking (Erci & Karabulut, 2007; Hong et al., 2014). There might be a gap between what patients and healthcare professionals perceive as the most important needs (Snyder et al., 2007; Sanders et al., 2010). In their study, Widmark-Petersson et al. (2000) found that care providers were unsuccessful at judging the greatest health concerns of patients. The most common needs of patients were related to vital functions, whereas nurses considered environmental needs (i.e. needs of information and hospital processes) as patients’ main concern (Lauri et al., 1997). Patients with esophageal cancer desired ample information (i.e. treatment details, side-effects, extent of the disease, its cure and prognosis, and their return to normality), but health professionals tended to underestimate this informational need (Mills & Sullivan, 2000).
For the previously mentioned reasons, gaining further understanding of patients’ nursing support needs through qualitative interviews is a useful step to enable us to describe participants’ perceptions and experiences directly using their own language (Traa et al., 2014; Tsangaris et al., 2014). To the best of our knowledge, there is a lack of qualitative research in China investigating the perspectives of patients with cancer regarding their nursing support needs and how well those needs are being met. This study was part of a series aimed at exploring cancer patients’ experiences, including expectations and the acquisition of nursing support. The potential reasons for the discrepancies between the identified needs and the needs actually met by nurses were also investigated.
Methods
Design and participants
A phenomenological approach with semistructured guidelines was used to deeply explore the topic being discussed, and to understand what the participants said in detail, uncovering new areas or ideas that were not anticipated beforehand (Britten, 1995). A purposive sampling strategy was adopted to provide an in-depth understanding of the needs of patients with different types of cancer (Kuzel, 1999). Participants were recruited from five departments in two teaching hospitals affiliated with a medical university in Anhui Province, China. The inclusion criteria were as follows: (i) histopathological diagnosis of cancer; (ii) being aware of their cancer diagnosis; (iii) aged between 18 and 85 years; (iv) ability to speak Mandarin; and (v) agreement to the interview and audio-recording. Participants were excluded if they were not sufficiently physically fit to attend the interview or had a history of mental health problems or cognitive disorders. The guiding principle in determining the sample size was data saturation. In total, 22 patients with different types of cancer were individually invited to participate in the interviews.
Procedure and ethical considerations
After ethical approval was obtained from the Ethics Committee of Anhui Medical University, we contacted eligible cancer patients to explain the purpose of the study and invite them to participate. To ensure that a wide variety of experiences would be represented, potential participants were informed that knowing their illness diagnosis was a prerequisite for study participation. Confidentiality was assured, and informed consent was obtained from all participants. Participants were informed that they had the right to withdraw from the study at any time.
Semistructured interview guidelines were developed based on an analysis of the literature, discussion among the research group, and a pilot interview. After the pilot interview, we considered the differing education levels of participants, and some interview questions were changed to simple sentences in the final version of the guidelines. Semistructured interviews were conducted individually to minimize any influence or other bias from other patients or caregivers, and they continued until no new ideas emerged. Data saturation was achieved with a total of 22 participants. The interviews were conducted in a quiet ward or the head nurse's office at a time of the patient's choosing.
Data analysis
The interviews were analyzed using phenomenological analytic method with no predetermined categories or themes. This analytic method was chosen because it allows for an in-depth exploration of cancer patients’ experiences with nursing support. The analysis was performed according to the following seven steps (Colaizzi, 1978): (i) transcribing the interviews verbatim and reading the transcripts multiple times to obtain an overall impression; (ii) identifying the significant text segments that formed meaning units; (iii) abstracting and condensing the meaning units to form codes; (iv) sorting the codes into subcategories, and the subcategories into clusters and categories; (v) comparing categories and subcategories with the entire interview to ensure that the interpretation was consistent and coherent with the text as a whole; (vi) developing content descriptions to state the essential structure of the phenomenon; and (vii) using quotations to exemplify the findings.
Rigor
To further ensure the trustworthiness of the findings, credibility, confirmability, dependability, and transferability were considered (Lincoln & Guba, 1985). To address credibility, member checking was applied to clarify the coherence between the interpretation and patients’ initial perspectives. To address dependability, two investigators independently evaluated the issues using original transcripts and field notes with no subjective judgement. Differences in coding were resolved through discussion among team members, and agreement was reached in all cases. To address confirmability, we performed an inquiry audit, in which a competent peer, who is a practicing professional in the qualitative research field, audits the research methods independently. The auditor thoroughly examined our audit trail with an open mind to explain the evidence as clearly as possible and concluded the entire process. To address transferability, we used the acquisition of “rich information” to enable the transfer of our findings to other contexts by providing clear descriptions of the context, selection, and characteristics of the participants; the data collection; and the analysis (Sandelowski, 1986). We translated the categories, subcategories, and some relevant quotes into English. The Chinese and English versions were compared and discussed among the researchers to ensure translation equivalence.
Results
Demographic and disease characteristics
Participants’ demographic and disease information is presented in Table 1.
| Variable | Patients with cancer (n = 22) |
|---|---|
| Age (years) | |
| Mean (SD) | 52.2 (11.3) |
| Range | 34–78 |
| Sex | |
| Male | 8 (36.4%) |
| Female | 14 (63.6%) |
| Have/no metastasis | |
| Yes | 11 (50.0%) |
| No | 11 (50.0%) |
| Level of education | |
| Under primary or primary | 5 (22.7%) |
| Junior middle school | 12 (54.6%) |
| Senior middle school | 2 (9.1%) |
| College degree or above | 3 (13.6%) |
| Cancer sites | |
| Lung | 9 (40.9%) |
| Breast | 3 (13.6%) |
| Cervical | 2 (9.1%) |
| Adrenal | 1 (4.6%) |
| Colorectal | 1 (4.6%) |
| Stomach | 3 (13.6%) |
| Liver | 3 (13.6%) |
| Interview time (min) | |
| Mean (SD) | 46.5(12.0) |
| Range | 30–61 |
- SD, standard deviation.
Categories and subcategories for the three research questions
Research Question #1: Expectations of nursing support among patients with cancer
Data were obtained from audio-recordings. A total of four main categories and 14 subcategories emerged and are summarized in Table 2.
| Categories | Descriptions of categories | Subcategories |
|---|---|---|
| Informational needs | Need for information regarding diagnosis, testing results, prognosis, nursing/treatment plan, diet, rehabilitation, recurrence monitoring, and recognizing unhealthy lifestyles. | Disease-related information |
| Nutritional information | ||
| Medical expense information† | ||
| Sensitive information† | ||
| Clinical needs | Need for nursing skills in promoting physical comfort, relieving pain or other symptoms, and health maintenance. | Proficient venipuncture skills |
| Symptom management | ||
| Daily life assistance | ||
| Environmental maintenance | ||
| Psychological needs | Need for help in coping with the illness and its subsequent consequences by understanding patients’ emotional/psychological reactions, managing negative emotions, and offering hope. | Psychological comfort† |
| Coping strategies† | ||
| Maintaining dignity and autonomy | ||
| Needs for care coordination and communication† | Need for close interaction between nurses and other individuals, including healthcare professionals, social organizations, and patients and their families to ensure better services; active communication with patients and family members during hospitalization; and discharge to facilitate an understanding of patients’ needs. | Coordination of services between nurses and other healthcare professionals |
| Coordination of services between nurses and social organizations | ||
| Effective communication between nurses and patients and their families |
- † Supportive care needs that are difficult to satisfy.
Informational needs
All participants indicated that informational needs were especially important for patients with cancer. Specifically, informational needs consisted of several facets.
Disease-related information
Although our participants all knew their cancer diagnosis, a level of restrained disclosure and protective medical measures are still common in China. Thus, patients were eager to know more about their disease state: “I hope to truly know the stage of the disease. Then, I could rearrange my remaining life appropriately” (Patient [P] 10). In addition to the state of their illness, patients also expected nurses to provide information, such as explanations of test results, reasons for the illness's metastasis, frequency of chemotherapy, disease progression and prognosis, drug side-effects, symptoms of recurrence, and rest versus exercise, before discharge.
Nutritional information
It's critical for me to know something about diet. If what I am eating isn't good for my health, how about my recovery and immunity? (P9)
It is urgent for me to know something about my postoperative diet. What foods should I eat or avoid? (P18)
I am concerned about receiving food information before discharge. (P17)
Medical expense information
(Although) it might be beyond the nurse's ability to provide financial information…I still expect some information from nurses, such as costs of treatment, charge itemizations, and specific issues related to medical reimbursement. (P1)
I really don't know how much I will be refunded from the New Rural Cooperative Medical System. I expect more information about the medical insurance from nurses, like the reimbursement place, proportion, and procedures. (P17)
We hoped the nurses could provide information on what types of drugs are paid for by the government or by ourselves. (P4).
Sensitive information
I even lied to my husband that I was still in a menstrual period or just slept (in the same bed as) my daughter deliberately (to refuse sex with him). I am not sure whether I can have normal sex. If there is a nurse who can give me some related information, that would be better. (P1)
So if possible in my terminal stage, I want to get some information from healthcare professionals about euthanasia. (P5).
Clinical needs
The most important nursing skills are successfully injecting into a blood vessel on the first attempt and removing the needle with minimal pain. (P10)
The significance of protecting blood vessels was self-evident, especially among participants who were receiving chemotherapy: “It's really important for a nurse to protect my vessels” (P19).
Symptom management
Chemotherapy drugs make me vomit and feel fatigued. I wish nurses would give me an injection to ease my symptoms. (P13)
I keep opening my eyes the whole night. It's harmful for me to lose sleep. I need the nurses’ help. (P5)
Although some of the cancer patients knew of certain measures to relieve sleep disturbances, such as taking hypnotics, they were still confused, asking: “Will I become dependent on hypnotics, and how do I manage the side effects?” (P6).
Daily life assistance
Sometimes, I want the nurses to help me get some hot water because I can't move one of my legs smoothly. (P7)
I expect the nurse to feed me when I cannot take care of myself. (P2)
Environmental maintenance
Though I am here for chemotherapy only one week each time, I expect the nurses to change the sheets every three days to keep my bed clean and tidy. (P10)
We have hardly any body immunity because of illness. It's unimaginable how bad it would be if the ward environment or air quality was poor. (P5)
Psychological needs
Though I know a good attitude is good for my recovery, sometimes I feel psychologically uncomfortable. I hope a nurse can sit beside me to comfort and listen to me. (P1)
Psychological support from nurses is extremely necessary. Psychological comfort should be one of the most critical needs for every patient. (P2)
Each of us laid on a narrow bed like a pig waiting to be butchered. All sorts of bad ideas revolved in my mind, and I wished there was a nurse helping me calm down, even though nurses walked up and down. Actually, there was no one to comfort me until I was wheeled into the operation room. (P2)
Coping strategies
I don't even think I'm a female after having a breast removed. I still cannot face it now. I need more help from nurses regarding specific coping strategies. (P12)
Cancer patients are under considerable pressure. I hope nurses can put themselves in our position to understand and provide more detailed coping measures. (P11)
I hope the nurses tell me how to cope with awkwardness in talking with others about the illness. (P17)
Maintaining dignity and autonomy
I can make decisions by myself; I hope nurses and doctors will let me be involved in the decision-making regarding my treatment plan instead of letting my husband do it. (P6)
I hope nurses can respect me as a person instead of treating me as another case. Please call me by my name instead of my bed number. (P4)
I hope the nurse will pull the curtain around when she gives me an injection into my buttocks. (P10)
When I can take care of myself, nurses should give me full autonomy rather than substituting for me. (P11)
Needs for care coordination and communication
Nurses should help us arrange testing or make a phone call to the radiologists to make an appointment and shorten the wait time. (P10)
I hope I have a smooth transition between the emergency room and the ward. The clinic nurse could connect with a ward to arrange a vacant bed in advance so that I am not temporarily cared for in the corridor. (P3)
I wish nurses could contact the office of Medicare spending regarding my medical costs. Then I would not need to ask so many people regarding reimbursement. It is time consuming, and I have to come and go many times. (P8)
I hope the nurses can coordinate with the insurance agency. It might be easier when nurses tell them the medicine I need to use. Otherwise, they might misunderstand that I prefer to use expensive imported drugs. (P6)
I hope nurses would proactively communicate with me instead of just telling what I have asked about. (P17)
So many things make me confused. I hope nurses can actively tell me something. (P7)
Another said:It's necessary for nurses to tell my family the correct way to protect the catheter, change the dressing, and observe potential complications. (P8)
It's difficult for me to remember everything the nurses have told me. I hope the nurses can communicate with my husband and daughter, who can understand and remember. (P13)
Research Question #2: Partially-met and unmet nursing support among identified expectations
From the interviews, it was found that the main expectations regarding nursing support that met or partially met by nursing staff members were providing information about the disease and about nutritional and clinical needs, whereas needs for information concerning medical expenses and sensitive issues, psychological needs, and needs for care coordination and communication were unmet. Specific explanations of the partially-met or unmet needs were as follows.
Partially-met needs
Disease-related information
Although all participants knew their cancer diagnosis either directly or indirectly, they still felt that their information needs were only partially met because nurses did not provide “the reasons for pain” (P6), there was “limited time for further consultation” (P11), “they told me (my) test results with only one word, ‘normal’” (P17), and “I came here again for my wound infection. If the nurse had told me how to prevent infection at home, everything might be different” (P4).
Nutritional information
Nurses provided the cancer patients with general cautions about diet, such as no spicy or greasy food, no alcohol, better nutrition, and more soup and vegetables, but patients still did not know whether they could eat their favorite specific foods: “Can I have chicken soup or eggs?” (P15) and “Can I eat carp, red dates, or shrimp?”(P16).
Proficient venipuncture
There is an obvious technical (venipuncture skill) difference between senior and junior nurses. Some junior nurses can't even pull out the needle from the vein without causing pain. (P10)
Symptom management
It's unrealistic for a nurse to control my pain immediately. (P7)
Nurses try to help improve the quality of my sleep. However, the problem of sleep disturbance still existed especially when night shift nurses frequently enter the ward for disease observation. (P13)
Unmet needs
Medical expense and sensitive information
Nurses do not know about the reimbursement when I ask them. I could not obtain this information from them. (P6) Not every nurse will inform me about medical expenses, or they just tell me that “You can ask for help at the discharge office”. (P15)
With the New Rural Cooperative Medical System, some nurses said I could be reimbured 40–60% of hospitalization costs, while others said I could even request over 70%. Actually, I still don't know the accurate proportion. (P6)
I need information about the influence of the hysterectomy on intimacy with my husband. No one has asked if I have any special concerns. (P14)
Psychological comfort
Nobody but the head nurse comforts me, and (she) even uses me as a good example to other patients because of my optimism. (P5)
If a nurse sits beside me, I will talk to her about everything, but…do you believe that is possible? (P3)
Coping strategies
I am not sure whether the nurses could give me any specific coping strategies because I have never experienced it. (P5) With mental adjustment, it might only depend on ourselves, slowly over time. I have not (received) any effective coping assistance from the nurses so far. (P15)
Coordination of services between nurses and other healthcare professionals or social organizations
It's unrealistic for a nurse to help me make an appointment for an X-ray test by connecting me with a radiologist in the clinic. (P2)
Actually, we make the appointments for these tests all by ourselves. No nurse will help you unless you are in an emergency room. (P20)
I have to wait for a vacant bed in the ward while not being treated by the physician I wished. None of the nurses would coordinate with the doctor whom I preferred. (P22)
I have to convince the insurance agency that the drug used was not selected by myself. How I wish the nurses could help me. (P6)
Effective communication between nurses and patients and their families
It's difficult for nurses to adequately communicate with me if I do not ask something. In fact, it seems an excessive demand to request that nurses actively communicate with me. (P17)
Nurses do not even use one superfluous word, not to mention active communication. (P16)
It's normal for us to have no effective communication. Some nurses might have an emotional response because of their individual personalities and heavy workloads. (P4)
Research Question #3: Key reasons for the discrepancy between what patients expected and what they received, as well as areas in which nurses need to improve
The interview data indicated several potential reasons for the discrepancies between patients’ expectations and the nursing support they actually received. Suggestions for improving support were also provided. From the patients’ viewpoints, the reasons included both patient and nurse aspects, as follows.
Lack of awareness how to find assistance and express needs
Most participants cited reasons for not receiving full nursing support, including fear of being a bother, seeking the nurse's help as a last resort, feeling embarrassed about wasting the nurse's time, choosing to “let it pass”, the feeling that it was not the nurse's business, being reluctant to speak out, or not knowing who could help. In fact, they preferred to focus on completely adhering to their treatment, rather than expressing themselves: “I will just follow whatever the nurses say. After all, the nurses’ advice is beneficial” (P16).
Lack of active communication with patients
Nurses will only talk with me when I ask for some help. (P7)
Nurses seldom communicate with me proactively. (P4)
If nurses could actively communicate with me like you (the researcher), my psychological status might be better. However, this is not the case. (P3)
Spending more time communicating with patients initially and giving more health guidance should dictate the nurses’ further efforts. I do not perceive this kind of support right now. (P10)
Inability to provide specific support
If nurses do not understand my reactions and thoughts, how can they help me in terms of coping with my disease? (P21)
Some young nurses even ignore patients’ psychological needs; they pay too much attention to physical needs. They should learn to understand patients’ mental status throughout the disease trajectory. (P22)
Limited power or resources for coordination
If the coordination in one department for an ordinary nurse is so hard, what about the food quality in the whole hospital? (P21)
When will ward nurses have the power to coordinate radiologists or physicians in another department? Except in the case of emergencies, nurses could help me make a phone call to the X-ray room. (P14)
Based on these explanations, improvements in access and coordination were suggested, such as being empowered to use medical resources, improving the hospital's corresponding policies, and promoting the connection between nurses and related social organizations.
Heavy workload
It's difficult for a nurse to address all patients’ problems and satisfy our needs because they are too busy all the time. (P10)
An ordinary person can't be competent at this job except for those young girls who are physically capable of working as nurses. (P1)
Thus, one improvement would be to add more nurses, especially during busy working periods.
Discussion
The data from the perspective of cancer patients indicated that these patients had a wide range of nursing support needs. The fact that not all of these needs were satisfied should not be ignored. Many of the patients’ needs were only partially met by nurses, most notably with regard to information needs and symptom management. This finding is consistent with recent studies that reported patients’ lack of disease-related information and their desire for more information on later effects (Gianinazzi et al., 2014; Pinto et al., 2014). Due to considerable individual variations in symptom experiences, even among patients with the same diagnosis, healthcare professionals cannot automatically anticipate a patient's need for symptom-management support. Partially-met symptom management needs might stem from patients’ reluctance to express their experienced symptoms, problems, and concerns (Ruland et al., 2010). Nevertheless, some needs remained unmet, especially psychological and care coordination needs. While nurses appeared to neglect several aspects of psychological care knowledge; studies have consistently revealed that patients’ unmet psychological needs primarily result from the Chinese social behavior of expressing emotional needs only to close family members and not to health professionals (Lam et al., 2009; Wu et al., 2015). In addition, it was not surprising that some participants were reluctant to discuss personal and sensitive topics (Stead et al., 2003). Open discussion of sensitive topics is less common in China than in some Western cultures; however, to our surprise, some participants did mention these issues. Patients might expect nurses to take the lead in these discussions. Therefore, nurses should make an effort to understand the reasons for patients’ ambivalence toward expressing needs, and thus take effective measures to reassure them.
Compared with the findings from our previous study, which asked similar questions with the aim of exploring healthcare professionals’ perceptions, a notable finding of this study was that patients’ reported needs were not always identical to the needs perceived by healthcare professionals (Hong et al., 2014). Three types of common needs (i.e. informational, psychological, and clinical needs) were identified by both patients and healthcare professionals. Additionally, healthcare professionals perceived patients to need the mobilization of social resources and palliative care, whereas cancer patients themselves reported that they needed nurses’ support with respect to care coordination and communication. These and several issues that have relevant clinical implications are detailed.
First, we can infer that by carefully listening to and clearly understanding patients’ views, nurses can help bridge the gap between patients’ expectations and the support provided by healthcare professionals, especially regarding active communication. An increasing number of international studies have consistently indicated that communication between patients and healthcare providers is critical for helping patients to express their concerns and report their needs and for adherence to cancer treatment (Schofield et al., 2008; Lin et al., 2014). In contrast, the lack of active communication might exacerbate patients’ reluctance to express their needs and the nurses’ difficulty in identifying latent issues that could deteriorate patients’ health. Meanwhile, one of the concerns is whether patients’ expectations of nursing supports are realistic given nurses’ finite capacities and skills. In this study, several patients were uncertain about whether their expectations were reasonable. Patient education will be needed about what support they can receive and what alternatives are available to them. Additionally, the training or educational curriculum of effective communication with patients who have chronic illness for nurses is insufficient and even detached from nursing practice in China (Qing et al., 2014). Nurse education about effective communication skills and techniques should be continually emphasized in nursing school and practice settings.
Second, emphasis should be placed on care coordination, which is advocated internationally (Butts et al., 2013). This coordination benefits patients by providing access to care, ensuring timeliness of care, and increasing patient satisfaction, in addition to having the potential to improve patients’ experiences of care and their outcomes (Walsh et al., 2011; Collinson et al., 2013). Care coordination needs have been scarcely addressed in cancer-related studies in China, and improvements could be made with respect to clearly defining the nurses’ role within multidisciplinary medical systems. Nurses also need to learn about intraprofessional and interprofessional collaboration in the practice setting to fulfill the care coordination needs for cancer patients. In Western countries, nurses, together with other multidisciplinary team members, carry out home care for patients with cancer (Tralongo et al., 2011). However, in China, we only rely on limited numbers of community nurses to follow up with patients at home to address their health needs. In a recent study, care coordination was reported as one of the self-reported deficits in competence among healthcare professionals. Community nurses felt less skilled in the long-term management of cancer patients (Faithfull et al., 2016). Thus, preparing nurses with higher education, specializing in community and oncology nursing, is an essential step to assist them to fulfill their roles.
Third, there are some types of support that healthcare professionals perceive patients need that patients do not report needing, such as the mobilization of social resources and palliative care, which might result in underutilizing social resources (Skeels et al., 2010). In this case, nurses should motivate patients to appropriately use the support services because of the lack of awareness of these services is a widely existing problem (Hong et al., 2014; Mosher et al., 2014).
Fourth, both nurses and patients acknowledged the excessive nursing workload as being a barrier for nurses to provide care to meet patients’ needs. This implies the issue of understaffing in oncology nursing. Although oncology units might require more staffing than general medical–surgical units, few units meet the nurse-to-bed ratio standard recommended by the Chinese Nurses Association (Blay et al., 2002). Studies have consistently indicated that poor nurse staffing has negative effects on clinical outcomes such as the quality of patient care and meeting emotional needs (Hong et al., 2014; Lemonde & Payman, 2015). Therefore, issues with staffing in oncology settings should be considered when determining nursing staffing policies.
Finally, the identification of patients’ needs and the delivery of nursing support to meet those needs during cancer treatment were influenced by patient and nurse aspects. To optimize the attainment and management of cancer patients’ needs, future nursing support should focus on the following steps: (i) encourage patients to express their needs and provide professional support based on patients’ expectations; (ii) perform timely and continuous needs assessments and management throughout the course of the cancer; (iii) address the issue of nurse staffing; (iv) empower healthcare professionals, including nurses, to use available medical resources; (v) facilitate sufficient teamwork and communication among multidisciplinary care teams; and (vi) develop comprehensive intervention programs by considering both patients’ and healthcare providers’ views with the aim of resolving any discrepancies.
Study limitations include the participant exclusion criteria and the study area. Patients who did not know their diagnosis were excluded. An additional study is needed that explores the discrepancy between cancer patients who know their diagnoses and those who do not. The generalizability of the findings is limited, because the study was conducted in two affiliated teaching hospitals in the same Chinese city. Therefore, additional studies should be performed that extend from Anhui to other cities in China.
Conclusion
Patients with cancer have several expectations regarding nursing support needs, such as informational needs, clinical needs, psychological needs, and the need for care coordination and communication. However, nurses’ ability to fulfill these needs was found to be less than ideal in this study. Understanding the discrepancies between patients’ expectations and actual nurses’ provision can potentially improve nurses’ capacity to develop tailored interventions to meet and manage cancer patients’ needs.
Acknowledgement
The National Natural Science Foundation of China (approval no. 81101750, 81573017), The Natural Science Foundation of Anhui Provincial Universities’ key project (approval no. KJ2015A083), and the Scientific Research Foundation for the Returned Overseas Chinese Scholars, State Education Ministry provided funds (approval no. 2013 [1792]).
Contributions
Study Design: JFH, WLW, WRW
Data Collection and Analysis: JJL, YXS, XQL, DH, JFH
Manuscript Writing: YXS, JJL, XQL, JFH
