How do New Zealand nurses who work in the area of oncology educate and provide follow-up support to patients who are prescribed oral capecitabine and what are nurses’ perceptions of this process?

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Reid, Carol
Author ORCID Profiles (clickable)
Master of Nursing
Eastern Institute of Technology
Thompson, Shona
Hantler, Alexa
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
New Zealand
registered nurses
oncology outpatients
oral chemotherapy
patient education
ANZSRC Field of Research Code (2020)
Reid, C. A. (2016). How do New Zealand nurses who work in the area of oncology educate and provide follow-up support to patients who are prescribed oral capecitabine and what are nurses’ perceptions of this process? (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Nursing). Eastern Institute of Technology (EIT), New Zealand.
Oral therapy is an increasingly popular treatment option for individuals with cancer, replacing the traditional method of administering this treatment intravenously (IV). When chemotherapy is given IV the responsibility for administration rests with health professionals and it is usually given in a medical environment such as a chemotherapy outpatient clinic. With oral chemotherapy, the patient or his/her caregivers are responsible for administering the medication. Both IV and oral therapy have the potential for side effects and it is important patients receive education about this prior to commencing therapy. Capecitabine is an oral chemotherapy prescribed to treat gastro-intestinal and bowel cancers. This therapy has been in New Zealand for approximately fifteen years. As New Zealand has one of the highest rates of bowel cancer worldwide, capecitabine is widely used in this country. Capectibine is regarded as having a complex medication schedule, as it is taken intermittently and patients may also be required to take supportive medications to treat occurring side effects. If left untreated, side effects from capecitabine can quickly escalate and become serious and/or life threatening, requiring hospital admissions. This thesis describes qualitative research undertaken to explore how registered nurses (RNs) who work in oncology outpatient settings educated and provided follow-up support to patients who were about to commence capecitabine. Participants were also asked what they thought about the service they provided. Semi-structured questions were asked via telephone interviews. Results showed that the RNs gave patients large amounts of information in both verbal and written format and there were different systems in place for follow-up support. All the RNs provided contact telephone numbers to patients should they require advice from a health professional. Although the RNs supplied information to patients who were prescribed capecitabine, there were concerns about patients not complying with their medication schedule. It was thought that some patients were not receptive to new information following a cancer diagnosis. One RN found it difficult to educate a patient who had a low literacy status and could not read or write. Implications for nursing practice included reconsidering the way follow-up support is given for patients who take any long term therapy to assist with compliance, as it is known compliance decreases when patients are required to take medication over a long period to time. Recommendations for future practice was discussed; all patients on capecitabine should receive weekly follow-up support for the duration of the treatment, written guidelines for treatment of side effects need to be available at the introduction of any new chemotherapy and all oncology nurses need to be educated about new oral chemotherapy agents prior to them becoming available for prescribing. It was also suggested that two education sessions may be beneficial for some patients to increase their level of understanding. Patients with low literacy levels or disabilities such as decreased vision or hearing need to receive information in a format they can understand. RNs who are assessing patients and deciding whether the next cycle of capecitabine could commence should consider the role of becoming a Nurse Practitioner to be able to give a complete service. Finally, if nurses feel that capecitabine is not the suitable treatment for some patients, they need to discuss the appropriateness of this with the prescriber. Recommendations for future research include exploring different methods of education and exploring the feasibility of providing home-based nursing care, especially for elderly patients.
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