A Nurse-led Case Management Model For Women With Breast Cancer:An Action Research Project

BackgroundBreast cancer is the most common cancer among women worldwide, and the incidence is evidencing a gradual rise. Due to the comprehensive treatments, breast cancer survivals suffered from long-term physical and psychological distress, which reduced the quality of life. Nurse-led case management is a model of continuing, holistic and supportive nursing care, contributing to an improvement in health and well-being, including quality of life, overall rehabilitation, patient satisfaction and decision making processes. However, few studies have been reported using case management as a nursing model in Chinese context. Therefore, based on Brown advanced nursing practice model, the purpose of this action research was to develop and evaluate a nurse-led case management program for breast cancer patients and explore a new model of specialized cancer nursing.AimsThe specific aims of this study were to diagnose the problems of current breast cancer nursing practice; to design a practice model of the nurse-led case management; to implement the model and redesign; to evaluate the effect of nurse-led case management model in patient outcomes; to explore the impact of nurse-led management model on nursing practice.MethodsAn action research approach was applied, which included 5 stages. In the first stage, key informant interview, in-depth interview and participatory observation were used to diagnose the breast nursing care; In the second stage, literature review and team discussing were conducted to design a preliminary nurse-led case management model; In the third stage, the preliminary nurse-led case management model was implemented in practice, revised and redesigned by participatory observation, interview and group reflection; In the fourth stage, a six-month quasi-experimental intervention study was conducted to evaluate the effect of the revised nurse-led case management model on patients’outcomes, both physical and psycho-social; In the five stage, a reflexible discussion and interview were carried out to explore the impact of nurse-led case management on nurses themselves, nursing practice and healthcare system. Participants in the study covered patients with breast cancer, nurses and surgeons working in breast care center, managers in hospital and researchers from university. Data were collected by different ways, including in-depth interview, focus group interview, key informant interview, participatory observation and quasi-experimental intervention study. The qualitative data were recorded and read to identify themes, while the quantitative data were analyzed by Multivariate ANOVA and Repeated Measures ANOVA.ResultsOngoing needs in treatment, appropriate accessibility to information, and needs of emotional and social support were identified from patients with breast cancer. However, breast cancer nursing was still limited in hospital. Nursing care for patients after discharge was less developed.The core of the nurse-led case management was to provide continuing nursing care and support by using expertise and skills. The content of the nurse-led case management was to provide direct care, health education, information, emotional and social support, advisory services and reasonable referral. The ability of practitioners included knowledge, clinical experience, specific training, and communication skills. Follow-up methods varied in bed visit, clinic visit and telephone.Nurse-led case management improved the physical function of breast cancer patients; reduced their uncertainty to disease and promote their health-related quality of life. Nurse-led case management played a positive role on practitioners, increasing their knowledge, ability, professional value and responsibility. Nurse-led case management developed the nursing specialty, expanded nursing services, and improved patient satisfaction. Nurse-led case management played an important role in cancer therapy, promoted cooperation and coordination of multidisciplinary team, and complemented healthcare service system.ConclusionNurse-led case management was one of the models of advanced nursing practice. Nurse case manager improved rehabilitation of patients with breast cancer. It was a valuable and effective model of healthcare service. However, how to achieve sustainable development of nurse-led case management model need further study. Supports from policies, regulations, management and nursing human resources are needed.