A Nurse-Led Palliative Care Programme for Women Receiving Palliative Chemotherapy for Breast Cancer in Ghana

Abstract

Introduction: Breast cancer is the most common cancer among women worldwide. In Ghana, the majority of the breast cancer patients present with advanced disease qualifying for palliative treatment only. Palliative chemotherapy is the first line of treatment for women diagnosed with breast cancer. The use of palliative chemotherapy drugs brings about unpleasant life experiences. Yet, there seems to exist no evidence-based nurse-led palliative care programme for women receiving palliative chemotherapy for breast cancer in Ghana. Purpose of the study: The study developed, validated and pilot tested a nurse-led palliative care programme for women receiving palliative chemotherapy for breast cancer in Ghana. Research design and methods: The study adopted a sequential multi-method design in four phases. Phase 1 consisted of a scoping review; Phase 2 was a qualitative descriptive design with a semi-structured interview guide as a data collection instrument. Based on the results of Phases 1 and 2, Phase 3 developed the palliative nursing care programme that was pilot tested in Phase 4 using an intervention approach and a pre-test post-test method to collect the data. The primary outcome was symptoms’ distress reduction while the secondary outcomes were pain reduction, improve quality of life and meet their spiritual needs. Results: The scoping review in Phase 1 resulted in the identification of 110 articles, with 6 of them meeting the inclusion criteria after screening. Fourteen (14) themes were generated and discussed. In Phase 2, three themes and twelve sub-themes were identified from interviewing the patients. Among the palliative care needs recognized were professional information support needs, symptom management needs, psychosocial needs, socio-economic needs, and spiritual needs. In Phase 3, the palliative nursing care programme was developed, building upon the outcomes of Phases 1 and 2, along with the Fitch model. The programme was subsequently validated by experts. In Phase 4, the Wilcoxon rank signed-rank test showed that before the intervention severity of pain among patients was high with a mean score m=9.34 (SD±1.04). However, after the intervention the severity of pain among breast cancer patients reduced, with a low mean score m=2.75 (SD±0.00), with a significance of p- value ≤0.05. Conclusion: This study developed a nurse-led palliative care programme based on literature and the needs of women receiving palliative chemotherapy for breast cancer. The programme was validated by experts, and the outcomes have been met as the women experienced reduce pain, improved quality of life, and fulfilment of their spiritual needs.