Traditional or individualised follow-up in women after breast cancer surgery

• The general aim was to compare different follow-up approaches after breast cancer surgery, i.e. traditional follow-up to a physician and individualised approaches, with specific emphasis on satisfaction, well-being and self-care. Both quantitative and qualitative research methods have been employed. This thesis is based on two study cohorts; in studies 1-III, 264 women who had undergone surgery for breast cancer between 1991-2001 at two hospitals in Sweden were consecutively randomised to two parallel groups (study I). From this study cohort 20 women were interviewed about their experience of traditional follow-up to a physician (study II) and 19 women were interviewed about their experience from the nurse-led follow-up on demand (study III). Study I compared and evaluated the two systems; traditional physician follow-up and nurse led follow-up on demand. Studies II and III explored the needs of women after breast cancer surgery. Study IV contains a new study cohort of 96 women who had undergone surgery for breast cancer and who were consecutively selected and divided into two parallel groups between 2001-2003 at two hospitals in Sweden. Study IV compared traditional physician follow-up with a multi-disciplinary educational programme. Instruments such as The Hospitality Anxiety and Depression-scale, the Functional Assessment of Cancer Therapy-General scale and the Sense of Coherence scale as well as semi-structured interviews were used for the data collection. Analysis of the data was mainly performed by inferential statistical mainly non-parametric methods and by a phenomenographic approach. The result showed that women with breast cancer in stages I to II could be followed up by a specialist nurse leading to high patient satisfaction and good medical safety (study I). Women tend to vary in their appreciation of different aspects of the follow-up; some need routine while others require accessibility, continuity, confidence and security were demanded as self-care education and individualised information (studies II, III). A multidisciplinary education programme based on patients' needs led to a similar level of well-being, self-care and coping ability as that resulting from traditional physician follow-up and thus, can be considered as a viable alternative (study IV).The women value the nurses professional knowledge and skills. Accessibility and early assessment by healthcare professionals or an oncology nurse are essential in a system without routine follow-up. There are good reasons for reviewing and changing the design of the traditional follow-up system in order to ensure the most effective and well-functioning system possible, to better meet the needs of women with breast cancer and to involve them in decision making concerning follow-up.

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MEDICINE

MEDICIN

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