2004 - 2007 - Cicely Saunders Institute - King's College London

2.1.1 Improving Care and Services for People
Affected by Cancer
Gysels and Higginson conducted, for the National
Institute of Clinical Excellence (NICE), the first comprehensive
robust appraisal of research evidence in
Supportive and Palliative Care in Cancer. Published in
2004, this was the culmination of three years research,
building on earlier systematic reviews within the
department. It combined and appraised findings from
339 studies from across the globe. It showed for the first
time evidence for the effectiveness of some components
of supportive and palliative care, especially for multiprofessional
specialist palliative care teams, information
provision and communication skills training 68 .
Communication, co-ordination and patient
education
In an analysis of effectiveness, 12 studies (15 papers)
showed communication skills training improved the
communication of doctors and nurses, as assessed by
self-report and patients, with effect sizes ranging from
0.15 (modest) to 2 (high) 9 . One further study showed
deterioration in outcomes. In depth analysis found that
to be most effective at changing practice (and not just
skills in artificial situations) training programmes need to
take into account and address attitudes and beliefs 9 .
These findings led the Department of Health in the UK
to support a national roll out of communication skills
training, to commit funding to specialist palliative care
services and provided for the first time a research basis
for supportive and palliative care elements of National
Standards in Cancer Care, which now form part of the
National Health Service Peer Review for cancer.
However, there is also the problem of communicating
between services. Farquhar, Barclay and colleagues
studied in depth the concerns of GPs - of most concern
was tardiness (with delays of up to eight days) especially
at three stages in the patient journeys: (1) in the prediagnostic
and diagnostic stage; (2) in the active
treatment phase; and (3) when oncology withdrew and
the focus of care switched back to the community for
the terminal phase 142 , leading to suggestions in the NICE
guidance about the prompt timing of information and the
use of standardised formats.
Interactive technologies and videotapes appear to be a
promising method for patient education in cancer care.
In an analysis of 1,678 patients, educational technologies
showed improved patient knowledge but no change
in patient satisfaction 320 although the analysis identified
problems of heterogeneity (see figure 2.3).
Figure 2.2 The NICE Research evidence produced by the
team at King’s in 2004, which is now improving how cancer
care and support is provided
Figure 2.3. Meta-analysis showing that video technologies in patient education improve knowledge but not satisfaction
Source: Gysels and Higginson, Supportive Care in Cancer, 2007;15:7-20
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