Colleen Sherriff

The purpose of this quality improvement project was to evaluate the effectiveness of breast cancer care support provided by breast cancer care navigators (BCCN) for women attending the breast health clinic (BHC). This evaluative process examined patients' satisfaction with the nurse navigator program that focused on addressing breast cancer patients' informational needs, emotional support, and guidance through the cancer trajectory. A survey approach using Likert-type scales and open-ended questions was utilized to gather data. Patients seen at the BHC between July 2011 and July 2013 were sent the surveys by mail. The 154 responses constituted a 69% response rate. More than 90% of participants understood the information provided by the BCCN and were satisfied with the information that had been received. Psychosocial support from patient/family counselling services at the agency and in the community were among the most common request for resources. Recommendations include contacting patients directly after their initial meeting at the clinic and at least once after their treatments began, to ensure continuity and support. BCCN role was identified as being valuable with a positive effect on patients' experience.

AIMS: Type 2 diabetes mellitus (DM) has a high prevalence in Asian subjects. A simple method of screening using self-testing for postprandial glycosuria achieved a good response rate and a sensitivity which compared favourably to more expensive and invasive methods in a semirural Caucasian population. We examined its effectiveness in Asian subjects. METHODS: Caucasian and Indo-Asian subjects aged 35-70 years in two general practices in Leicester (n=9896 (6198=Asian subjects, 3698=Caucasian)) were screened. Those known to have diabetes were excluded. Subjects were asked to self-test for glycosuria 1 h after their main meal. Instruction and response cards were translated in Punjabi and Gujarati and sent to the Asian subjects, depending on age and surname. RESULTS: Response rate was 34.4% in Asian subjects compared to 54.0% in Caucasian subjects. Prevalence of glycosuria was 8.2% in Asian subjects and 3.2% in Caucasian subjects. Two hundred and thirty-nine subjects recorded glycosuria and 202 (84.5% of the total, 86.9% of Asian subjects, 78.1% of Caucasian) attended for oral glucose tolerance test (OGTT). Sixty-three (31.2%) were found to have diabetes (46, 73% Asian), 29 (14.4%) impaired glucose tolerance (24, 82.8% Asian) and 110 (54.4%) normal glucose tolerance (82, 74.6% Asian). Thus 30% of Asian subjects and 34% of Caucasian subjects had diabetes on OGTT. The prevalence of diabetes in 35-70 years in the total population after screening was 5.6% (6.8% in Asian subjects, 3.6% in Caucasian) and in the screened population was 12.7% (17.9% in Asian subjects, 6.3% in Caucasian). CONCLUSIONS: Screening for diabetes using this method, in terms of response rate, is not as effective in a large city setting, particularly in the Asian population. However, the yield of diabetes in the age group 35-64 years compares well to much more expensive and labour intensive approaches and its use in this population in a primary care setting is justified.

Le projet d’amélioration de la qualité présenté ici avait pour but d’évaluer l’efficacité des soins de soutien prodigués par les infirmières pivots en cancer du sein (IPCS) aux patientes qui en sont atteintes et qui fréquentent une clinique de santé du sein. Le processus d’évaluation a examiné la satisfaction des patientes envers le programme des infirmières pivots, qui vise à offrir aux patientes de l’information, du soutien émotionnel et de l’orientation tout au long de la trajectoire de soins. Les données ont été recueillies grâce à un sondage constitué de questions de type « échelle de Likert » et de questions ouvertes. Le sondage a été envoyé par la poste aux patientes qui étaient passées à la clinique entre juillet 2011 et juillet 2013. Nous avons reçu 154 réponses, ce qui représente un taux de réponse de 69 %. Plus de 90 % des participantes avaient compris l’information fournie par l’IPCS et étaient satisfaites des renseignements qu’elles avaient reçus. Le soutien psychosocial offert par les services de counseling aux patientes et aux familles, à l’agence même et dans la collectivité, comptait parmi les ressources les plus communément en demande. Parmi les recommandations formulées, mentionnons la prise de contact directement avec les patientes après le premier rendez-vous à la clinique, puis au moins une fois après le début des traitements pour assurer la continuité et le soutien. Le rôle de l’IPCS était considéré comme très utile et ayant une influence positive sur l’expérience de la patiente.

Abstract Rationale and background: The Fraser Valley Cancer Center serves a large geographic population of urban and rural areas. Selected data on wait times and diagnostic pathways are available for mammography screening programs in British Columbia (BC), but not for patients presenting with clinical abnormalities such as a palpable breast lump. Diagnostic pathways in BC are managed by primary care physicians and community surgeons. Anecdotal evidence from oncology services suggests large variation in wait times and pathways.Objective: To examine time intervals and pathways between the detection of a breast abnormality and formal assessment by medical or radiation oncology for adjuvant treatment.Methods: Retrospective chart review of all patients with a new diagnosis of breast cancer first seen at the Fraser Valley Cancer Center in 2002, linked with demographic and other registry data. Data collected included type, location, date of investigations, surgical procedures, diagnosis, treatment and stage. Exclusion criteria were patients initially diagnosed with metastatic breast cancer, patients with recurrent breast cancer, male breast cancer patients, patients diagnosed or previously treated outside BC. Microsoft Access and SAS 9.2 were used to enter and analyse data.Results: From a total of 513 women diagnosed in 2002 with invasive breast cancer, 422 women (82%), without metastases (age 30 to 97 yrs, median 59 yrs), presented with abnormal screen (45%), breast lump (47%) or other findings. These women had up to 7 different radiological breast investigations and up to 5 surgical interventions. About 5% had 5 or more breast investigations. Median time (days) from presentation to first surgery was 41 days and varied by location of first investigation. Time to surgery was highest among women who presented with abnormal screening mammogram (median 49 days). Median time from first surgery consultation to first surgery was lowest for women presenting with breast lumps (15 days).Conclusions: These data indicate wait times beyond national and international targets and identified wide variability and some inefficient, redundant or unnecessary steps. Recognition and analysis of abnormal pathways will guide changes in breast health service delivery. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3083.