Overview
Nearly 90% of all cancer care is delivered in outpatient settings.[1] This
places increased responsibility on the patient and family [2] and requires a
coordinated approach by the health care system. While health care continues to
increase in complexity, regulatory and fiscal pressures have become more
restrictive.[3] Optimal care is now dependent on careful planning across
different care settings to ensure a continuum of care. Patients now move
across numerous care settings during treatment (e.g., the transition from being
an inpatient at a hospital to being an outpatient in need of home care). Key
components to successful outpatient and home care treatment of patients with
cancer are a coordinated team for delivery of health care, an involved and
committed patient and/or family, and the availability of ongoing support and
education for the patient and family. (Throughout this section, the broad term family has been used to refer to individuals who are
closely bonded socially to the patient. The nature of close relationships
varies widely, and some people who are considered family may not be next of kin
or immediate relatives. In the home care setting, these individuals are
frequently caregivers for the ill person.) Not only is the delivery of care at
risk if care is fragmented, but the demands of illness may place families
at risk for job loss and economic hardship as they struggle to care for their
family members at home.[4] The planning for and delivery of home
care services to patients and their families are often fragmented. The most
vulnerable of those experiencing cancer—such as those with a low income,
urban-dwelling minorities,[5] and those in a rural setting—may be at a higher
risk of experiencing fragmented care.[6]
A team
approach to the care of patients and their families is optimal to meet their needs, which frequently are unrecognized and complex.[7] Depending on the
diagnosis, disease stage, level of nursing care required, and a variety of
psychosocial factors, patient needs range from low technology to high technology and
from low intensity of support to high intensity of support. Care needs are dictated by medical and biologic factors
and by demographics, setting (urban vs. rural), and psychosocial
factors. Thus, care needs are unique to each patient and family.
However, the delivery of care for those in transition and for those in
need of assessment, planning, and ongoing management is challenging and time
consuming and may become unsystematic and haphazard.
References
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Haylock PJ: Home care for the person with cancer. Home Healthc Nurse 11 (5): 16-28, 1993 Sep-Oct.
[PUBMED Abstract]
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Given BA, Given CW: Family home care for individuals with cancer. Oncology (Huntingt) 8 (5): 77-83; discussion 86-8, 93, 1994.
[PUBMED Abstract]
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Wolfe LC: A model system. Integration of services for cancer treatment. Cancer 72 (11 Suppl): 3525-30, 1993.
[PUBMED Abstract]
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Muurinen JM: The economics of informal care. Labor market effects in the National Hospice Study. Med Care 24 (11): 1007-17, 1986.
[PUBMED Abstract]
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O'Hare PA, Malone D, Lusk E, et al.: Unmet needs of black patients with cancer posthospitalization: a descriptive study. Oncol Nurs Forum 20 (4): 659-64, 1993.
[PUBMED Abstract]
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Buehler JA, Lee HJ: Exploration of home care resources for rural families with cancer. Cancer Nurs 15 (4): 299-308, 1992.
[PUBMED Abstract]
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Glajchen M: The emerging role and needs of family caregivers in cancer care. J Support Oncol 2 (2): 145-55, 2004 Mar-Apr.
[PUBMED Abstract]
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