Influence of Nursing Care on Perceptions of Care Coordination in Older Minority Adults with Treated with Radiation Therapy for Advanced or Recurrent Cancer

Abstract

To describe the influence of nursing care on the perception of care coordination of ethnically diverse older adults with advanced or recurrent cancer treated with radiation therapy at an urban academic center. Despite the increasing number of older mostly minority adults living with advanced cancer in poorly resourced urban communities, there is a lack of research that describes the patient’s perception of the impact of nurses on care coordination and participation in the healthcare team. Qualitative component of an Institutional Review Board approved mixed methods study that involved semi structured interviews conducted to discuss perceptions of coordination of care, distress and supportive care needs. The participants included 31 community dwelling adults (≥ age 60), who received radiation therapy at an urban academic medical center. All interviews were audio-taped, and then transcribed by a HIPAA compliant transcription service. The transcripts were entered into computer software to facilitate coding and analysis. Of the 31 participants who completed the interviews, 20(64.5%) men and 11 women (38%). The mean age for both men and women was 70. Participants had a variety of cancers; the most prevalent were prostate (32%), head and neck (29%) and breast (10%) and 45% were actively receiving treatment. The race/ethnic groups were represented with African Americans, 35%, Caucasian and Hispanic were 19% and Mixed/other 6%. The themes revealed showed that most participants perceptions were nurses were not viewed as part of the healthcare team and care coordination was viewed as a relationship between the patient and the healthcare team with the patient viewed as an integral part of the team. The nurse was not routinely perceived as part of the healthcare team therefore did not influence care coordination. The themes identified were based on the participants’ perceptions of the healthcare team, evidence of coordination of care and sources of personal strength. We found that older adults are aware of the concept of coordination of care and believe their care is coordinated successfully. Despite daily interactions with patients receiving radiation therapy most patients do not acknowledge the impact of nurses on care coordination and are not able to articulate the role of nurses as members of the healthcare team. Additional research is needed to explore and improve patient perception of the nurse’s role in the coordination of care.