Chapter 3: Implementing the SBN model
This chapter describes the preparation undertaken by SBNs and Collaborating Centre project teams for this project. During the implementation of the SBN model, the seven participating SBNs were in regular contact with the project coordinator, in order to discuss and deal with any issues arising. Common experiences are also recorded in this chapter.
Chapter 4: What do SBNs do?
Although the clinical pathway gives guidelines for the intervention provided by SBNs, it is necessary to analyse in detail what the SBNs in this project did on a daily basis. For this reason, SBNs completed a day log detailing their clinical and non-clinical activities during their working day. The logs were completed for one week a month, for six months.
A patient log was also kept for each woman recruited to the project. In this, SBNs recorded demographic details, treatment undertaken, psychological risk factors and details of all their interactions with the patient and family. This chapter examines what SBNs did with women in the project, and what their daily activities were.
Chapter 5: How the treatment team and SBNs view the SBN role
To be successful, the SBN model must be understood and accepted within the multidisciplinary team. This chapter reports the perceptions of treatment team members, allied health professionals, the Breast Cancer Support Service (BCSS) volunteers, and participating SBNs. These perceptions were assessed at the end of the project by means of a semi-structured telephone survey conducted by
C h a p t e r 2 : P r o j e c t o v e r v i e w
Chapter 6: Women’s perceptions of the SBN role
Women participating in the study were contacted at two and six months after diagnosis to assess their contact with, and satisfaction with the care provided by, the SBN. They completed a self-administered questionnaire and returned it to the NBCC in a reply paid envelope. This chapter reports on this data.
Chapter 7: The impact of the SBN on women’s perceptions of care
The impact of the SBN model on women's perceptions of care was assessed six to twelve months after diagnosis using a previously validated interview schedule, the National Consumer Survey (Williams et al. in review 2000). This was conducted as a telephone interview administered by an external research agency, using a
computer assisted telephone interview system.
Responses of women receiving the SBN intervention were compared to those of women from a nationally representative sample of women with early breast cancer (referred to as the national control). This comparison does not control for
potential differences already existing between the Collaborating Centres and other treatment centres in Australia in terms of other aspects of care (ie other than the breast nurse). Women’s responses were therefore also compared with a sample of women treated for breast cancer at the Collaborating Centres prior to the
introduction of the SBN intervention (referred to as the retrospective control) (Figure 2.2). This allowed the Collaborating Centres to be compared with the national average before the introduction of the SBN model. Furthermore, site differences could be controlled for, by evaluating women’s satisfaction pre and post SBN intervention at the Collaborating Centres.
C h a p t e r 2 : P r o j e c t o v e r v i e w
Chapter 8: The nature and impact of SBNs’ psychological care
One of the core tasks of the SBN is to assess women’s psychological needs and to adjust their intervention accordingly, in an attempt to reduce levels of
psychological morbidity in women with breast cancer. In particular, SBNs should refer women with significant psychological problems to appropriate health professionals. The impact of the SBN model on the emotional wellbeing of women in this project was assessed at two and six months after diagnosis using the self-administered General Health Questionnaire – 12 (GHQ-12) (Goldberg et al.
1988), which was mailed with the satisfaction questionnaire. This chapter analyses the outcomes of SBNs’ psychological treatment of women in the project.
Chapter 9: Evaluating the economic feasibility of the SBN role
Key factors to be considered when examining the economic feasibility of the SBN role were also investigated in this project. A case study exploring the impact of the SBN on resource use within the multidisciplinary team was conducted in one participating breast clinic, and is reported here.
Chapter 10: Feasibility of the evidence-based SBN model of care
This final chapter examines issues affecting the translation of the SBN model of care into Australian practice. Three key issues are examined: skills needed by SBNs; sustainable caseloads; and the ongoing support needs of SBNs.
C h a p t e r 3 : I m p l e m e n t i n g t h e s p e c i a l i s t b r e a s t n u r s e m o d e l
Chapter 3: Implementing the specialist
breast nurse model
This chapter defines the ideal role of a specialist breast nurse (SBN) and describes how the breast nurses were prepared for this position. Transcripts from discussions with the nurses during the six months they implemented the model are analysed. The chapter also examines issues that emerged for the SBNs while they introduced the role, and how the model worked in practice.