Care transitions among oncological patients: from hospital to community

To analyze the transition of care from the perspective of cancer patients, in a Southern Brazil hospital, correlating perspectives with sociodemographic and clinical characteristics.

Method:

Cross-sectional study using the Care Transitions Measure (CTM) with cancer patients undergoing clinical or surgical treatment following hospital discharge. Data collection was completed by telephone, between June and September 2019. Data analysis was performed using descriptive and inferential statistics.

Results:

The average CTM score was 74.1, which was considered satisfactory. The CTM factors: understanding about medications (83.3) and preparation for self-management (77.7) were deemed satisfactory; while: secured preferences (69.4) and care plan (66.1) were unsatisfactory for an effective and safe care transition. No statistically significant difference was found between sociodemographic variables and the CTM. Among the clinical variables, primary cancer and the secured preferences factor showed a significant difference (p = 0.044).

Conclusion:

The transition from hospital care to the community was considered satisfactory in the overall assessment.

DESCRIPTORS
Continuity of Patient Care; Transitional Care; Neoplasms; Patient Safety

Variables	Total sample (n = 213)*
Variables	n	%
Staging
I	6	3.4
II	26	14.5
III	50	27.9
IV	68	38.0
Other^* *Others: Chronic Lymphocytic Leukemias (LLC); Acute Lymphocytic Leukemia (ALL); Acute Myelocytic Leukemia (AML); Polycythemia Vera; Plasmablastic lymphoma.	29	16.2
Metastasis
Yes	92	44.2
No	116	55.8
Comorbidity
Yes	110	52.6
No	99	47.4
Reason for hospitalization
Chemotherapy Treatment/Radiotherapy	95	45.0
Surgical treatment	46	21.8
Clinical complications^ Clinical complications: pain; anemia; fatigue/tiredness/asthenia; pulmonary complications; inappetence; nausea; fever; diarrhea; oliguria; dysphagia; recurrence; jaundice; abdominal pain; convulsion; bleeding.	70	33.2
Use of continuous medication
Yes	146	68.5
No	64	30.0
Do not know	3	1.4
Tumor location^* *Respiratory system (rhinopharynx, oropharynx, lung); Digestive system (pharynx, esophagus, gastric, colon, rectum, liver, pancreas); Reproductive system (ovary, uterus, vulva, prostate, testis); Leukemias/Lymphomas (Chronic Lymphocytic Leukemia; Acute Lymphocytic Leukemia; Acute Myelocytic Leukemia; Polycythemia Vera; Plasmablastic Lymphoma).
Respiratory System Neoplasm	14	6.6
Breast Neoplasm	14	6.6
Digestive System	135	63.4
Reproductive system	15	7.0
Leukemias/Lymphomas	9	4.2
Others^** **Others (CNS, thyroid, urinary, renal, melanomas, soft tissues).	26	12.2
Type of cancer
Primary	128	60.7
Secondary	83	39.3
Oncological treatment
Chemotherapy (neoadjuvant, adjuvant)	128	63.1
Surgical	42	20.7
Others^*** ***Others: radiotherapy; chemotherapy/radiation therapy; hormone therapy.	19	9.4
Does not perform	14	6.9

CTM-15 estimates (n = 213)
Questions	Average	Standard deviation	Amplitude		Median	α C
Questions	Average	Standard deviation	Minimum	Maximum	Median	α C
CTM-15 GENERAL	74.1	10.0	31.3	100.0	73.4	.876
Factors
Preparation for self-management	77.7	12.1	25.0	100.0	75.0	.852
Understanding about medications	83.3	11.5	25.0	100.0	83.3	.819
Secured preferences	69.4	16.5	25.0	100.0	75.0	.932
Care plan	66.1	13.9	25.0	100.0	62.5	.696

Variables
	Preparation for self-management		Understanding medications		Secured preferences		Care plan
	Average	SD	Average	SD	Average	SD	Average	SD
Sex
Male	78.4	11.8	83.2	11.0	69.9	16.5	65.6	14.2
Feminine	76.6	12.5	83.5	12.2	68.7	16.6	66.8	13.6
p value	.295		.844		.615		.523
Age range
25 to 59	78.5	13.0	84.2	11.4	70.8	16.4	67.0	15.4
60 to 69	76.9	11.6	82.9	11.0	69.8	17.5	67.0	13.0
≥70	77.0	11.0	82.1	12.2	66.4	15.6	63.5	11.9
p value	.653		.537		.281		.260
Marital status
Not married	79.0	8.5	82.9	11.3	72.0	14.9	65.3	12.7
Married or in a stable relationship	77.2	12.9	83.3	11.5	68.8	16.9	66.4	14.3
p value	.395		.846		.266		.645
Breed
White	77.3	12.4	83.2	11.6	69.5	16.7	65.8	14.3
Black or brown	79.6	10.1	84.9	11.2	71.0	17.3	66.7	12.2
p value	.353		.454		.659		.739
Education
Illiterate	77.1	14.2	80.9	18.2	76.4	17.7	68.8	18.8
Less than high school	77.1	12.8	82.8	11.1	68.9	17.0	65.8	14.3
High school	77.9	11.4	82.7	10.6	68.6	15.6	65.4	13.3
University education	80.3	8.7	88.9	10.0	70.3	15.5	67.9	10.6
p value	.731		.100		.490		.814
Worked before hospitalization
Yes	76.7	11.1	84.3	10.4	71.3	14.5	64.7	15.0
No	77.8	12.3	83.1	11.7	69.1	16.8	66.3	13.8
p value	.658		.598		.514		.545
Place of residence
Urban area	78.2	11.7	83.3	11.2	68.7	16.5	66.4	13.3
Countryside	76.4	12.9	83.2	12.1	70.9	16.6	65.5	15.3
p value	.316		.970		.366		.684

Variables
	Preparation for self-mana gement		Understanding medications		Secured preferences		Care plan
	Average	SD	Average	SD	Average	SD	Average	SD
Staging
I	81.3	15.3	86.8	13.5	72.2	17.2	75.0	13.7
II	80.0	10.7	84.6	11.8	69.1	16.1	66.1	13.9
III	76.4	15.7	82.7	13.4	70.5	16.8	62.1	16.4
IV	77.0	10.7	83.4	9.6	68.7	16.2	67.9	11.6
Other^* *Other: Chronic Lymphocytic Leukemias (LLC); Acute Lymphocytic Leukemia (ALL); Acute Myelocytic Leukemia (AML); Polycythemia Vera; Plasmablastic lymphoma.	80.2	9.6	84.7	11.2	67.9	20.1	69.1	16.2
p value	.513		.876		.948		.076
Metastasis
Yes	77.0	9.5	83.6	9.5	67.8	16.3	66.6	10.5
No	78.6	13.6	83.3	12.4	70.9	16.8	66.2	15.9
p value	.338		.824		.177		.866
Comorbidities
Yes	76.9	11.2	83.9	11.3	68.2	16.4	65.2	13.0
No	78.4	13.0	82.6	11.8	70.6	16.6	66.8	14.8
p value	.383		.419		.287		.416
Reason for Hospitalization
Chemotherapy Treatment/Radiotherapy	77.2	12.6	83.1	11.3	68.8	16.1	65.6	14.0
Surgery	78.4	12.7	80.8	11.9	73.2	16.8	67.9	14.3
Clinical complications^ Clinical complications: pain; thrombocytopenia; anemia; fatigue/tiredness/asthenia; pulmonary complications; inappetence; nausea; fever; diarrhea; oliguria; dysphagia; cancer recurrence; jaundice; abdominal pain; convulsion; bleeding.	77.6	11.3	85.0	11.5	67.2	16.6	66.1	13.6
p value	.867		.156		.149		.640
Use of continuous medication
Yes	77.4	12.2	84.0	12.0	69.2	16.5	65.7	14.0
No	78.3	12.3	81.5	10.3	69.9	17.1	67.3	14.2
Do not know	75.6	1.1	87.2	4.6	67.4	8.4	63.5	1.7
p value	.857		.311		.947		.704
Tumor location^* *Respiratory system (rhinopharynx, oropharynx, lung); Digestive system (pharynx, esophagus, gastric, colon, rectum, liver, pancreas); Reproductive system (ovary, uterus, vulva, prostate, testis); Leukemias/Lymphomas (Chronic Lymphocytic Leukemia; Acute Lymphocytic Leukemia; Acute Myelocytic Leukemia; Polycythemia Vera; Plasmablastic Lymphoma).
Respiratory system	78.7	9.4	83.3	9.7	63.8	14.9	64.5	11.9
Breast	76.0	17.3	81.8	18.1	73.4	14.6	68.1	16.0
Digestive system	77.8	12.1	83.7	11.4	69.8	16.8	66.0	14.7
Reproductive system	79.3	11.0	82.7	10.7	71.8	16.6	65.2	10.8
Leukemia	82.2	12.2	86.0	12.7	68.7	19.4	72.6	16.1
Others^** **Others (CNS, thyroid, urinary, renal, melanomas, soft tissues).	74.8	10.8	81.4	8.9	67.1	16.4	65.0	10.6
p value	.658		.894		.657		.762
Type of cancer
Primary	78.9	11.9	83.6	11.1	71.4	16.9	66.1	14.9
Secondary	76.2	12.0	82.8	12.2	66.8	15.1	66.1	12.5
p value	.116		.649		.044		.989
Current cancer treatment
Chemotherapy (neoadjuvant/adjuvant)	77.2	11.8	84.0	11.0	67.4	17.3	65.7	13.8
Surgical	77.5	10.8	82.0	10.1	71.8	17.3	66.4	11.2
Others^*** ***Others: Radiotherapy, Chemotherapy plus Radiotherapy, Hormone Therapy.	77.9	16.4	81.4	15.2	71.8	12.1	68.9	17.2
Does not perform	77.1	13.3	80.8	14.2	73.5	13.8	63.8	17.3
p value	.995		.567		.271		.746

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Adriane Cristina Bernat Kolankiewicz Rua do Comércio, nº 3000, Universitário 98700-000 – Ijuí, RS, Brazil adri.saudecoletiva@gmail.com