Cancer patients’ perspectives on participating in a community pharmacy-based hyperglycaemia screening service – A qualitative exploration of enablers and barriers
Introduction
Patients diagnosed with cancer are frequently treated with high dose glucocorticosteroids (HGCS), either to directly reduce tumour size and associated oedema, offset predictable adverse effects of cytotoxic therapies, or to treat immune related adverse effects of immune checkpoint inhibitors. One of the common adverse effects of HGCS is an increase in insulin resistance and subsequent elevation of blood glucose levels (BGL), leading to the development of acute glucocorticoid-induced diabetes and potentially type 2 diabetes (T2D) long-term.1 The risk of developing T2D during HGCS therapy increases by up to 34% for patients with cancer.2, 3, 4 In addition, acute hyperglycaemia impairs immune function and wound healing, which can lead to prolonged stays in hospital and an increase in all-cause mortality.5 Patients commenced on HGCS without a pre-existing diagnosis of diabetes are ideally monitored at least once daily to reduce the risk of developing hyperglycaemia while in hospital.6 A clear follow-up strategy for ongoing monitoring of BGL has to be communicated to patients and outpatient care providers and made accessible in primary care settings, e.g in general practices or community pharmacies, rather than offering outpatient hospital care.
Community pharmacies (CP) provide an easily accessible location for BGL monitoring in many countries, for example, in Australia, the UK, Germany, and the USA. Monitoring of BGL, screening for hyperglycaemia and supporting diabetes care by pharmacists has been shown to contribute to the early detection of T2D, lowering of HbA1C and a reduction in cost of overall care, particularly when established within a multidisciplinary care framework.7, 8, 9, 10, 11
In order to safeguard patients with a cancer diagnosis, who are cared for in a community setting and primary care with prolonged HGCS treatment, from adverse effects a follow-up program was designed by a multidisciplinary team at a quaternary cancer centre in Australia, in collaboration with community pharmacies, a pharmaceutical wholesaler and general practitioners (GP). The ‘Glucocorticoid Induced Diabetes Prevention Program’ (GIDPP) was designed for patients commenced on HGCS and offered regular screening for hyperglycaemia through a CP. Although CP based screening services are acceptable to non-cancer patients little is known about cancer patients' attitudes towards regular attendance of a BGL monitoring service in a CP. Fatigue, morbidity and multiple healthcare appointments associated with a cancer diagnosis and treatment may make it difficult for patients to attend any regular follow-up care.12,13 This qualitative study aimed to identify motivations, enablers and barriers for cancer patients to participate in a CP based BGL screening and monitoring service for the duration of their treatment with HGCS. The overall implementation and feasibility assessment of this novel program will be reported separately, with this report focusing on patients' attitudes and perceptions at the time of their enrolment.
Section snippets
Methods
Approval for this study was granted by the study centre's ethics committee (18/25 L) and patient written consent was obtained. The study adheres to the SRQR standards for the reporting of qualitative research.14
Results
Seventy-five percent of patients (114/153) meeting eligibility criteria consented to enrol in the GIDPP. Not all patients who enrolled in the program consented to interviews and some who provided consent left the hospital before an interview could be conducted, particularly those who had declined participation in the GIDPP. This resulted in a convenience sample of participants, based on their availability and consent to participate in the interviews.
Patients’ carers were present and involved in
Discussion
Community-based health services play an important part in addressing the healthcare needs of patients following acute care received in hospital. Limited knowledge exists about the acceptability of monitoring and support services provided by CP for cancer patients. This qualitative study, conducted at a major cancer treatment and research centre in Australia, provides useful information on patients’ knowledge, concerns and behavioural factors which influenced their perceptions and attitudes
Conclusion
Community pharmacy-based hyperglycaemia and BGL monitoring services were generally acceptable for patients with cancer, although their altruistic attitude to participation in a research study may overestimate the ongoing willingness to attend regular monitoring in a community pharmacy in addition to cancer related appointments. Tailoring supportive care programs to meet the individual needs of patients will increase the overall likelihood of them receiving appropriate care. These findings may
CRediT authorship contribution statement
Antoine Sedrak: Conceptualization, Investigation, Formal analysis, Writing - original draft, Writing - review & editing, Supervision, Project administration. Sarah Glewis: Conceptualization, Investigation, Project administration. Marliese Alexander: Conceptualization, Formal analysis, Writing - review & editing, Supervision. Mr Senthil Lingaratnam: Conceptualization, Resources, Writing - review & editing. Cherie Chiang: Conceptualization, Writing - review & editing. Karen Luetsch:
Acknowledgements
The research team would like to thank the participants in this study.
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