Literature review
The diagnostic journey of ovarian cancer: A review of the literature and suggestions for practice
Victoria Jayde
Faculty of Nursing and Midwifery, University of Sydney, Sydney NSW
Maureen Boughton
Faculty of Nursing and Midwifery, University of Sydney, Sydney NSW
Karen Alexander
Communities, Ageing Disability & Home Care, Department Human Services
Penny Blomfield
University of Tasmania, Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Hobart TAS
PP: 5 - 17
Abstract
Ovarian cancer is the most lethal form of gynaecological cancer. It can be difficult to diagnose, with the majority of diagnoses made at a late stage of disease. An integrative literature review was conducted to explore the ovarian cancer diagnostic journey of women and to examine the potential contribution of using a person-centred approach. Factors associated with ovarian cancer diagnostic delay were described in terms of two phases. The principles of person-centred health care (PCHC) were identified. This paper proposes utilising the principles of PCHC to improve women's experience of the diagnostic journey. Specific strategies are suggested for each delay phase to enhance the experience for women. Whilst the challenges in diagnosing the disease are likely to remain until a screening test is available, it is hoped that by implementing strategies based upon PCHC, nurses may facilitate the ovarian cancer diagnostic process and improve the diagnostic experience for women.
Article Text
Ovarian cancer (OvCa) is a challenging disease to diagnose due to the vague nature of presenting symptoms and the lack of knowledge by many members of the public of the disease's symptoms and risk factors. There is currently no reliable OvCa screening tool and so most diagnoses are made when the disease is at an advanced stage with a correspondingly poor prognosis.
The diagnosis of OvCa is an important and challenging area of healthcare, which urgently needs to be addressed. New ways of approaching the diagnostic journey are needed and this paper intends to explore alternative ways to approach the diagnostic journey of OvCa, by undertaking an integrative review of the literature. The results of the review presented in this paper, combine factors known to be related to the OvCa diagnostic journey with the principles of person centred health care (PCHC). The fresh perspective generated provides a lens through which the diagnostic experience can be approached. Strategies for incorporating PCHC to facilitate the diagnostic pathway are suggested. This holistic conceptualisation of the process might provide a framework for health care professionals (HCPs) seeking to improve the OvCa diagnostic experience for women.
Ovarian cancer:
Ovarian cancer is the most lethal form of gynaecological cancer (Gynecologic Cancer Foundation & Society of Gynecologic Oncologists 2010). In Australia, in 2006, 1226 women were diagnosed with ovarian cancer, and 795 women died from the disease (Australian Institute of Health and Welfare (AIHW) & National Breast and Ovarian Cancer Centre (NBOCC) 2010).
The average five-year survival rate for women with ovarian cancer is 40%, however this includes all types and stages of the disease (AIHW & NBOCC 2010). The poor prognosis of epithelial ovarian cancer (the most common histological type) has been attributed to the fact that the majority of women diagnosed with the disease are diagnosed with late stage disease (American College of Obstetricians and Gynecologists Committee on Gynecologic Practice (ACOGCGP) 2002; Bhoola & Hoskins 2006; Chu & Rubin 2006; Kurman et al. 2008; Target Ovarian Cancer (TOC) 2009; Tracey et al. 2009). These women have a five-year survival rate of 20-30% (ACOGCGP 2002:237).
Diagnosing OvCa can be difficult because there is currently no reliable screening test recommended for use (NBOCC 2009a; NBOCC 2009b; Society of Gynecologic Oncologists 2005; Bhoola & Hoskins 2006). Further, diagnosis is often complicated by vague symptoms (AIHW & NBOCC 2010; Lurie et al 2009), which are confusing for women and health care practitioners (HCPs). Until recently, the disease was described as being 'silent' (Cass & Karlan 2010; Hamilton et al. 2009; Jasen 2009) suggesting that it has no symptoms until it is widespread. It is now known that the majority of women with ovarian cancer do have symptoms but they are vague and non-specific and are common to many other conditions (Ryerson et al. 2007). The nature of presenting symptoms depends on whether a woman has early stage disease involving the ovaries and pelvis only, or disease that has metastasised widely within the abdominal cavity. Possible symptoms include: abdominal bloating; abdominal pain; early satiety; back pain; unexplained weight gain/loss; indigestion; excessive fatigue; and alterations in 'toilet habits' (NBOCC 2010a:7).
The often arduous experience of seeking a diagnosis for the symptoms of ovarian cancer is well documented in the literature (Jasen 2009; TOC 2009) with one report likening it to an 'illness career' (Markovic et al. 2004:376) and another to a 'long and winding path' (Fitch et al. 2002:154). Women often report feeling angry and frustrated with their health care professionals (HCPs) (Ferrell et al. 2003, Thompson 2004). The timely diagnosis of ovarian cancer is an identified area of need in Australia (Cancer Australia and the Royal Australian College of Obstetricians and Gynaecologists (CA & RACOG) 2011:79).
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