Assessment of rehabilitation needs in colorectal cancer treatment: Results from a mixed audit and qualitative study in Denmark

Figures & data

Table 1. Distribution of findings from retrospective clinical journal audit of n = 40 patients with colorectal cancer from four randomly selected hospital departments of surgery (n = 20) and oncology (n = 20). Geographically divided into east and west Denmark.

	Departments of surgery (n = 20)		Subtotal	Departments of oncology (n = 20)		Subtotal	Total
	East (n = 10)	West (n = 10)	(n = 20)	East (n = 10)	West (n = 10)	(n = 20)		(n = 40)
Journal audit of clinical documentation	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)
Patient demographics and length of hospitalization
Mean age, year (SD)	71 (8.3)	74.7 (8.2)	72.9 (8.5)	64.6 (7.1)	61 (7.0)	62.8 (8.7)	67.8 (10.6)
Sex
Male	6 (60)	6 (60)	12 (60)	5 (50)	5 (50)	10 (50)	22 (55)
Female	4 (40)	4 (40)	8 (40)	5 (50)	5 (50)	10 (50)	18 (45)
Mean surgical hospital stay. days (SD)	5.6 (1.4)	7.7 (3.4)	6.7 (2.6)
Mean oncological ambulant chemotherapy, days (SD)				162.3 (30.2)	172.7 (19.9)	167.8 (29.3)
Assessment of physical psychological and social functioning during initial treatment trajectory
Physical	10 (100)	9 (90)	19 (95)	10 (100)	9 (90)	19 (95)	38 (95)
Psychological	4 (40)	1 (10)	5 (25)	6 (60)	10 (100)	16 (80)	21 (52.5)
Social	9 (90)	2 (20)	11 (55)	8 (80)	10 (100)	18 (90)	29 (72.5)
Assessment of physical psychological and social functioning at end of treatment trajectory*
Physical	9 (90)	9 (90)	18 (90)	10 (100)	9 (90)	19 (95)	37 (92.5)
Psychological	7 (70)	4 (40)	11 (55)	4 (40)	8 (80)	12 (60)	23 (57.5)
Social	1 (10)	1 (10)	2 (10)	4 (40)	7 (70)	11 (55)	13 (32.5)
Assessment of physical, psychological and social functioning
Initial and at end of treatment trajectory*	2 (20)	0 (0)	2 (10)	0 (0)	7(70)	7 (35)	9 (22.5)
Referral to specialized rehabilitation services in hospitals
During initial treatment trajectory*	0 (0)	0 (0)	0 (0)	1 (10)	7 (70)	8 (40)	8 (20)
At end of treatment trajectory*	3 (30)	2 (20)	5 (25)	5 (50)	9 (90)	14 (70)	19 (47.5)
Referral to municipal rehabilitation services
At end of treatment trajectory*	0 (0)	1 (10)	1 (5)	0 (0)	1 (10)	1 (5)	2 (5)

SD, standard deviation;

*Surgery, discharge + 1 month; Oncology, from four months to end of course of treatment.

Table 2. Selected interview quotes illustrating main themes divided between surgical and oncological hospital departments.

Themes	Surgical hospital departments	Oncology hospital departments
Varying knowledge of responsibilities in national rehabilitation policies	‘The 2012 national rehabilitation policies aren’t something we’re informed about.(Nurse, surgical department – west)	‘We’ve had a few meetings with the quality assurance department about what to do with the national rehabilitation policies in our department (…). We’re waiting for a kickoff seminar in our region’. (Nurse, oncology department – east)
Rehabilitation as informal part of nurses’ responsibilities	‘It’s the nurses who have overall responsibility’.(Nurse, surgical department – east)	‘It’s the nurses who deal with it. The doctors are informed, but it’s the nurses who conduct rehabilitation interviews with the patients’.(Nurse, oncology department – west)
Different surgical and oncology interpretations of rehabilitation	‘When we talk about rehabilitation, what we mean is re-training to recover habitual functional ability’.(Nurse, surgical department – east)	‘I see rehabilitation as supporting the patients in regaining their strength and being able to return to how they were before the cancer diagnosis, physically, psychologically and socially –’.(Nurse, oncology department – west)
	A good deal of rehabilitation takes place during hospitalization as part of our nursing, which is mobilization. We focus on it in advance as part of the fast-track system so we can avoid surgical complications’.(Nurse, surgical department – east)	‘I think there’s some confusion among doctors and nurses about what rehabilitation is. The patients don’t really understand either’.(Nurse, oncology department – east)
Rehabilitation integrated into fast-track concepts versus trials using DT	‘We have our standard care schedules that we fill out. We can’t fill them out if we haven’t mobilized the patients. We feel a certain amount of professional pride when patients are mobilized because we’ve seen that fast-track and early mobilization really work’.(Nurse, surgical department – east)	‘With DT something is noted in all areas, which makes it really good. ‘.(Nurse, oncology department – west)
		‘The patients are given DT to take home. It’s not something we keep in our journals. The patients take it with them for the rest of their program’.(Nurse, oncology department – west)
Time, money and competence: obstacles to implementation of DT in clinical practice		‘The drawback with DT is that it takes time and time is in short supply. Initially we had 30 min. allocated for a rehabilitation interview, which isn’t very much. Now we have heard from the head nurse that we have 15 minutes at the most, which is really hard to achieve if you want to discuss any problem in detail’.(Nurse, oncology department – west)
Insufficient need for local authority rehabilitation services	‘I don’t think we refer very many patients to rehabilitation provided by the local municipalities, but that’s also because the fast-track system is so good. Our patients are just as fit when they leave us as when they come in’.(Nurse, surgical department – east)
Lack of information about rehabilitation for cancer patients offered by local authorities	‘I think we have patients from 10 to 12 local districts. I don’t know that much about what they offer, but there are clearly many other possibilities we don’t use and don’t know about’.(Nurse, surgical department – east)	‘We know that all local authorities offer services but our knowledge of specific facilities is haphazard, since the local municipalities keep changing what services they offer’.(Nurse, oncology department – west)

DT, distress thermometer.

Figure 1. Whether clinician documented patient’s physical, psychological and social functioning during initial course of treatment (n = 40).

Figure 2. Whether clinician documented patient’s physical, psychological and social functioning at end of a treatment (n = 40).