People’s reluctance to report sepsis can be overcome by building therapeutic relationships
Neutropenic sepsis occurs in about 20% of people receiving chemotherapy (Smith et al 2006, Aapro et al 2011). There are about 4,000 neutropenic sepsis admissions and 700 deaths annually in the UK (National Institute for Health and Care Excellence (NICE) 2012). Delivery of intravenous antibiotics within one hour of presentation saves lives but patients often delay reporting the symptoms to acute oncology services (AOS) (National Confidential Enquiry into Patient Outcome and Death (NCEPOD) 2008, Oakley et al 2016).
Cancer Nursing Practice. 22, 1, 20-20. doi: 10.7748/cnp.22.1.20.s10
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Published: 03 January 2023
Delays can lead to distress, hospital admission, greater risk of treatment interruptions that affect prognoses and increased health service costs. However, nurses can promote earlier presentation through understanding the reasons for the delays.
I found that neutropenic sepsis information provided during medically led consent, nurse-led pre-treatment consultation appointments and throughout treatment can heighten patients’ fears of dying (Oakley et al 2016).
Normality and empowerment
» Empower patients to stay fit during treatment
» Check understanding of the patient agenda
» Cancer Research UK’s Your Cancer Treatment Record and accompanying patient video promote confidence to manage side effects
» Your Cancer Treatment Record and the Macmillan cancer treatment alert card include a version of the UKONS traffic light symptom reporting tool (Oakley et al 2010)
Address fears
» Address patient fears to help them hear information
» Explain neutropenic sepsis and management, and the benefits of presenting early
Relationships
The information often made patients realise how seriously ill they were so they avoided learning about neutropenic sepsis and ignored early symptoms.
Increasingly, clinicians discussed infections rather than sepsis specifically because they recognised that patients were frightened and feared treatment refusal.
Chemotherapy services can focus on drug delivery where information is delivered dispassionately, thereby encouraging patient passivity.
Common reasons for delays across neutropenic sepsis, stroke and myocardial infarction include fear, denial, poor motivation, not recognising symptoms as important, self-medicating, advanced disease, bereavement, fatalism, carer exclusion and poor clinician relationships (Oakley et al 2016, Mandelzweig et al 2006, Mackintosh et al 2012, Thuresson et al 2007).
Pre-treatment consultations that promote normality, empower patients, address fears and maximise relationships may encourage early symptom reporting.
Aapro MS, Bohlius J, Cameron DA et al (2011) 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. European Journal of Cancer. 47,1 1, 8-32.
Mackintosh JE, Murtagh MJ, Rodgers H et al (2012) Why people do, or do not, immediately contact emergency medical services following the onset of acute stroke: qualitative interview study. PloS one. 7, 10, e46124.
Mandelzweig L, Goldbourt U, Boyko V et al (2006) Perceptual, social, and behavioural factors associated with delays in seeking medical care in patients with symptoms of acute stroke. Stroke. 37, 5, 1248–1253.
National Confidential Enquiry into Patient Outcome and Death (2008) For Better, for Worse? A Review of the Care of Patients who Died within 30 Days of Receiving Systemic Anticancer Therapy. www.ncepod.org.uk/2008sact.html
National Institute for Health and Care Excellence (2012) Neutropenic Sepsis: Prevention and Management in People with Cancer. www.nice.org.uk/guidance/cg151
Oakley C, Taylor C, Ream E et al (2016) Avoidant conversations about death by clinicians cause delays in reporting of neutropenic sepsis: grounded theory study. Psycho-Oncology. 26, 10, 1505-1512.
Oakley C, Johnson J, Ream E (2010) Developing an intervention for cancer patients’ prescribed oral chemotherapy, a generic patient diary. European Journal of Cancer Care. 19, 21-28.
Smith TJ, Khatcheressian J, Lyman GH et al (2006) 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. Journal of Clinical Oncology. 24, 19, 3187–3205.
Thuresson M, Jarlöv MB, Lindahl B et al (2007) Thoughts, actions, and factors associated with prehospital delay in patients with acute coronary syndrome. Heart & Lung: The Journal of Acute and Critical Care. 36, 6, 398-409.
