This section describes the samples from whom data was collected and the settings where the participants worked and lived. The study was conducted within the primarily rural island state of Tasmania, Australia. Participant selection was population-based, thus selection bias was minimised. The study included two sample populations, women with breast cancer and RBNs. The results can
therefore be understood as generally representing the breast nursing practices of Tasmanian RBNs and the experiences of the women consulting them. Figure 4 visually presents the sampling flow chart.
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97 * It is not known how many of the 239 clients were actually eligible (e.g. fit within the one month and three months post-diagnosis timeframes of consulting an RBN). Women with breast cancer consulting with a BN in Tasmania for early breast cancer during the study period were eligible to participate. Patients were excluded if they were 18 years of age or under and/or if their English language abilities would inhibit their completion of the Supportive Care Needs Survey. During time one (T1) 74 of 89 eligible participants returned surveys, while during time two (T2) 83 of 107 eligible women participated (78% and 83% response rates respectively). Sixty-three women returned both time one and time two surveys. As RBNs recruited women with breast cancer, it is unknown how many eligible women were invited to participate, declined participation, and/or RBNs chose not to invite.
Based on the prevalence figures from the Tasmanian Cancer Registry Data, it is estimated that 290 women were diagnosed with breast cancer in the study area during the study period (i.e. one year spanning 2003-2004). As the study period cut across two registry years, the exact number of women diagnosed during the study period is unknown. It is estimated that 85% would have had access to one or more RBN (all women within the Public/Private Hospital and Community RBN Site regions, and half of those from within the Private Hospital RBN Site region) – but not
necessarily all women knew about and/or chose to utilise the service. This would have resulted in approximately 247 eligible participants (i.e. 85% of 290 women). The RBNs reportedly consulted with 239 clients with early breast cancer (data obtained from RBN held study patient lists). Thus, it is estimated that
approximately 50 women diagnosed with early breast cancer during the study period did not access an RBN.
The representativeness of respondents who completed SCNS was analysed. By qualitatively comparing the age and regional distribution of these study samples with the cancer registry (Newman et al., 2006), the respondents’ representativeness
98 of the Tasmanian early breast cancer population is better understood. Figure 5 and Figure 6 display the age and regional representativeness of the samples as
compared to the Tasmanian cancer registry data. The proportion of respondents from within each region appears representative, especially considering only half of northern women with breast cancer had access to a BN and thus were able to participate. The study samples differed in age from the registry data in fewer respondents proportionally in the 31-40 and 71-90 age ranges and more in the 41- 50 age range. The 51-70 age range was proportionally very similar between study samples and the Tasmanian registry population.
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Figure 6: Regional representativeness of SCNS samples
Importantly, all nurses employed as an RBN in Tasmania during the study participated in the research project. Eligible nurse participants included RBNs employed in this role within Tasmania, Australia13. All participating RBNs had completed an accredited breast care nurse education course. Six RBNs participated in the phase one portion of the study. These nurses fulfilled five breast nursing roles over the one year quantitative data collection. One RBN resigned from her position (S2) and was replaced by another (S3).
Of the six RBNs who participated in quantitative data collection, all but one also participated in the qualitative data collection (phase two). Thus, five RBNs
participated in both phases of the study, enabling a connection of quantitative and qualitative data. In total, six RBNs participated in qualitative data collection. They represented all four RBNs employed in the role at the time, the three RBN sites studied during phase one, and an additional RBN in the midst of establishing a new practice (N3). The additional informant was included as this was a new position
13
Consistent to what was reported in Chapter One, Tasmanian BNs held a multitude of titles as well. For simplicity, these have all been entitled RBNs for this study.
100 established since the quantitative data collection14. A visual representation of individual RBN participation in quantitative and qualitative strands is at Figure 4.
4.3.1. Comparisons with Other Studies
Results from previous studies were used for comparison to better understand the results of this research project. The NBCC SBN Demonstration Project’s results were used to compare BNs use of time and consultation activities. Two important
differences between these samples were that those in the NBCC Project
demonstrated the implementation of SBN clinical pathway protocol, and six of the seven SBNs were based in city centres rather than rural hospitals or settings. By contrast, the RBNs in this study were all rurally based.
Results comparisons were also made with the unmet supportive care needs of people with cancer. The study samples used for comparison are described in Chapter Five. Specifically, a previous SCNS study involving women with breast cancer in urban and rural Australia was the most comparable reference sample (Girgis, et al., 2000). Reference values can serve as a benchmark against which data can be compared. These results provide a “guide as to the scores you might expect to see for a given cancer population with specific characteristics” (Boyes et al., 2006). An important difference between respondents in this study and other reporting SCNS results is that these women were receiving supportive care from a BN.