DOI: 10.14457/tu.the.2020.123
title: Development of person-centered model for patients with head and neck cancer receiving concurrent chemoradiotherapy: participatory action research

description: The adherence to concurrent chemoradiotherapy can be a practical challenge and a factor influencing patients’ choices for treatment. In a bid to enhance true benefits of person-centered care, the radiation oncology team need to focus on quality of relationships and interactions between patients with head and neck cancer and their family, as well as health care professionals. This study applied a participatory action research for the development of a person-centered model towards treatment adherence, symptom management, and satisfaction among radiation oncology team and patients with head and neck cancer and their family during concurrent chemoradiotherapy. The study was divided into 2 phases, with data collection including the interviews and observations of focused-groups and document reviews. Moreover, the Graneheim and Lundman’s steps were employed for content analysis throughout the study.The first phase was designed to explore the experiences and needs of 15 patients and 8 family members with regard to care process and radiation oncology team services during concurrent chemoradiotherapy. The findings revealed 3 main categories: overwhelming information, unpleasant symptom cluster, and strategies to adhere to treatment regimen. Meanwhile, the experiences of 23 radiation oncology team members were also investigated. The results emerged 4 main categories: role and competency, environment of healing, person-centered approaching, and fragmentation of care. All of these data and information can lay a foundation for the development of a tentative person-centered model in the delivery of concurrence chemoradiotherapy services. The second phase was purposed to develop the person-centered model. This model was based on the approach of participatory action research of Kemmis and McTaggart’s (1988), which included the action research spiral of individual and collective self-reflective cycles as a methodology contained four activities, plan, act and observe, and reflect. Then, the revised-plan was continued during the model development with 3 cycles in this study. According to the findings, the antecedent of person-centered model was derived from the participatory action research approach, specifically the crucial role of radiation oncology nurses and their competences as a pivotal part in building the effective radiation oncology teamwork, as well as healing environment towards the efficacious management of unfavorable symptoms. Whereas, the clinical practice guidelines, work procedures, educational and information systems, continuity, empowerment, and person-centered approach were also implemented to contribute the direct care for patients with head and neck cancer, which required a good collaboration between the radiation oncology team and other healthcare professionals. The specific outcomes comprised treatment adherence, symptom status, and satisfaction on the changing towards a better care process in practice for both patients and healthcare team.For suggestions, some replications and continuous reviews are needed in the person-centered model towards a complete confidence in its effectiveness and efficacy. Moreover, further collaboration with other multidisciplinary health care teams should be promoted and developed in the long run.