Understanding the dilemmas inherent in the communication between clinicians, patients and carers about neutropenic sepsis

: a grounded theory study

Abstract

Cancer chemotherapy can reduce immunity. The lowered immune response increases the risk of infection that can develop into a life threatening secondary complication called neutropenic sepsis. The neutropenic sepsis causes a significant number of hospital admissions and an estimated 700 deaths within the United Kingdom (UK) each year. Delays in patients reporting symptoms of neutropenic sepsis may exacerbate the problem, causing longer and more costly hospital stays and a greater risk of death. Furthermore, chemotherapy treatment may also be delayed, which may affect prognosis. 
This study took an ethnographic and constructivist grounded theory approach to develop a theory to explain why patients delay presenting to hospital with neutropenic sepsis. A longitudinal element of the study involved non-participant observation of women with breast cancer being provided with information about neutropenic sepsis by oncology doctors and chemotherapy nurses. Interviews were carried out, with observed patients following the observation and at the end of treatment. A retrospective element involved interviews with women with breast cancer who had developed neutropenic sepsis, their carers and doctors and nurses who worked within oncology and Accident and Emergency (A&E) departments. Analyses commenced with the earliest data gathered and a rich theoretical picture was built through comparing perspectives, pursuing areas of inquiry and recruiting particular participants who became of interest to the developing theory. 
A grounded theory evolved, which suggests patients may delay presenting to hospital with neutropenic sepsis because the seriousness of it is underplayed by clinicians, patients and their carers. Findings of this study have immediate implications for clinical practice to ensure patients and their carers are adequately supported by clinicians to understand the seriousness and be equipped to identify and report neutropenic sepsis. Furthermore, study findings should inform the design of future research to develop interventions, to promote earlier recognition and treatment for this important chemotherapy complication.

Date of Award	1 Mar 2015
Original language	English
Awarding Institution	King's College London
Supervisor	Emma Ream (Supervisor) & Alison Metcalfe (Supervisor)