Patient, carer, and health service outcomes of nurse-led early discharge after breast cancer surgery: A randomized controlled trial

Citation Wells, M. Harrow, A., Donnan, P., Davey, P., Devereux, S., Little, G., McKenna, E., Wood, R., Chen, R., & Thompson, A. (2004). Patient, carer, and health service outcomes of nurse-led early discharge after breast cancer surgery: A randomized controlled trial. British Journal of Cancer, 91, 651-658.

Design experiment

Purpose The purpose of this study was to test the hypothesis that nurse-led early discharge would not adversely affect quality of life or carer burden at 2 weeks after surgery, this study evaluated the impact of nurse-led early discharge following axillary clearance on patients, carers and the health service. The evaluation addressed key psychosocial and economic outcomes of a new model of care, implemented across the primary secondary care interface.

Participants The participants were N=108 patients undergoing axillary clearance with mastectomy or wide local excision for breast cancer.

Outcome / Dependent Variables The dependent variables were quality of life and carer burden. Secondary outcomes included patient satisfaction, arm morbidity, impact on community nurses, health service costs, surgical cancellations and in-patient nursing dependency.

Procedure Patients were stratified according to breast operation (mastectomy or wide local excision) to receive either: Nurse-led early discharge within 36 hours of surgery, with wound drains still in situ. Conventional hospital stay following surgery until wound drains were removed (approximately 6 days).

Outcomes Nurse-led early discharge had no adverse effects on quality of life or patient satisfaction, had little effect on carer burden, improved communication between primary and secondary care, reduced cancellations and was safely implemented in a mixed rural/urban setting. This study provides further evidence of the benefits of early discharge from hospital following axillary clearance for breast cancer. However, if given the choice, most patients prefer to stay in hospital until their wound drains are removed.

Author Wells, M. Harrow, A., Donnan, P., Davey, P., Devereux, S., Little, G., McKenna, E., Wood, R., Chen, R., & Thompson, A.