Is your clinical change project highly significant to nursing? Does the project encompass the core graduate nursing competencies of patient-centered care,

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Improving Recurrent Breast Cancer Care: Problem Identification Using the PICOT Framework

Name: Milena B Lopez Hernandez

Instructor: Professor Guelsy Diaz

School: West Coast University

Date: 7/13/2025

Improving Recurrent Breast Cancer Care: Problem Identification Using the PICOT Framework

i. Clinical Setting and Problem Description

The clinical practice that will be used in this identification of a PICOT problem is an oncology clinic involved in the treatment of recurrent breast cancer. The clinic offers follow-up services to the patients diagnosed with breast cancer, those who have recurred cancer even after undergoing anticancer treatment. The given field is an important sphere of oncology, and controlling recurring breast cancer has several challenges including complicated treatment plans, the psychological distress on individuals, and monitoring them on a regular basis to check the occurrence of a recurring condition.

The clinic covers a big metropolitan area with massive population that includes people with specific needs of treating cancer. The patients are mainly adults over the age of 40 but a significant proportion is of those who have already had before the breast cancer treatment but are currently experiencing the reoccurrence. It is also observed that the clinic has a high concentration of people who are found at the lower end of the socioeconomic ladder, or have having difficulties in accessing care; thereby aggravating their health issues. Also, underserved minority groups are highly represented and this leads to the fact that such people experience cultural and linguistic barriers related to access to care.

It is possible to single out a number of recurrent issues in the clinic, such as the absence of individual care plans offered to the patients, coordination among various healthcare services, as well as the overall inability to manage the emotional and psychological aspects of patients with recurring breast cancer. The emotional load of recurrence is very problematic to many patients, and the mental health needs of many patients are simply provided with no attention but rather concentrated on the clinical treatment. The other significant concern is the problem of the constant monitoring of recurrent breast cancer treatment that can be addressed only with constant surveillance and advanced diagnostic equipment.

ii. Problem Statement and Target Population

The identified problem is insufficient care and treatment of recurrent breast cancer in the clinic. These comprise lapses in clinical as well as emotional support to the patients, which means poor outcomes in both survival rates and quality of life. A total number of adult women diagnosed with recurrent breast cancer and their families, which are frequently involved in the process of care, should become the target population of this problem.

The scale of this issue is not narrow enough so that it can be approached only through a single perspective; this is clinical, psychological, and socio-cultural. Clinically, the issue is the difficulty in coping with a long-term disease, the need to pay constant attention to it, treating side effects, and developing an individual treatment strategy. The psychological aspect consists of the emotional burden on patients who could be affected by anxiety, depression, and hopelessness concerning their cancer returning. Lastly, at a social level, the issue consists of socio-economic position, care accessibility issues, and cultural challenges among heterogeneous populations as well.

The problem of recurring breast cancer cannot be ignored, since it is relevant enough to be explored and carefully planned in terms of interventions. Due to the challenges of managing cancer recurrence effectively, its issue has numerous aspects that have to be handled comprehensively and multidisciplinary. By creating an evidence-based project, it will be possible to work on these dimensions and develop a more effective care model that does not only look at clinical treatment of a patient but also his/her emotional well-being and provide care to more people, especially underserved populations.

iii. Significance of the Evidence-Based Project

Recurrent breast cancer is one of the biggest issues in the field of oncology. The recurrent cancer is one of the areas where the know-how is lacking due to the changes in the treatment protocols. This renders it an extremely important subject of evidence-based practice (EBP) and intervention. These gaps will be important in the improvement of clinical outcomes and the quality of life of the patients with recurrent breast cancer through this project.

Among the key clinical gaps revealed based on the observations, the lack of coordination among various healthcare providers can be pointed out. Although the oncologists are concerned with medical management, patients usually lack adequate services regarding the provision of emotional counseling, symptom management, and primary care/specialist integration services. Most patients in the clinic have complained of a lack of consistency in follow-up visits as well as psychological support to enable them to bear the psychological stress associated with recurrent cancer. This failure to coordinate care is why it usually creates an uncoordinated treatment plan that makes the patient feel not supported, medically and psychologically.

This evidence-based project is also important due to such studies as the importance of psychosocial support in cancer care in the research. Research has indicated that the survivors of breast cancer, especially those who have a recurring cancer, are at risk of depression, anxiety, and distress. A research study performed in one of the cities revealed that 4 out of 10 breast cancer victims show a high degree of psychological distress, and victims with the recurrence of cancer report more anxiety (Sohrabei et al., 2024). Neglecting these psychological needs will result in poorer clinical consequences, and the patient might fail to comply with the treatment regimen because of mental issues.

In addition, breast cancer is also characterized by intermittent and costly pre- and post-treatment regimes, which have to be carefully monitored and modified. Due to the availability of resources or a lack of coordination among the healthcare providers, the implementation of innovative diagnostic technologies and bespoke treatment programs might be obstructed (Hu, 2022). This points to the robustness of the system of care toward more holistic provision of support, which combines clinical and emotional assistance as a way to meet multidimensional needs of patients.

The studies on the management of recurrent breast cancer have been numerous, but that does not say that they are perfect, as there are still loopholes in projecting the most comprehensive study on breast cancer management. Evidence-based models have proven that multidisciplinary teams are capable of increasing patient outcomes by applying both the physical and the emotional requirements of patients (Franzoi et al., 2025). Nevertheless, they are not always implemented consistently into various clinical environments, therefore failing to provide an opportunity to achieve better patient satisfaction and clinical outcomes.

The nursing profession will be added to this evidence-based project by improving the quality of care for patients with recurrent breast cancer, filling in the care gaps, facilitating coordination with other healthcare providers, and adding psychosocial support for the patients in the care plan. This way, it will conform to the objectives of the nursing profession, such as holistic care practice, patient-centered practice, and better patient outcomes.

 

 

 

References

Hu, K. (2022).  Psychological distress and breast cancer: a bidirectional link. Karolinska Institutet (Sweden). https://search.proquest.com/openview/de7854730fe5d3da28536a211c7197ae/1?pq-origsite=gscholar&cbl=2026366&diss=y

Sohrabei, S., Moghaddasi, H., Hosseini, A., & Ehsanzadeh, S. J. (2024). Investigating the effects of artificial intelligence on the personalization of breast cancer management: a systematic study.  BMC cancer,  24(1), 852. https://link.springer.com/article/10.1186/s12885-024-12575-1

Franzoi, M. A., Janni, W., Erdmann-Sager, J., Kline-Quiroz, C., Schäffler, H., Pfister, K., … & Luis, I. V. (2025). Long-Term Follow-Up Care After Treatment for Primary Breast Cancer: Strategies and Considerations.  American Society of Clinical Oncology Educational Book,  45(3), e473472. https://ascopubs.org/doi/abs/10.1200/EDBK-25-473472

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Improving Care for Recurrent Breast Cancer Patients: A Microsystem Approach

Name

Instructor

School

Date

Improving Care for Recurrent Breast Cancer Patients: A Microsystem Approach

Among the provisions in the readings this week, the chapter in the Clinical Microsystems Greenbook that corresponds the most to my project topic of recurrent breast cancer is the chapter on improving care to the patients with chronic illness. Recurrent breast cancer is a complex and chronic ailment that requires regular and all-encompassing care management. The chapter provides the framework on how to enhance the care of patients at the microsystem level: in interdependent teams of small size (healthcare professionals) where the provision of care is personalized. It is notable that this concept especially applies to recurrent breast cancer, whereby patients may have long-term follow-up, need management of various symptoms, and may need adjustment of the treatment plans.

The microsystem approach focuses more on the patient engagement that is important in the repeated breast cancer management. Patients have to deal with constant treatment and emotional issues, and therefore, it is essential to think about how they see the situation and include their own preferences in the course of treatment. As one example, through regular reassessment of physical and emotional needs and engaging patients with the decision-making process, clinicians will be able to create more efficient plans of care that would be based on the unique needs of a particular patient (Fathiya et al., 2023).

More than that, the focus on the usage of data on monitoring the process and the improvement of processes constantly is noted in the chapter, and it can be directly applied to my project. In case of recurrent cases of breast cancer, information regarding the effectiveness of treatments, recurrence, and, in general, the quality of life may be gathered and frequently analyzed to adjust clinical methods and guarantee the best roles. With the help of this microsystem concept, healthcare teams will greatly transform their collaboration to meet the many needs of recurrent breast cancer patients in terms of structure and functioning as well as to finally improve patient outcomes.

This reading has applied strong footing in implementing change in my project because it puts importance on individualized care, collaboration between teams, and application of data-driven changes, which all play an important role in enhancing care and treatment of breast cancer episodes.

References

Fathiya, L. Y., Siswanto, A., Diah, P., & Chlara, Y. P. (2023). Empowerment-Based Palliative Care to Improve Psychological Well Being and Quality of Life in Women with Breast Cancer.  International Journal of Scientific Multidisciplinary Research (IJSMR),  1(8), 1085-1102. http://repository.um-surabaya.ac.id/id/eprint/8341

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Integrating Psychosocial Support in Recurrent Breast Cancer Care

Name: Milena Lopez Hernandez

Instructor: Guelsy Diaz

School: West Coast University

Date: 8/17/2025

Integrating Psychosocial Support in Recurrent Breast Cancer Care

I. Introduction

Breast cancer has been known to be one of the greatest causes of mortality and morbidity in women across the world. Recurrent breast cancer poses even further challenges, especially on the psychosocial level, including anxiety and depression that play a significant role in negatively impacting quality of life and compliance rates of patients. This clinical change planning aims to introduce a patient-involved holistic intervention of clinical care in cooperation with a psychosocial intervention. The project will treat the psychological needs of recurrent breast cancer using two principal theoretical frameworks, the Health Belief Model (HBM) and the Bio-Psychosocial Model, and improve their level of response to treatment.

The intervention will be aimed at enhancing the female standards of living by taking care of their physical and emotional aspects. This project guarantees the holistic approach to the treatment of breast cancer because of the involvement of the Advanced Practice Registered Nurses (APRN). This intervention conforms with the research problem, which focuses on the necessity of more exhaustive cancer survivorship models for breast cancer survivors, especially those who have a recurrence. Such combined strategies are supposed to target the imperfections in the standards of the current care provision and enhance patient outcomes (Mehrabizadeh et al., 2024; Kahan et al., 2022).

II. Clarification of the Issue

The intricate problems experienced by women with repeat breast cancer are handled in this project, which does not center solely on the comeback of the disease itself but on the psychosocial issues that come with it as well. Fear, depression, and confusion on the part of the patient may make the treatment difficult to follow and may complicate recovery and survival. These psychosocial concerns are imperative to discuss to enhance patient outcomes and the experiences of breast cancer survivors in general.

Women with a relapse of breast cancer experience more physical and emotional loads, such as the fear of metastases, short- and long-term effects of the treatment, and social loneliness. All these variables directly influence clinical results because the patients may procrastinate, lack compliance, or withhold supportive care (King et al., 2024). Moreover, the disadvantages in health conditions of underserved populations aggravate the situation of these women. Members of racial and other minorities, low-income patients, and patients in rural locations cannot resort to the psychosocial support and healthcare facilities to provide comprehensive care (Wells et al., 2022).

The intervention involves the combination of clinical care and psychosocial support following the Health Belief Model, which focuses on the effect of perception on health behaviors, and the Bio-Psychosocial Model, which considers the level of emotional and social contexts of health (Mehrabizadeh et al., 2024). This sort of holistic practice will most presumably increase the compliance of the patients to the treatment, their good quality of life, and clinical outcomes occurrence.

III. Proposed Solutions or Interventions

The suggested intervention combines clinical treatment as well as psychosocial assistance and provides the whole picture of the recurrent breast cancer management. Using the Health Belief Model (HBM) and Bio-Psychosocial Model, the intervention will target the physical as well as emotional needs. The HBM will evaluate the patient perception of the risk of recurrence and the value of treatment so that the intervention will address the attitude towards the psychosocial support and compliance with the treatment (Mehrabizadeh et al., 2024).

The Bio-Psychosocial Model will make sure that the care plan reflects the emotional, psychological, and social needs of the patients and offers counseling sessions, group therapy, and support networks to minimize the incidence of anxiety and depression (Kahan et al., 2022). Learning will also be an important element, and it will involve discussing the role that mental health plays in persistent therapy and recovery.

Research demonstrates that incorporating psychosocial support into clinical care better helps the health outcomes to improve adherence to the treatment and decrease stress levels (Wells et al., 2022; Kahan et al., 2022). It is studied that this type of holistic care model, especially in underserved patients, is able to also increase the perception by patients of their quality of life. It is best to integrate the mentioned components and have a general solution that can correct both clinical and emotional issues in the care of recurrent breast cancer.

IV. Comparison of Other Views on the Problem and Solutions

Such psychological counseling or cognitive-behavioral therapy (CBT) is described as another intervention in the literature in order to handle psychological issues of anxiety and depression that are widespread in this population. Although these approaches are effective in terms of offering emotional support, they deal much with psychological well-being and do not take into account the overall needs of the clinical care (King et al., 2024).

Support groups and peer counseling are other methods that also decrease isolation, but their interventions are not suggested to be linked closely with clinical care, as is necessary with women with repeated breast cancer (Mehrabizadeh et al., 2024).

In comparison, the suggested intervention offers an overall combination of psychosocial and clinical care, which offers a complete approach to the requirements of patients. This intervention, unlike other solutions, focuses on the cooperation of healthcare providers, mental health professionals, and community agencies that will contribute to adherence to treatment and increasing the overall improvement in the patient population's quality of life. Such a holistic and patient-centered model is providing a stronger solution regarding the more emotional and physical process of the recurring breast cancer.

V. The Role of Advanced Practice Registered Nurses (APRN) in the Intervention

APRNs are essential in the success of this intervention because they monitor the clinical and psychosocial care that was to be given to the recurring breast cancer patients. APRNs are trained at a higher level and thus capable of evaluating complicated needs and organizing comprehensive care that considers both physical and emotional parts of health conditions.

By thoroughly assessing the patients based on the Health Belief Model, APRNs will be able to determine how patients felt about their condition and their participation in the treatment (Mehrabizadeh et al., 2024). Through the Bio-Psychosocial Model, they will be able to make sure the care plan focuses on the emotional, psychological, and social needs of every patient, which will play a pivotal role in ensuring their treatment adherence and the decrease of distress (Kahan et al., 2022).

The collaboration between mental health professionals and community agencies will also come smooth since APRNs will participate to make sure that psychosocial care is part of the treatment plan. This comprehensive solution will cover both physical as well as emotional and social aspects involved in the disease to influence its recovery.

Another critical role of APRNs is to check the intervention and modify it per feedback made by the patient. Gathering these data on treatment adherence, quality of life, and psychosocial well-being, they will have an opportunity to adjust the intervention where necessary to keep it effective.

APRNs can also experience difficulties, which include lack of sufficient resources or patients resisting participation in psychosocial care, even though APRNs are necessary to the proper functioning of healthcare organizations. In order to overcome them, APRNs could lobby for access to support services as well as educate about the positive effect of integrated care. Their management and vindication will play a key role in breaking through the obstacles and making the intervention successful.

VI. Data Collection Methods and Analysis

In order to evaluate the efficiency of the intervention, the data will be collected with the help of surveys and interviews. The perception about psychosocial well-being, adherence, and quality of life of the patients will be surveyed both pre- and post-intervention. To obtain both the quantitative and qualitative data, both Likert-scale and open-ended questions will be used. Participants will include patients and medical staff members who will be interviewed to obtain in-depth information about psychosocial care, therapeutic results, and adherence challenges (Giaquinto et al., 2024).

The techniques are selected to measure clinical and psychosocial outcomes. Surveys will present a wide, quantitative picture, and interviews will offer qualitative information that can be used to bring out the details of the experiences of patients. The kind of analysis that will be done on the data is qualitative analysis on the interview data and quantitative analysis on the survey data using statistical software such as SPSS to find trends and establish the state of statistical significance. 

Convenience sampling will be chosen in the sampling, which will exclude women with recurrent breast cancer in oncology clinics and community support programs. The participants should be 18 years of age or older and under treatment. This sampling technique will be suitable, since the sample will represent the population that is at risk of recurrent breast cancer.

VII. Potential Limitations of the Intervention

Various constraints could be involved in the collection, implementation, and patient participation. The barriers can be significant, both social and financial, since patients can be having troubles with access to psychosocial support, counseling, and transport. There is also a potential limitation of limited resources that might limit the intervention to all different groups, especially underserved groups.

In order to overcome these obstacles, the intervention will consider partnering with community organizations, social workers, and mental health professionals to make sure that patients will be provided with the required resources. Telehealth opportunities are to be put into consideration in order to enable patients in the remotest geographic areas to engage.

It may also be an issue to balance between psychosocial and clinical care that APRNs can face because of the lack of resources and patient reluctance to partake in psychosocial care. The following challenges will be mitigated through training and continued education of APRNs whereby they will be efficient in delivering integrated care. Incorporation of other healthcare professionals will aid the provision of comprehensive care by the APRNs even with scarce resources.

VIII. Filling Gaps in Understanding the Research Problem

This intervention is filling the gaps in knowledge concerning the combination of clinical treatment and psychosocial support of the patients with repeated breast cancer. The psychosocial requirements of breast cancer survivors, especially in recurrent disease survivors, have not received much attention or documentation, whereas breast cancer clinical treatment has been documented well. The goal of the project is to provide a more thorough insight into the influence that emotional well-being has on clinical outcomes.

Also, the intervention would be relevant to the broader area of oncology since it promotes multidisciplinary intervention that integrates APRNs, mental health professionals, and community agencies in the care of patients with cancer. These roles together are not used to full effect in numerous environments and are central to better patient results.

Over the long term, such intervention might enhance patient outcome with respect to enhancing good compliance with treatment as well as suppressing psychosocial distress. The model would also help eliminate the difference in healthcare provision since it would give access to underserved populations in integrated care and eventually increase the overall survival of breast cancer patients.

IX. Conclusion

The offered intervention to recurrent breast cancer care is the combination of both clinical and psychosocial assistance that provides holistic care to the women with recurrent breast cancer. The intervention based on the Health Belief Model and Bio-Psychosocial Model is expected to increase the adherence to the treatment, decrease levels of anxiety and depression, and raise the level of the quality of life.

The research problem is directly related to the intervention since it seeks to support the need to have comprehensive care models in the survivorship of breast cancer, especially in the aspect of recurrence among women. Engagement with APRNs, community agencies, and mental health professionals will make it so that psychosocial care can be easily incorporated into the clinical process of treatment.

Perhaps the long-term effects of this integrated care model were not empirically checked and should be examined in the future, especially in the underserved community. Scaling up this model to other types of cancer services would help enhance the results in different patients. This intervention can leave a permanent mark on breast cancer care and survivorship.

References

Giaquinto, A. N., Sung, H., Newman, L. A., Freedman, R. A., Smith, R. A., Star, J., … & Siegel, R. L. (2024). Breast cancer statistics 2024. CA: A Cancer Journal for Clinicians, 74(6), 477-495. https://acsjournals.onlinelibrary.wiley.com/doi/abs/10.3322/caac.21863

Kahan, Z., Szanto, I., Dudas, R., Kapitany, Z., Molnar, M., Koncz, Z., & Mailath, M. (2022). Breast cancer survivorship programme: Follow-up, rehabilitation, psychosocial oncology care. 1st Central-Eastern European professional consensus statement on breast cancer. Pathology and Oncology Research, 28, 1610391. https://pmc.ncbi.nlm.nih.gov/articles/PMC9200958/

King, R., Stafford, L., Butow, P., Giunta, S., & Laidsaar-Powell, R. (2024). Psychosocial experiences of breast cancer survivors: A meta-review. Journal of Cancer Survivorship, 18(1), 84-123. https://link.springer.com/article/10.1007/s11764-023-01336-x

Mehrabizadeh, M., Zaremohzzabieh, Z., Zarean, M., Ahrari, S., & Ahmadi, A. R. (2024). Narratives of resilience: Understanding Iranian breast cancer survivors through health belief model and stress-coping theory for enhanced interventions. BMC Women's Health, 24(1), 552. https://link.springer.com/article/10.1186/s12905-024-03383-7

Wells, K. J., Drizin, J. H., Ustjanauskas, A. E., Vázquez-Otero, C., Pan-Weisz, T. M., Ung, D., … & Quinn, G. P. (2022). The psychosocial needs of underserved breast cancer survivors and perspectives of their clinicians and support providers. Supportive Care in Cancer, 30(1), 105-116. https://link.springer.com/article/10.1007/s00520-021-06286-7

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Integrating Theoretical Frameworks in Breast Cancer Care

Name

Instructor

School

Date

Integrating Theoretical Frameworks in Breast Cancer Care

The variables that I will use as far as my change project is concerned include the Health Belief Model