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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

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

i. Clinical Setting and Problem Description

The clinical practice setting for this PICOT-based problem identification is an oncology clinic that focuses on the treatment of recurrent breast cancer. The clinic provides follow-up care for patients who have experienced breast cancer recurrence after prior anticancer treatments. This specialty area of oncology presents multiple challenges, including complex treatment plans, ongoing psychological distress, and the need for continuous monitoring to detect and address cancer recurrence promptly.

The clinic serves a large metropolitan area with a diverse and dense population, including a significant proportion of underserved individuals. Most patients are adults over the age of 40, many of whom are experiencing a recurrence after completing initial breast cancer treatment. The clinic population includes a high number of individuals with low socioeconomic status and those facing barriers to care, such as lack of insurance, transportation challenges, and cultural or language obstacles. Minority and underserved groups are highly represented, which contributes to health disparities and complicates access to care.

Several recurrent issues are evident in the clinic. These include the absence of individualized care plans for recurrent breast cancer, poor coordination among different healthcare providers, and inadequate attention to the emotional and psychological aspects of the disease. The emotional burden of recurrence is profound, yet mental health needs often remain overlooked while the focus stays narrowly on clinical treatment. Additionally, consistent monitoring of patients with recurrent breast cancer requires continuous surveillance and advanced diagnostic resources, which are not always available or well-integrated into care.

ii. Problem Statement and Target Population

The identified problem is the insufficient and fragmented care provided to patients with recurrent breast cancer in this oncology clinic. These gaps include both inadequate clinical management and lack of emotional support, which contribute to poorer survival outcomes and diminished quality of life.

The target population consists of adult women diagnosed with recurrent breast cancer and their families, who often play an essential role in the care process. This problem is multidimensional—clinical, psychological, and socio-cultural. Clinically, patients face the difficulty of living with a long-term disease, managing side effects, and needing personalized treatment strategies. Psychologically, they experience high levels of anxiety, depression, and fear regarding the recurrence of their cancer. Socially, they often struggle with low socioeconomic status, reduced access to care, and cultural or linguistic barriers to receiving treatment.

Addressing recurrent breast cancer care requires comprehensive and multidisciplinary approaches. By developing an evidence-based project, it will be possible to create a more effective care model that addresses not only the clinical treatment of the disease but also the emotional well-being and social needs of this vulnerable population—especially those in underserved communities.

iii. Significance of the Evidence-Based Project

Recurrent breast cancer is a major concern in oncology, yet there is a lack of standardized protocols and integrated care models for managing it effectively. This gap highlights the importance of developing an evidence-based practice (EBP) project aimed at improving outcomes and quality of life for this patient population.

One critical gap is the lack of care coordination among multiple healthcare providers. Oncologists often focus solely on medical management, leaving gaps in emotional counseling, symptom management, and integration with primary or supportive care. Many patients report inconsistent follow-up visits and limited psychological support, which contributes to a sense of abandonment and increased distress during recurrence. Without coordinated, patient-centered care, treatment plans can become fragmented and less effective.

There is strong evidence supporting the importance of psychosocial support in cancer care. Research shows that survivors with recurrent breast cancer experience higher rates of depression, anxiety, and psychological distress than those without recurrence. For example, Sohrabei et al. (2024) found that approximately 40% of breast cancer survivors report significant psychological distress, and those with recurrence exhibit even higher anxiety levels. Neglecting these psychological needs not only worsens mental health but can also undermine adherence to treatment regimens.

Additionally, recurrent breast cancer requires ongoing, costly, and carefully monitored treatment strategies. Limited resources, lack of access to new diagnostic technologies, and poor provider coordination can hinder the development of individualized care plans (Hu, 2022). These challenges underscore the need for a more holistic model of care that integrates both clinical management and psychosocial support.

Evidence-based studies have demonstrated that multidisciplinary care teams improve patient outcomes by addressing both physical and emotional needs (Franzoi et al., 2025). However, such approaches are not consistently implemented across clinical settings, leaving many patients without access to comprehensive care.

Nurses play a vital role in filling these gaps by providing patient-centered, holistic care, coordinating with other providers, and ensuring that psychosocial support is included as part of the overall care plan. This aligns with the nursing profession’s core goals of improving patient outcomes, promoting quality of care, and addressing the multifaceted needs of patients with complex chronic illnesses such as recurrent breast cancer.

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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