Assignment Prompt & Instructions
– ## IntgrativeLiteratureReviewinstructions.docx
– ## ProblemIdentificationandDescriptionUsingPICOTFormat21.docx
**## IntgrativeLiteratureReviewinstructions.docx**
Much effort should be devoted to this section as it is
**a key component of your work**. This should be a synthesis of the literature, not a catalog of studies or simply an analysis of the research you discover.
1. Perform a literature review using a minimum of seven (7) peer-reviewed articles and books, as well as non-research literature such as evidence-based guidelines, toolkits, standardized procedures, etc.
2. Review of areas in relationship to medicine, nursing, public health, etc.
1. The review should be critical and synthesize rather than just being a catalog of studies.
3. Summarize the key findings of the research and its relevancy to your project that point out the scientific status of the phenomenon under question. Such a statement includes:
1. What we know and how well we know it.
2. What we do not know.
4. Describe any gaps in knowledge that you found and the effects this may have on advanced practice nursing as it relates to your project topic.
Your integrative literature review should be 5–6 pages in length, not including the cover or reference pages. You must reference a minimum of 7 scholarly articles published within the past 5–7 years.
Use current APA format to style your paper and to cite your sources. Review the rubric for more information on how the assignment will be graded.
**FEEDBACK FROM PROFESSOR:**
**Your assignment demonstrates a clear understanding of the clinical setting and the problem at hand. You've identified a relevant issue within the patient population and articulated the clinical gap well. Your ability to analyze the problem from multiple perspectives shows thoughtful engagement. Keep refining the PICOT as needed along the way once you start your Literature Review. Now is the time to tweak it if you see that you cannot find too much information on the topic or specifications that you chose, this is the last chance to edit it. Every paper after this will be about your chosen PICOT and cannot be changed after week 3. Thank you!**
**Remember you must include the actual PICOT format with your project question included.**
**For example, In adults aged 30–65 years living in medically underserved communities with a diagnosis of hypertension (P), does the**
**implementation of a nurse-led, culturally tailored hypertension management program (I), compared to standard care (C), result in improved blood pressure control (O) over 12 weeks (T)?**
**## ProblemIdentificationandDescriptionUsingPICOTFormat21.docx**
2
**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](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](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](https://ascopubs.org/doi/abs/10.1200/EDBK-25-473472)
**## ProblemIdentificationandDescriptionUsingPICOTFormat21.docx**
2
**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](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](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](https://ascopubs.org/doi/abs/10.1200/EDBK-25-473472)
**## IntgrativeLiteratureReviewinstructions.docx**
Much effort should be devoted to this section as it is
**a key component of your work**. This should be a synthesis of the literature, not a catalog of studies or simply an analysis of the research you discover.
1. Perform a literature review using a minimum of seven (7) peer-reviewed articles and books, as well as non-research literature such as evidence-based guidelines, toolkits, standardized procedures, etc.
2. Review of areas in relationship to medicine, nursing, public health, etc.
1. The review should be critical and synthesize rather than just being a catalog of studies.
3. Summarize the key findings of the research and its relevancy to your project that point out the scientific status of the phenomenon under question. Such a statement includes:
1. What we know and how well we know it.
2. What we do not know.
4. Describe any gaps in knowledge that you found and the effects this may have on advanced practice nursing as it relates to your project topic.
Your integrative literature review should be 5–6 pages in length, not including the cover or reference pages. You must reference a minimum of 7 scholarly articles published within the past 5–7 years.
Use current APA format to style your paper and to cite your sources. Review the rubric for more information on how the assignment will be graded.
**FEEDBACK FROM PROFESSOR:**
**Your assignment demonstrates a clear understanding of the clinical setting and the problem at hand. You've identified a relevant issue within the patient population and articulated the clinical gap well. Your ability to analyze the problem from multiple perspectives shows thoughtful engagement. Keep refining the PICOT as needed along the way once you start your Literature Review. Now is the time to tweak it if you see that you cannot find too much information on the topic or specifications that you chose, this is the last chance to edit it. Every paper after this will be about your chosen PICOT and cannot be changed after week 3. Thank you!**
**Remember you must include the actual PICOT format with your project question included.**
**For example, In adults aged 30–65 years living in medically underserved communities with a diagnosis of hypertension (P), does the**
**implementation of a nurse-led, culturally tailored hypertension management program (I), compared to standard care (C), result in improved blood pressure control (O) over 12 weeks (T)?**
**## ProblemIdentificationandDescriptionUsingPICOTFormat21.docx**
2
**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](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](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](https://ascopubs.org/doi/abs/10.1200/EDBK-25-473472)
**## IntgrativeLiteratureReviewinstructions.docx**
Much effort should be devoted to this section as it is
**a key component of your work**. This should be a synthesis of the literature, not a catalog of studies or simply an analysis of the research you discover.
1. Perform a literature review using a minimum of seven (7) peer-reviewed articles and books, as well as non-research literature such as evidence-based guidelines, toolkits, standardized procedures, etc.
2. Review of areas in relationship to medicine, nursing, public health, etc.
1. The review should be critical and synthesize rather than just being a catalog of studies.
3. Summarize the key findings of the research and its relevancy to your project that point out the scientific status of the phenomenon under question. Such a statement includes:
1. What we know and how well we know it.
2. What we do not know.
4. Describe any gaps in knowledge that you found and the effects this may have on advanced practice nursing as it relates to your project topic.
Your integrative literature review should be 5–6 pages in length, not including the cover or reference pages. You must reference a minimum of 7 scholarly articles published within the past 5–7 years.
Use current APA format to style your paper and to cite your sources. Review the rubric for more information on how the assignment will be graded.
**FEEDBACK FROM PROFESSOR:**
**Your assignment demonstrates a clear understanding of the clinical setting and the problem at hand. You've identified a relevant issue within the patient population and articulated the clinical gap well. Your ability to analyze the problem from multiple perspectives shows thoughtful engagement. Keep refining the PICOT as needed along the way once you start your Literature Review. Now is the time to tweak it if you see that you cannot find too much information on the topic or specifications that you chose, this is the last chance to edit it. Every paper after this will be about your chosen PICOT and cannot be changed after week 3. Thank you!**
**Remember you must include the actual PICOT format with your project question included.**
**For example, In adults aged 30–65 years living in medically underserved communities with a diagnosis of hypertension (P), does the**
**implementation of a nurse-led, culturally tailored hypertension management program (I), compared to standard care (C), result in improved blood pressure control (O) over 12 weeks (T)?**
**## ProblemIdentificationandDescriptionUsingPICOTFormat21.docx**
2
**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](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](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](https://ascopubs.org/doi/abs/10.1200/EDBK-25-473472)
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