Impact of a novel nurse-led prechemotherapy education intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs: results from a randomised, controlled trial

A review of question prompt lists used in the oncology setting with comparison to the Patient Concerns Inventory

A question prompt list (QPL) is a simple and inexpensive communication tool used to facilitate patient participation in medical consultations. The QPL is composed of a structured list of questions and has been shown to be an effective way of helping ensure patients' individual information needs are appropriately met. This intervention has been investigated in a variety of settings but not specifically head and neck cancer (HNC). The aim of this paper was to perform a narrative review of literature reporting the use of a QPL for oncology patients and to draw comparison to the Patient Concerns Inventory (PCI-HN). The databases Scopus, PubMed and MEDLINE were searched using the key terms 'question prompt list', 'question prompt sheet', 'cancer' and 'oncology'. Of 98 articles hand searched, 30 of which were found to meet all inclusion criteria, and described in a tabulated summary. The studies concluded that the QPL was an effective intervention, enabling active patient participation in medical consultations. The PCI-HN is specific for HNC and differs from many QPLs, which are more general cancer tools. The QPL approach should prove to be a useful intervention for HNC sufferers, however further research into the clinical utility is required.

Effect on Symptom Management Education Receiving Patients of Chemotherapy

The study of a planned education in patients receiving chemotherapy can alleviate the side effects of chemotherapy and, thus, can increase the quality of the patients' lives. In accordance with this view, this study was conducted with the purpose of examining the effect of planned education given to patients receiving chemotherapy on their symptom control. The study was quasi-experimental. A sample of 140 patients participated, of which 70 were in the experimental group and 70 were in the control group. A patient data form and the chemotherapy symptom assessment scale (C-SAS) were used in order to collect the data. Median, Mann-Whitney U test, and Wilcoxon signed rank test were used to analyze the data. There were statistically significant decreases in the frequencies of the following symptoms: nausea, vomiting, feeling distressed/anxious, feeling pessimistic and unhappy, unusual fatigue, and difficulty sleeping. Also, there were statistically significant decreases in the severity of the 11 symptoms and on the discomfort levels of these symptoms. In the study, the planned education provided by the health-care providers had a positive effect on the symptom control of patients receiving chemotherapy.

The effect of individualized patient education, along with emotional support, on the quality of life of breast cancer patients - A pilot study

PURPOSE

This study aimed to determine the effect of individualized patient education along with emotional support on the quality of life (QoL) of breast cancer patients undergoing chemotherapy. It also aimed to determine the intervention's feasibility in the Pakistani context.

METHODS

A quasi-experimental design, with pre- and post-test, in two groups, via time block, was used. The study was conducted at a public hospital in Karachi with a sample of 50 patients; 25 patients each in the intervention and control group. The intervention was delivered over a period of six weeks. It comprised verbal and written patient education, availability of a nurse during patients' chemotherapy administration and over the telephone, and a telephone follow-up of the patients by the nurse. patients' QoL was assessed at baseline and at the sixth week of receiving chemotherapy.

RESULTS

Tests indicated a significant improvement in the overall QoL, breast cancer subscale scores, and the physical and emotional well-being of the intervention group, as compared to the control group. The intervention effect size was moderate (0.655) for the QoL.

CONCLUSION

The intervention was found to be effective in improving patients' QoL. However, a larger study, in a multi-center setting, is recommended to ascertain the findings of this pilot study.

The validity and reliability of the Korean version of the Cancer-chemotherapy Concerns Rating Scale

OBJECTIVE

The Cancer-chemotherapy Concerns Rating Scale was developed in Japan for outpatients undergoing chemotherapy, and its validity and reliability have been reported. The purpose of the study was to test the reliability and validity of the Korean version of the Cancer-chemotherapy Concerns Rating Scale.

METHODS

The questionnaire was filled out by 199 cancer patients, who were currently undergoing outpatient chemotherapy. The data were analyzed using exploratory factor analysis with Promax Rotation to determine the factor construct validity. The reliability of the Cancer-chemotherapy Concerns Rating Scale was investigated by Cronbach's alpha and the Spearman Brown coefficient.

RESULTS

Four factors were obtained and the overall structure was similar to that of the Japanese version; reorganization of daily life, self-existence, disease progress, and social and economic concerns. Cronbach's alpha for the total scale was 0.91 and the Spearman Brown coefficient was 0.85.

CONCLUSIONS

We found that the Korean version of the Cancer-chemotherapy Concerns Rating Scale could be clinically useful. It could provide health-care providers with information useful to understand the psychological state of patients undergoing outpatient chemotherapy.

The Patient Remote Intervention and Symptom Management System (PRISMS) - a Telehealth- mediated intervention enabling real-time monitoring of chemotherapy side-effects in patients with haematological malignancies: study protocol for a randomised controlled trial

Background

Outpatient chemotherapy is a core treatment for haematological malignancies; however, its toxicities frequently lead to distressing/potentially life-threatening side-effects (neutropenia/infection, nausea/vomiting, mucositis, constipation/diarrhoea, fatigue). Early detection/management of side-effects is vital to improve patient outcomes, decrease morbidity and limit lengthy/costly hospital admissions. The ability to capture patient-reported health data in real-time, is regarded as the ‘gold-standard’ to allow rapid clinical decision-making/intervention. This paper presents the protocol for a Phase 3 multi-site randomised controlled trial evaluating a novel nurse-led Telehealth intervention for remote monitoring/management of chemotherapy side-effects in Australian haematological cancer patients.

Methods/Design

Two hundred and twenty-two patients will be recruited from two hospitals. Eligibility criteria include: diagnosis of chronic lymphocytic leukaemia/Hodgkin’s/non-Hodgkin’s lymphoma; aged ≥ 18 years; receiving ≥ 2 cycles chemotherapy. Patients will be randomised 1:1 to either the control or intervention arm with stratification by diagnosis, chemotherapy toxicity (high versus low), receipt of previous chemotherapy and hospital. Patients allocated to the control arm will receive ‘Usual Care’ whilst those allocated to the intervention will receive the intervention in addition to ‘Usual Care’. Intervention patients will be provided with a computer tablet and software prompting twice-daily completion of physical/emotional scales for up to four chemotherapy cycles. Should patient data exceed pre-determined limits an Email alert is delivered to the treatment team, prompting nurses to view patient data, and contact the patient to provide clinical intervention. In addition, six scheduled nursing interventions will be completed to educate/support patients in use of the software. Patient outcomes will be measured cyclically (midpoint and end of cycles) via pen-and-paper self-report alongside review of the patient medical record. The primary outcome is burden due to nausea, mucositis, constipation and fatigue. Secondary outcomes include: burden due to vomiting and diarrhoea; psychological distress; ability to self-manage health; level of cancer information/support needs and; utilisation of health services. Analyses will be intention-to-treat. A cost-effectiveness analysis is planned.

Discussion

This trial is the first in the world to test a remote monitoring/management intervention for adult haematological cancer patients receiving chemotherapy. Future use of such interventions have the potential to improve patient outcomes/safety and decrease health care costs by enabling early detection/clinical intervention.

Trial registration

ACTRN12614000516684.

Date registered: 12 March 2014 (registered retrospectively).

Women with breast cancer: self-reported distress in early survivorship

PURPOSE/OBJECTIVES

To identify and compare levels of distress and sources of problems among patients with breast cancer in early survivorship.

DESIGN

Descriptive, cross-sectional.

SETTING

A National Cancer Institute-designated comprehensive cancer center.

SAMPLE

100 breast cancer survivors were selected to represent four time points in the cancer trajectory.

METHODS

Distress was self-reported using the Distress Thermometer and its 38-item problem list. Analysis of variance and chi-square analyses were performed as appropriate.

MAIN RESEARCH VARIABLES

Distress scores, problem reports, and time groups.

FINDINGS

Participants scored in range of the cutoff of more than 4 (range = 4.1-5.1) from treatment through three months post-treatment. At six months post-treatment, distress levels were significantly lower. Significant differences were found between groups on the total problem list score (p = 0.007) and emotional (p = 0.01) and physical subscale scores (p = 0.003).

CONCLUSIONS

Comparison of groups at different points in the cancer trajectory found similar elevated levels from diagnosis through three months. Distress remained elevated in early survivorship but significantly decreased at six months post-treatment.

IMPLICATIONS FOR NURSING

Interventions to reduce or prevent distress may improve outcomes in early survivorship.

Developing an Evidence-Based, Nurse-Led Psychoeducational Intervention With Peer Support in Gynecologic Oncology

BACKGROUND

The physical and psychosocial impact of radiotherapy for gynecologic cancer requires complex interventions to address treatment-related, psychosocial, and psychosexual and survivorship needs. A multidisciplinary approach is required to address these needs, but standard practice is varied and lacks a sound evidence base.

OBJECTIVE

The aim of this study was to describe the process of development and pilot testing of a novel evidence-based, complex psychoeducational intervention aiming to improve psychosocial outcomes for gynecologic-oncology patients treated curatively with radiotherapy.

METHODS

The intervention combines tailored nursing consultations with telephone peer support pretreatment, midtreatment, end of treatment, and posttreatment. The UK Medical Research Council framework for developing complex interventions was used to produce an evidence-based, feasible, and acceptable intervention.

RESULTS

Intervention manuals and study materials were informed by literature reviews of best-available evidence, relevant theory, and iterative consumer and expert consultations. The nurse manual specified content for consultations providing self-care information, coaching tailored to individual needs, and multidisciplinary care coordination. The peer manual described phone consultations aimed at providing psychosocial support and encouraging adherence to self-care strategies. Three peers and 1 nurse underwent rigorous skills and knowledge-based intervention delivery training. The intervention was pilot tested with 6 patients. Qualitative feedback led to minor design and content changes.

CONCLUSIONS

The intervention was found to be feasible, relevant, and acceptable to participants and clinicians and is currently being tested in a national randomized controlled trial (PeNTAGOn).

IMPLICATIONS FOR PRACTICE

The Medical Research Council framework is useful in developing nursing interventions. The specific methods and strategies described are useful for designing future complex studies targeting patient supportive care.

Protocol for the RT Prepare Trial: a multiple-baseline study of radiation therapists delivering education and support to women with breast cancer who are referred for radiotherapy

INTRODUCTION

There is limited evidence to guide the preparation of patients for radiotherapy. This paper describes the protocol for an evaluation of a radiation therapist led education intervention delivered to patients with breast cancer in order to reduce psychological distress.

METHODS

A multiple-baseline study is being used. Usual care data is being collected prior to the start of the intervention at each of three sites. The intervention is delivered by radiation therapists consulting with patients prior to their treatment planning and on the first day of treatment. The intervention focuses on providing sensory and procedural information to patients and reducing pretreatment anxiety. Recruitment is occurring in three states in Australia. Eligible participants are patients who have been referred for radiotherapy to treat breast cancer. 200 patients will be recruited during a usual care phase and, thereafter, 200 patients in the intervention phase. Measures will be collected on four occasions-after meeting with their radiation oncologist, prior to treatment planning, on the first day of treatment and after treatment completion. The primary hypothesis is that patients who receive the radiotherapy preparatory intervention will report a significantly greater decrease in psychological distress from baseline to prior to radiotherapy treatment planning in comparison with the usual care group. Secondary outcome measures include concerns about radiotherapy, patient knowledge of radiotherapy, patient preparedness and quality of life. Patient health system usage and costs will also be measured. Multilevel mixed effects regression models will be applied to test for intervention effects.

ETHICS

Ethics approval has been gained from Curtin University and the three recruiting sites.

DISSEMINATION

Results will be reported in international peer reviewed journals.

TRIAL REGISTRATION NUMBER

Australian and New Zealand Clinical Trials Registration: ACTRN12611001000998.

Evidence-Based Self-care Guidelines for People Receiving Chemotherapy: Do They Reduce Symptom Burden and Psychological Distress?

BACKGROUND

Despite numerous evidence-based guidelines (EBGs) being developed to manage the symptom burden associated with cancer and chemotherapy, there is a paucity of research exploring their efficacy.

OBJECTIVE

The aim of this study was to explore the effect of implementing EBGs to reduce the symptom burden and psychological distress of cancer patients requiring outpatient chemotherapy at an acute, tertiary care public hospital in Western Australia.

METHODS

The study was conducted in 2 populations and stages, using action research to promote change. Stage 1 assessed prevalence; in stage 2, specific EBGs were implemented. Symptom prevalence, severity, and bother were determined at baseline and 1 week and 1 month after initial chemotherapy, to allow comparison between stages.

RESULTS

Stage 2 participants did better at managing feeling low (odds ratio, 2.33; 95% confidence interval, 1.47-3.70; P < .001) and vomiting (odds ratio, 2.37; 95% confidence interval, 1.13-4.97; P = .022). Bother was greater in stage 2 at baseline for vomiting (P = .040), pain (P = .017), feeling tired (P = .038), feeling anxious or worried (P = .001), and feeling low (P = .024). By 1 month, only feeling anxious or worried (P = .023) and feeling low (P = .006) differed. Severity was greater in stage 2 at baseline for pain (P = .025) and feeling anxious or worried (P = .008). By 1 month, only feeling anxious or worried (P = .010) differed.

CONCLUSION

Effective self-care strategies to manage the adverse effects of chemotherapy should be evidence based but individualized, as our findings suggest; for some, focusing on their symptoms may not always be beneficial.

IMPLICATIONS FOR PRACTICE

Providing patients with pathways to information as needed may be preferable to administering multiple EBGs.

Effect on symptom control of structured information given to patients receiving chemotherapy

PURPOSE

The performance of a planned education model in patients receiving chemotherapy can alleviate the side effects of chemotherapy and thus can increase the quality of the patients' lives. In accordance with this view, this study was conducted with the purpose of examining the effect of planned education given to patients receiving chemotherapy on their symptom control.

METHODS

The study was quasi-experimental. A sample of 120 patients participated, of which 60 were in the experimental group (EG) and 60 were in the control group (CG). A patient data form and the chemotherapy symptom assessment scale (C-SAS) were used in order to collect the data. Median, Mann-Whitney U test and Wilcoxon signed rank test were used to analyze the data.

RESULTS

There were statistically significant decreases in the frequencies of the following symptoms: nausea, vomiting, constipation, pain, infectious signs, problems of mouth and throat, problems of skin and nails, appetite changes, weight loss or weight gain, feeling distressed/anxious, feeling pessimistic and unhappy, unusual fatigue, difficulty sleeping. Also, there were statistically significant decreases in the severity of eleven symptoms and on the discomfort levels of nine symptoms.

CONCLUSION

In the study, the planned education provided by the health-care providers had a positive effect on the symptom control of patients receiving chemotherapy.

Self-management in palliative medicine

PURPOSE OF REVIEW

Self-management in the palliative care domain means equipping patients and carers to manage medical aspects of illness, managing life roles and allowing adaptation to the changing dynamics brought on by illness and its progression. As well as dealing with the psychological consequences of living with a life-threatening illness in which the aim is to optimise living. This review will consider the rationale for developing and adopting self-management as a model of care.

RECENT FINDINGS

Health policy currently advocates de-investment in traditional approaches to patient management paralleled with a re-engineering of services towards approaches required to underpin self-management care. However, the literature suggests that patients lack a fundamental knowledge and more importantly an understanding of the progression of their illness or what palliative of hospice care is. As a first step, this issue must be addressed in any self-management intervention. In terms of outcomes evidence continues to emerge that when compared with care self-management imparts sustainable understanding in targeted areas and has the potential to create a preventive spend environment.

SUMMARY

The role of self-management in palliative care requires further elucidation yet based on the evidence which is predominately gleaned from long-term conditions it would seem sensible if not ethical to educate patients/carers to actively be involved in decision making.

A nurse- and peer-led support program to assist women in gynaecological oncology receiving curative radiotherapy, the PeNTAGOn study (peer and nurse support trial to assist women in gynaecological oncology): study protocol for a randomised controlled trial

Background

Women who undergo radiotherapy for gynaecological cancer (GC) can experience distressing side effects which impact on psychosocial functioning and intimate relationships. Cancer-related distress may be ameliorated by comprehensive preparation for treatment and addressing women’s informational, physical, psychological and psychosexual needs. This paper describes the protocol for a multisite randomised controlled trial (RCT) testing a novel intervention package which combines tailored specialist nursing consultations and telephone peer support with the primary aim to reduce psychological distress. Secondary aims assess patient quality of life, symptom distress, unmet supportive care needs, preparation for treatment, psychosexual functioning and vaginal stenosis.

Methods/design

This multifaceted intervention comprises four nurse-led consultations coupled with four phone calls from a peer support volunteer (GC survivor). The evidence-based intervention will be delivered at critical points in the illness trajectory: pre-treatment, mid-treatment, treatment completion and post-treatment. Nurses and peers undergo 2-day intensive training workshops, are guided by comprehensive study intervention manuals and receive ongoing supervision and support. Eligible patients will have a diagnosis of GC, be scheduled to receive curative radiotherapy, be aged 18 years or over and speak English. Three-hundred and six participants will be randomized to receive usual care or usual care with the intervention package. Study outcome measures will be collected at baseline, day 1 of radiotherapy and 1, 6 and 12 months post radiotherapy. Clinical assessments of vaginal toxicity will occur at baseline, and 3, 6, and 12 months post radiotherapy.

Discussion

This timely research has the potential to substantially reduce the physical, psychosexual and supportive care needs of women with GC. Using a telephone peer support model, the intervention package ensures equitable access to support services for geographically isolated patients. The novel intervention engages peer volunteers who liaise with nurses to encourage adherence to professionally-delivered information and provide emotional support. It has been designed to be potentially transferable to a range of treatment settings and diseases. Based on pilot data, the proposed intervention was found to be useful and acceptable to patients and clinicians. If effective and feasible in the multisite RCT, the program could be widely disseminated.

Trial registration

Australian New Zealand Clinical Trial Registry ACTRN12611000744954

Pilot randomised controlled trial of a radiation therapist-led educational intervention for breast cancer patients prior to commencing radiotherapy

PURPOSE

Although patients receive information prior to commencing radiotherapy, they often experience anxiety and distress. We conducted a pilot randomised controlled trial to determine whether a radiation therapist led psycho-educational intervention for breast cancer patients prior to radiotherapy is likely to be effective in reducing radiotherapy-related concerns, patient anxiety and depression.

METHODS

The intervention comprised two face-to-face consultations with a radiation therapist (one prior to radiation planning and the other prior to treatment). Patients completed surveys at baseline, prior to treatment planning and on the first day of treatment. Outcome measures included the Hospital Anxiety and Depression Scale, Radiation Therapy Related Patient Concerns and Radiation Therapy Knowledge Scales.

RESULTS

One hundred and twenty two patients completed baseline measures. Fifty-eight patients received usual care, and 64 received the intervention. After the first consultation, patient anxiety was significantly lower in the intervention group (p = 0.048), as were concerns about radiotherapy (p = 0.001). There were no differences between groups for depression. Patient knowledge for the intervention group was higher after the first consultation (p < 0.001).

CONCLUSION

This intervention is likely to be effective in reducing patient anxiety and concerns and increasing knowledge. Future research is required to test this intervention with a larger population.

Knowledge and practice among Hong Kong oncology nurses in the management of chemotherapy-induced nausea and vomiting

PURPOSE

To examine nurses' roles in the prevention and management of chemotherapy-induced nausea and vomiting (CINV), and to identify their related educational needs.

METHODS

This was a descriptive cross-sectional study with a self-reported survey completed by 103 oncology nurses caring for and administering chemotherapy to cancer patients in the department of oncology in three Hong Kong public hospitals. The survey was developed to identify key issues pertinent to the role of nurses in managing CINV. Data were collected from the following areas (a) demographics, (b) assessment of CINV, (c) CINV management and (d) barriers and facilitators to good CINV practice.

RESULTS

Only a third of respondents performed a CINV assessment before starting chemotherapy, and more than 40% reported that the use of a standardised assessment tool was uncommon. Nearly half recognised that they had inadequate knowledge of different aspects of CINV, but the majority could clearly state the most common pharmacological agents used to treat chemotherapy-induced nausea (88.3%) and vomiting (87.4%). The barriers respondents most frequently encountered in CINV prevention and management were lack of time and a heavy workload. Adopting a standardised CINV assessment tool and management protocol together with further professional training were identified as the major facilitators in improving CINV prevention and management.

CONCLUSIONS

Respondents perceived their knowledge of CINV prevention and management as inadequate. There is a need to adopt a standardised assessment tool, to develop a management protocol and to introduce further professional training to meet the expanding needs of both patients and nurses.

Information interventions for orienting patients and their carers to cancer care facilities

BACKGROUND

Cancer patients experience distress and anxiety related to their diagnosis, treatment and the unfamiliar cancer centre. Strategies with the aim of orienting patients to a cancer care facility may improve patient outcomes. Although meeting patients' information needs at different stages is important, there is little agreement about the type of information and the timing for information to be given. Orientation interventions aim to address information needs at the start of a person's experience with a cancer care facility. The extent of any benefit of these interventions is unknown.

OBJECTIVES

To assess the effects of information interventions which orient patients and their carers/family to a cancer care facility, and to the services available in the facility.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2); MEDLINE (OvidSP) (1966 to Jun 2011), EMBASE (Ovid SP) (1966 to Jun 2011), CINAHL (EBSCO) (1982 to Jun 2011), PsycINFO (OvidSP) (1966 to Jun 2011), review articles and reference lists of relevant articles. We contacted principal investigators and experts in the field.

SELECTION CRITERIA

Randomised controlled trials (RCTs), cluster RCTs and quasi-RCTs evaluating the effects of information interventions that orient patients and their carers/family to a cancer care facility.

DATA COLLECTION AND ANALYSIS

Results of searches were reviewed against the pre-determined criteria for inclusion by two review authors. The primary outcomes were knowledge and understanding; health status and wellbeing, evaluation of care, and harms. Secondary outcomes were communication, skills acquisition, behavioural outcomes, service delivery, and health professional outcomes. We pooled results of RCTs using mean differences (MD) and 95% confidence intervals (CI).

MAIN RESULTS

We included four RCTs involving 610 participants. All four trials aimed to investigate the effects of orientation programs for cancer patients to a cancer facility. There was high risk of bias across studies. Findings from two of the RCTs demonstrated significant benefits of the orientation intervention in relation to levels of distress (mean difference (MD) -8.96 (95% confidence interval (CI) -11.79 to -6.13), but non-significant benefits in relation to state anxiety levels (MD -9.77 (95% CI -24.96 to 5.41). Other outcomes for participants were generally positive (e.g. more knowledgeable about the cancer centre and cancer therapy, better coping abilities). No harms or adverse effects were measured or reported by any of the included studies. There were insufficient data on the other outcomes of interest.

AUTHORS' CONCLUSIONS

This review has demonstrated the feasibility and some potential benefits of orientation interventions. There was a low level of evidence suggesting that orientation interventions can reduce distress in patients. However, most of the other outcomes remain inconclusive (patient knowledge recall/ satisfaction). The majority of studies were subject to high risk of bias, and were likely to be insufficiently powered. Further well conducted and powered RCTs are required to provide evidence for determining the most appropriate intensity, nature, mode and resources for such interventions. Patient and carer-focused outcomes should be included.