Moore Sally, Corner Jessica, Haviland Jo, Wells Mary, Salmon Emma, Normand Charles, Brada Mike, O'Brien Mary, Smith Ian
Centre for Cancer and Palliative Care Studies, Institute of Cancer Research, Royal Marsden Hospital, London SW3 6JJ.
BMJ. 2002 Nov 16;325(7373):1145. doi: 10.1136/bmj.325.7373.1145.
To assess the effectiveness of nurse led follow up in the management of patients with lung cancer.
Randomised controlled trial.
Specialist cancer hospital and three cancer units in southeastern England.
203 patients with lung cancer who had completed their initial treatment and were expected to survive for at least 3 months.
Nurse led follow up of outpatients compared with conventional medical follow up.
Quality of life, patients' satisfaction, general practitioners' satisfaction, survival, symptom-free survival, progression-free survival, use of resources, and comparison of costs.
Patient acceptability of nurse led follow up was high: 75% (203/271) of eligible patients consented to participate. Patients who received the intervention had less severe dyspnoea at 3 months (P=0.03) and had better scores for emotional functioning (P=0.03) and less peripheral neuropathy (P=0.05) at 12 months. Intervention group patients scored significantly better in most satisfaction subscales at 3, 6, and 12 months (P<0.01 for all subscales at 3 months). No significant differences in general practitioners' overall satisfaction were seen between the two groups. No differences were seen in survival or rates of objective progression, although nurses recorded progression of symptoms sooner than doctors (P=0.01). Intervention patients were more likely to die at home rather than in a hospital or hospice (P=0.04), attended fewer consultations with a hospital doctor during the first 3 months (P=0.004), had fewer radiographs during the first 6 months (P=0.04), and had more radiotherapy within the first 3 months (P=0.01). No other differences were seen between the two groups in terms of the use of resources.
Nurse led follow up was acceptable to lung cancer patients and general practitioners and led to positive outcomes.
评估由护士主导的随访在肺癌患者管理中的有效性。
随机对照试验。
英格兰东南部的专科医院和三个癌症治疗中心。
203例已完成初始治疗且预计存活至少3个月的肺癌患者。
与传统医学随访相比，由护士主导对门诊患者进行随访。
生活质量、患者满意度、全科医生满意度、生存率、无症状生存期、无进展生存期、资源利用情况以及成本比较。
由护士主导的随访患者接受度较高：75%（203/271）符合条件的患者同意参与。接受干预的患者在3个月时呼吸困难较轻（P=0.03），在12个月时情绪功能得分更高（P=0.03），周围神经病变较少（P=0.05）。干预组患者在3、6和12个月时的大多数满意度子量表得分显著更高（3个月时所有子量表P<0.01）。两组全科医生的总体满意度无显著差异。在生存率或客观进展率方面未发现差异，尽管护士比医生更早记录到症状进展（P=0.01）。干预组患者在家中死亡而非在医院或临终关怀机构死亡的可能性更大（P=0.04），在最初3个月内与医院医生的会诊次数更少（P=0.004），在最初6个月内的X光检查更少（P=0.04），在最初3个月内接受放疗更多（P=0.0
