Schenker Yael, White Douglas, Rosenzweig Margaret, Chu Edward, Moore Charity, Ellis Peter, Nikolajski Peggy, Ford Colleen, Tiver Greer, McCarthy Lauren, Arnold Robert
1 Division of General Internal Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.
J Palliat Med. 2015 Mar;18(3):232-40. doi: 10.1089/jpm.2014.0325. Epub 2014 Dec 17.
Specialty palliative care is not accessible for many patients with advanced cancer. There is a need to find alternative palliative care strategies in oncology clinics.
The objective of the study was to assess the feasibility, acceptability, and perceived effectiveness of an oncology nurse-led care management approach to improve primary palliative care.
The study design was a single-arm pilot trial of the Care Management by Oncology Nurses (CONNECT) intervention, in which registered oncology nurses receive specialized training and work closely with oncologists to (1) address symptom needs; (2) engage patients and caregivers in advance care planning; (3) provide emotional support; and (4) coordinate care. The subjects were 23 patients with advanced cancer, 19 caregivers, and 5 oncologists from a community oncology clinic in western Pennsylvania. Feasibility was assessed through enrollment rates, outcome assessment rates, and visit checklists. Patients, caregivers, and oncologists completed three-month assessments of acceptability and perceived effectiveness.
The consent-to-approach rate was 86% and enrolled-to-consent rate, 77%. CONNECT was implemented according to protocol for all participants. No participants withdrew after enrollment. Four patients died during the study; three-month outcome assessments were completed with all remaining participants (83%). Patients and caregivers reported high satisfaction with CONNECT and perceived the intervention as helpful in addressing symptoms (85%), coping (91%), and planning for the future (82%). Oncologists unanimously agreed that CONNECT improved the quality of care provided for patients with advanced cancer.
An oncology nurse-led care management intervention is feasible, acceptable, and was perceived to be effective for improving provision of primary palliative care. A randomized trial of CONNECT is warranted.
许多晚期癌症患者无法获得专科姑息治疗。肿瘤诊所需要寻找替代的姑息治疗策略。
本研究的目的是评估由肿瘤护士主导的护理管理方法在改善初级姑息治疗方面的可行性、可接受性和感知效果。
本研究设计为肿瘤护士护理管理（CONNECT）干预的单臂试点试验，其中注册肿瘤护士接受专门培训并与肿瘤学家密切合作，以（1）满足症状需求；（2）使患者和护理人员参与预先护理计划；（3）提供情感支持；（4）协调护理。研究对象为宾夕法尼亚州西部一家社区肿瘤诊所的23名晚期癌症患者、19名护理人员和5名肿瘤学家。通过入组率、结局评估率和访视清单评估可行性。患者、护理人员和肿瘤学家完成了对可接受性和感知效果的三个月评估。
同意参与该方法的比例为86%，入组同意比例为77%。所有参与者均按照方案实施CONNECT。入组后无参与者退出。研究期间有4名患者死亡；其余所有参与者（83%）均完成了三个月的结局评估。患者和护理人员对CONNECT表示高度满意，并认为该干预有助于缓解症状（85%）、应对（91%）和规划未来（82%）。肿瘤学家一致认为CONNECT提高了晚期癌症患者的护理质量。
由肿瘤护士主导的护理管理干预是可行的、可接受的，并且被认为对改善初级姑息治疗有效。有必要对CONNECT进行随机试验。
