Institute of Higher Education and Research in Health Care, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
School of Health Sciences Fribourg, University of Applied Arts and Sciences Western Switzerland, Fribourg, Switzerland.
Psychooncology. 2018 Jul;27(7):1833-1839. doi: 10.1002/pon.4734. Epub 2018 May 4.
We developed 2 intensity levels of a complex intervention for interprofessional supportive care in cancer (IPSC-C) to facilitate resilience and reduce unmet supportive care needs. We aimed to test the feasibility, acceptability, and preliminary effectiveness of both intensity levels in routine practice.
In a randomized, noncomparative phase II trial, newly diagnosed patients received either low (LI-IPSC-C) or high (HI-IPSC-C) intensity interventions. Low-intensity-interprofessional supportive care in cancer (LI-IPSC-C) consisted of 3 electronic assessments of resilience, unmet supportive care needs, mood, and coping effort over 16 weeks with an immediate feedback to clinicians including tailored intervention recommendations to facilitate resilience and supportive care. High-intensity-interprofessional supportive care in cancer (HI-IPSC-C) added 5 structured consultations (face-to-face and telephone) provided by specialized nurses. Primary outcome was a change ≥5 in resilience score on the Connor-Davidson Resilience Scale (CD-RISC). Secondary outcomes were unmet supportive care needs, mood, and coping effort. We assessed feasibility by clinician-provided tailored interventions as recommended and acceptability through qualitative interviews with clinicians and patients.
In the LI-IPSC-C arm, 11 of 41, in the HI-IPSC-C arm 17 of 43, patients increased resilience scores by ≥5. Relatively more patients decreased unmet needs in HI-IPSC-C arm. Mood, in both arms, and coping effort, in HI-IPSC-C arm, improved meaningfully. Feasibility was limited for the LI-IPSC-C arm, mainly due to lack of time; acceptability was high in both arms.
Neither LI-IPSC-C nor HI-IPSC-C interventions reached the desired threshold. HI-IPSC-C showed positive effects on secondary outcomes and was feasible. Resilience as measured by the CD-RISC may not be the optimal outcome measure for this intervention.
我们开发了两种强度水平的癌症跨专业支持性护理（IPSC-C）综合干预措施，以促进恢复力并减少未满足的支持性护理需求。我们旨在测试这两种强度水平在常规实践中的可行性、可接受性和初步效果。
在一项随机、非对照的 II 期试验中，新诊断的患者接受低强度（LI-IPSC-C）或高强度（HI-IPSC-C）干预。低强度癌症跨专业支持性护理（LI-IPSC-C）包括在 16 周内进行 3 次电子评估，评估内容为恢复力、未满足的支持性护理需求、情绪和应对努力，立即向临床医生提供反馈，包括量身定制的干预建议，以促进恢复力和支持性护理。高强度癌症跨专业支持性护理（HI-IPSC-C）增加了由专业护士提供的 5 次结构化咨询（面对面和电话）。主要结局是 Connor-Davidson 恢复力量表（CD-RISC）的恢复力评分增加≥5。次要结局为未满足的支持性护理需求、情绪和应对努力。我们通过临床医生提供的根据建议量身定制的干预措施来评估可行性，并通过与临床医生和患者的定性访谈来评估可接受性。
在 LI-IPSC-C 组中，41 名患者中有 11 名，在 HI-IPSC-C 组中，43 名患者中有 17 名，恢复力评分增加≥5。HI-IPSC-C 组中未满足需求的患者相对减少。在两个组中，情绪和 HI-IPSC-C 组中的应对努力都有显著改善。LI-IPSC-C 组的可行性有限，主要是由于缺乏时间；两个组的可接受性都很高。
LI-IPSC-C 和 HI-IPSC-C 干预措施均未达到预期阈值。HI-IPSC-C 对次要结局显示出积极影响，且具有可行性。CD-RISC 测量的恢复力可能不是该干预措施的最佳结局测量指标。
