Reiser Victoria, Rosenzweig Margaret, Welsh Ann, Ren Dianxu, Usher Barbara
1 University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
2 Magee Women's Hospital of UPMC, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
Am J Hosp Palliat Care. 2019 Oct;36(10):864-870. doi: 10.1177/1049909119839696. Epub 2019 Apr 11.
Women with metastatic breast cancer (MBC) experience unique symptom management and psychosocial needs due to aggressive, yet palliative treatment with a progressive, chronic illness.
This article describes the effect of a quality improvement project for coordination of supportive care in MBC. Program evaluations included referral rates for supportive services, patient-reported outcomes of symptom distress, generalized anxiety, and overall well-being.
An interdisciplinary Support, Education and Advocacy Program (MBC-SEA) was developed. The 1-hour, weekly, patient review included collaborative assessments to determine needs for social service, psychological counseling, and palliative care. A prospective pre- and postexperimental cohort design with convenience sampling was used. Analysis was conducted with paired test analysis of pre- and postimplementation outcomes.
SETTING/PARTICIPANTS: Program outcomes of 118 women with MBC visiting an urban outpatient breast cancer clinic during September 2016 to November 2016 (pre) and January 2017 to March 2017 (post) were evaluated.
Referral rates to social work and palliative care, symptom, anxiety, and overall well-being scores.
Following program implementation, referrals to palliative care and social work supportive services increased significantly including patient-reported outcomes symptom distress scores mean difference 1.4 (95% confidence interval [CI]: 0.4306-2.6428), = .004; generalized anxiety scores mean difference 1.5 (95% CI: 0.5406-2.5781), = .003; and overall well-being mean difference of -0.7 (95% CI: -1.3498 to -0.0570), = .03.
Purposeful nurse-led assessment for social service and palliative care needs increases referrals with improvement in patient-reported outcomes.
转移性乳腺癌（MBC）女性患者因患有进展性慢性病且接受积极但姑息性的治疗，在症状管理和心理社会需求方面有其独特之处。
本文描述了一项质量改进项目对MBC支持性护理协调的影响。项目评估包括支持性服务的转诊率、患者报告的症状困扰、广泛性焦虑和总体幸福感的结果。
制定了一个跨学科的支持、教育和宣传项目（MBC-SEA）。每周1小时的患者评估包括协作评估，以确定社会服务、心理咨询和姑息治疗的需求。采用了方便抽样的前瞻性实验前后队列设计。对实施前后的结果进行配对t检验分析。
地点/参与者：评估了2016年9月至2016年11月（实施前）以及2017年1月至2017年3月（实施后）期间到城市门诊乳腺癌诊所就诊的118名MBC女性患者的项目结果。
转介至社会工作和姑息治疗的比率、症状、焦虑和总体幸福感得分。
项目实施后，转介至姑息治疗和社会工作支持性服务的比率显著增加，包括患者报告的结果：症状困扰得分平均差异为1.4（95%置信区间[CI]：0.4306 - 2.6428），P = .004；广泛性焦虑得分平均差异为1.5（95% CI：0.5406 - 2.5781），P = .003；总体幸福感平均差异为 -0.7（95% CI：-1.3498至 -0.0570），P = .03。
由护士主导的针对社会服务和姑息治疗需求的有目的评估可增加转诊，并改善患者报告的结果。
