Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
J Palliat Med. 2022 Sep;25(9):1367-1375. doi: 10.1089/jpm.2021.0618. Epub 2022 Mar 17.
Peritoneal carcinomatosis (PC) afflicts women with advanced gynecologic cancers. Patients with PC often require ostomies, gastric tubes, or catheters to palliate symptoms, yet patients and caregivers report feeling unprepared to manage these devices. The purpose of this study was to develop and field test the Building Out Lifelines for Safety, Trust, Empowerment, and Renewal (BOLSTER) intervention to support patients and their caregivers after hospitalization for PC. We adapted components of the Standard Nursing Intervention Protocol with stakeholders and topical experts. We developed educational content; built a smartphone application to assess patients' symptoms; and assessed preliminary feasibility and acceptability in two single-arm prepilot studies. Eligible participants were English-speaking adults hospitalized for gynecologic cancer-associated PC and their caregivers. Feasibility criteria were a ≥50% consent-to-approach ratio and ≥80% outcome measure completion. The acceptability criterion was ≥70% of participants recommending BOLSTER. During the first prepilot, BOLSTER was a 10-week intervention. While 7/8 (87.5%) approached patients consented, we experienced high attrition to hospice. Less than half of patients (3/7) and caregivers (3/7) completed outcome measures. For the second prepilot, BOLSTER was a four-week intervention. All (7/7) approached patients consented. Two withdrew before participating in any study activity because they were "too overwhelmed." We excluded data from one caregiver who completed baseline measures with the patient's assistance. All remaining patients (5/5) and caregivers (4/4) completed outcome measures and recommended BOLSTER. BOLSTER is a technology-enhanced, nurse-led intervention that is feasible and acceptable to patients with gynecologic cancer-associated PC and their caregivers.
腹膜癌转移（PC）会影响晚期妇科癌症患者。PC 患者通常需要造口术、胃管或导管来缓解症状，但患者和护理人员报告称，他们对管理这些设备感到准备不足。本研究的目的是开发和现场测试“建立生命线以确保安全、信任、赋权和更新（BOLSTER）”干预措施，以在 PC 住院后为患者及其护理人员提供支持。我们与利益相关者和主题专家一起改编了标准护理干预协议的组件。我们开发了教育内容；构建了一个智能手机应用程序来评估患者的症状；并在两项单臂预试验研究中评估了初步的可行性和可接受性。合格参与者为因妇科癌症相关 PC 住院的英语患者及其护理人员。可行性标准为≥50%的同意接近比例和≥80%的结果测量完成率。可接受性标准为≥70%的参与者推荐 BOLSTER。在第一次预试验中，BOLSTER 是一项为期 10 周的干预措施。虽然 87.5%（7/8）接近的患者同意，但我们经历了高比例的患者转介到临终关怀。只有不到一半的患者（3/7）和护理人员（3/7）完成了结果测量。对于第二次预试验，BOLSTER 是一项为期四周的干预措施。所有（7/7）接近的患者都同意。由于“压力太大”，有两名患者在参与任何研究活动之前就退出了。我们排除了一位护理人员的数据，该护理人员在患者的协助下完成了基线测量。所有剩余的患者（5/5）和护理人员（4/4）都完成了结果测量并推荐了 BOLSTER。BOLSTER 是一种技术增强型、护士主导的干预措施，对妇科癌症相关 PC 患者及其护理人员是可行且可接受的。
