Interprofessional, psycho-social intervention to facilitate resilience and reduce supportive care needs for patients with cancer: Results of a noncomparative, randomized phase II trial.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

[The association between the patient-nurse relationship and patient perception of substance use control in an addiction therapy setting: a descriptive correlation study]. / Relation entre l'alliance thérapeutique infirmière-patient, et les contrôles perçus par le patient en traitement de dépendances: une etude corrélationnelle descriptive.

The aim of this study is to explore the association between the patient-nurse working alliance and the degree of how much substance use control is perceived as burdensome in an addiction therapy setting. Imogene King's theory and the working alliance concept were used as the theoretical framework. The investigation was undertaken using a self-administered questionnaire with the short-form of the working alliance inventory (WAI) translated and validated in French and targeting a convenience sample (n=28). In this sample the working alliance was evaluated by 12 questions on a Likert-Scale and perceived as generally good (x = 61.68, max = 84). A significant negative linear relation was found between the perception of the drug-controls as burdensome, evaluated by an additional question on a visual analogue scale (VAS), and the establishment of a working alliance (r = -0.67, p-value > 0.001). Furthermore, the form of admission is important as involuntarily hospitalized patients (n = 7) (t, p-value = 0.018) form poorer working alliances, and perceive the controls as more burdensome (Z, p-value = 0.004) as opposed to voluntarily hospitalized patients (n = 21). Even though these results cannot be generalized because of the small sample (n = 28), they raise important questions for nursing practice, especially for involuntarily hospitalized patients. These patients seem to be more susceptible to any disturbance of the relationship and possible consequences need to be taken into account. In addition, drug-control might have to be reassessed. The findings also raise questions about the use of camera supervision as an alternative to nursing supervision and about the need for the primary nurses to refrain from control interventions.