Development and implementation strategies of a nurse-led symptom self-management program in outpatient cancer centres: The Symptom Navi© Programme.

PURPOSE: The Symptom Navi© Programme (SN©P) is a structured nurse-led intervention supporting symptom self-management in cancer patients. We describe the development and evaluation of the intervention, implementation strategy, and the evaluation of nurse training for the Symptom Navi© Pilot Study. METHODS: The intervention was developed using multiple methods (e.g. literature synthesis, focus groups) to produce SN©P information leaflets (SN©Flyers in French and German) and standardised training for nurses to deliver semi-structured consultations. We evaluated the SN©P using online surveys, focus groups, interviews, and the Item-Content Validity Index (I-CVI). Nurse training was evaluated in relation to content, acceptability, and confidence in implementing the SN©P. We examined the association between scored on the Work-related Sense of Coherence (Work-SoC) scale and nurses' confidence in implementing the SN©P. Thematic analysis was used to analyse qualitative data. Quantitative data was descriptively analysed and the Kendall Tau test was employed for correlations. RESULTS: Patients and health care professionals confirmed that SN©Flyers and semi-structured consultations facilitated symptom self-management. Nurses considered training content/format acceptable and appropriate and felt confident in implementing the SN©P. Overall Work-SoC scores were correlated with nurses' confidence in implementing the SN©P (rπ = .47, p = .04). CONCLUSIONS: Health care professionals and cancer patients perceived the SN©P as a useful support. Successful implementation of the SN©P depends on centre-specific factors including time, resources and workflow. CLINICAL TRIAL REGISTRY: NCT03649984 and SNCTP000002381.

Discharge intervention pilot improves satisfaction for patients and professionals.

BACKGROUND: The risk of adverse events and information loss following hospital discharge is particularly high for vulnerable multimorbid patients. Poor coordination of care at discharge increases the burden upon patients, caregivers and professionals, and can lead to increased morbidity and costs. Targeted programs can improve efficiency and health outcomes, but the ideal organization of hospital discharge remains to be specified. METHODS: This single-blind, randomized, controlled interprofessional pilot on two internal medicine wards in a teaching hospital in Baden, Switzerland tested a discharge management intervention using nurse care managers. Patients (n=60) were at high risk for adverse events, fulfilling criteria such as polypharmacy, therapy with anticoagulants or insulin, plus secondary criteria indicating vulnerability. Primary composite endpoint was fulfilled by any of the following: death, rehospitalization, urgent physician visit within five days of discharge or adverse medicine reaction. Secondary endpoints evaluated patient quality-of-life, caregiver burden, adequacy of information provided to primary care physicians and home care nurses, and satisfaction with discharge for all groups. Endpoint evaluation was via telephone interviews on days 5 and 30 post-discharge. Design was critically evaluated in anticipation of a larger trial. RESULTS: Intervention acceptance was high. In the intervention group, satisfaction was higher among patients (p=0.027) and caregivers (p=0.008), and primary care physicians rated discharge information higher (p=0.031). Primary endpoint showed no significant difference between groups. Necessary design modifications were identified. CONCLUSION: Discharge coordination and follow-up care by nurse care managers significantly improved subjective endpoints. A modified design is planned to test effectiveness in a well-powered study.