An Advanced Practice Nurse Coordinated Multidisciplinary Intervention for Patients with Late-Stage Cancer: A Cluster Randomized Trial.

BACKGROUND: Early palliative care provided through a palliative care consultative service is effective in enhancing patient outcomes. However, it is unknown whether the integration of palliative care as part of routine comprehensive cancer care improves patients' self-reported clinical outcomes. OBJECTIVE: The objective of this study was to evaluate the effects of a multidisciplinary coordinated intervention by advanced practice nurses at the clinic level on outcomes with patients newly diagnosed with late-stage cancer. METHODS: A clustered, randomized, controlled trial design was used. Four disease-specific multidisciplinary clinics were randomized to the 10-week intervention (gynecologic and lung clinics) or to enhanced usual care (head and neck and gastrointestinal clinics). Patient primary outcomes (symptoms, health distress, depression, functional status, self-reported health) were collected at baseline and one and three months, and secondary outcomes were collected one and three months postbaseline. General linear mixed model analyses with a covariance structure of within-subject correlation was used to examine the intervention's effect. RESULTS: The sample included 146 patients with newly diagnosed late-stage cancers. We found no differences between the two groups on the primary patient-reported outcomes at one and three months postbaseline; however, physical and emotional symptoms remained stable or significantly improved from baseline for both groups. Overall, secondary outcomes remained stable within the groups. CONCLUSION: In this translational study, we demonstrated that if patients newly diagnosed with late-stage cancer were managed by disease-specific multidisciplinary teams who palliated their symptoms, providing whole-patient care, patient outcomes remained stable or improved.

The five steps of comprehensive psychosocial distress screening.

Despite the growing recognition of the impact psychosocial distress has on the quality of life of patients with cancer, the implementation of the National Comprehensive Cancer Network (NCCN) Distress Management Guidelines and the mandate of evidence-based policy for routine distress screening continue to lag. To speed adoption of the guideline, the American Psychosocial Oncology Society (APOS) and Yale School of Nursing (YSN) launched the Screening for Psychosocial Distress Program in 2014. The program resulted in the development of five steps necessary to carry out routine psychosocial distress screening. The steps are consistent with the NCCN Distress Management Guidelines and the new criterion for accreditation by the American College of Surgeons (ACS) Commission on Cancer as of 2015. These five steps are as follows: (1) screening, (2) evaluating, (3) referring, (4) following up, and (5) documenting and quality improvement. The purpose of this article is to summarize the detailed procedure of the five steps for cancer care professionals-including oncologists, nurses, psychiatrists, psychologists, and social workers-so they can manage psychosocial distress efficiently in their own clinical environments.

Self-management for adult patients with cancer: an integrative review.

BACKGROUND: Individuals with cancer are surviving long term, categorizing cancer as a chronic condition, and with it, numerous healthcare challenges. Symptoms, in particular, can be burdensome and occur from prediagnosis through many years after treatment. Symptom severity is inversely associated with functional status and quality of life. OBJECTIVE: Management of these millions of survivors of cancer in a stressed healthcare system necessitates effective self-care strategies. The purpose of this integrative review is to evaluate intervention studies led by nurse principal investigators for self-care management in patients with cancer. METHODS: PubMed, CINAHL (Cumulative Index to Nursing and Allied health Literature), and the Cochrane Database were searched from January 2000 through August 2012. Search terms included "symptom management and cancer," "self-management and cancer," and "self-care and cancer." All articles for consideration included intervention studies with a nurse as the primary principal investigator. RESULTS: Forty-six articles were included yielding 3 intervention areas of educational and/or counseling sessions, exercise, and complementary and alternative therapies. Outcomes were predominately symptom focused and often included functional status and quality of life. Few studies had objective measures. Overarching themes were mitigation, but not prevention or elimination of symptoms, and improved quality of life related to functional status. No one intervention was superior to another for any given outcome. CONCLUSIONS: Current interventions that direct patients in self-care management of symptoms and associated challenges with cancer/survivorship are helpful, but incomplete. No one intervention can be recommended over another. IMPLICATIONS FOR PRACTICE: Guiding patients with cancer in self-care management is important for overall functional status and quality of life. Further investigation and tailored interventions are warranted.

Developing and testing a web-based survey to assess educational needs of palliative and end-of-life health care professionals in Connecticut.

Institute of Medicine reports have identified gaps in health care professionals' knowledge of palliative and end-of-life care, recommending improved education. Our purpose was to develop and administer a Web-based survey to identify the educational needs of multidisciplinary health care professionals who provide this care in Connecticut to inform educational initiatives. We developed an 80-item survey and recruited participants through the Internet and in person. Descriptive and correlational statistics were calculated on 602 surveys. Disciplines reported greater agreement on items related to their routine tasks. Reported needs included dealing with cultural and spiritual matters and having supportive resources at work. Focus groups confirmed results that are consistent with National Consensus Project guidelines for quality palliative care and indicate the End-of-Life Nursing Education Consortium modules for education.

Patterns of symptoms in women after gynecologic surgery.

PURPOSE/OBJECTIVES: To explore patterns of symptoms over time and the relationships between selected demographic and clinical characteristics. DESIGN: Secondary analysis of longitudinal data. SETTING: A hospital and comprehensive cancer center in the northeastern United States. SAMPLE: 66 women with gynecologic cancers, postsurgical, and scheduled to receive chemotherapy. METHODS: A secondary analysis using descriptive and general estimating equation statistical procedures was conducted on symptom and disease data in a subset of a larger nursing intervention study. MAIN RESEARCH VARIABLES: Demographic and clinical variables including cancer site, new diagnosis or recurrence, stage, treatment, comorbidities, emotional distress, use of a symptom management tool kit, and 10 symptoms over time. FINDINGS: Two patterns of symptoms were identified. The first pattern (pain, bowel dysfunction, disturbed sleep, depression, nausea, and lack of appetite) decreased, and the second pattern (fatigue, anxiety, hair loss, and numbness) remained constant over time. The total number of symptoms decreased over time. Factors associated with symptoms, such as the use of a tool kit and emotional distress, were identified. CONCLUSIONS: Tool kit use by women who experienced fatigue, bowel dysfunction, and anxiety suggests its usefulness as a self-care guide. Explanations for the two patterns of symptoms are discussed. IMPLICATIONS FOR NURSING: Postsurgical management should include management and monitoring of symptoms associated with treatment. Screening for emotional distress is recommended in this population. Use of the tool kit could be an effective postsurgical management strategy for women with gynecologic cancers.

Talking with patients about environmental health: the "I talk" mnemonic.

We conducted a survey regarding engagement in environmental health in an urban community. Although many people were concerned that environmental pollution affects health, talking about this with healthcare providers was an infrequent action. We propose a mnemonic--"I talk"--to guide nurses in inviting discussion about environment and health.