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Farrington N, Richardson A, Bridges J. Interventions for older people having cancer treatment: A scoping review. J Geriatr Oncol 2020; 11:769-783. [DOI: 10.1016/j.jgo.2019.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/24/2019] [Accepted: 09/25/2019] [Indexed: 01/05/2023]
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McCorkle R, Jeon S, Ercolano E, Lazenby M, Reid A, Davies M, Viveiros D, Gettinger S. An Advanced Practice Nurse Coordinated Multidisciplinary Intervention for Patients with Late-Stage Cancer: A Cluster Randomized Trial. J Palliat Med 2015; 18:962-9. [PMID: 26305992 PMCID: PMC4638201 DOI: 10.1089/jpm.2015.0113] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2015] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Ruth McCorkle
- School of Nursing, Yale University, New Haven, Connecticut
- School of Public Health, Yale University, New Haven, Connecticut
| | - Sangchoon Jeon
- School of Nursing, Yale University, New Haven, Connecticut
| | | | - Mark Lazenby
- School of Nursing, Yale University, New Haven, Connecticut
- Divinity School, Yale University, New Haven, Connecticut
| | - Amanda Reid
- Smilow Cancer Hospital at Yale–New Haven, New Haven, Connecticut
| | - Marianne Davies
- Smilow Cancer Hospital at Yale–New Haven, New Haven, Connecticut
| | - Diane Viveiros
- Smilow Cancer Hospital at Yale–New Haven, New Haven, Connecticut
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Bai M, Reynolds NR, McCorkle R. The promise of clinical interventions for hepatocellular carcinoma from the west to mainland China. Palliat Support Care 2013; 11:503-22. [PMID: 23398641 DOI: 10.1017/s1478951512001137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hepatocellular carcinoma (HCC) presents a major health problem with its steadily increasing incidence in Western countries, and persistent high fatality rates worldwide. The well-recognized complexity and toxicity of its treatment as well as inadequate care and limited resources in mainland China exacerbate the difficulty of maintaining quality of remaining life of patients living with this illness. The goal of this comprehensive literature review was to identify promising clinical interventions for improving quality of life (QOL) of people with advanced HCC in mainland China. METHOD A comprehensive literature review was performed in China Academic Journals (CAJ), Cochrane, and PubMed databases. The review was confined to studies of randomized controlled trials (RCT) for adults, in Chinese and English, from 1980 to 2012. RESULTS A total of 676 studies in Chinese and 391 studies in English were identified. Eighteen RCTs were selected for the final review, among which three were conducted in mainland China. SIGNIFICANCE OF RESULTS Nurse-led home-based comprehensive interventions using a collaborative care approach addressing multiple dimensions of QOL show promise for enhancing clinical outcomes for people with advanced HCC in mainland China. Education and psychosocial support combined with symptom management early in the illness trajectory and ongoing close attention to physical symptoms, emotional distress, as well as spiritual well-being are crucial for maintaining QOL of people with advanced HCC. Telephone monitoring appears to be a feasible way in rural as well as urban areas. Families are advised to be part of overall interventions. It is warranted that promising interventions aiming at improving QOL for advanced cancer patients reported in Western literature be further tested in mainland China.
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Affiliation(s)
- Mei Bai
- School of Nursing, Yale University, New Haven, Connecticut
| | | | - Ruth McCorkle
- School of Nursing, Yale University, New Haven, Connecticut
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Delivering palliative care to patients and caregivers in inner-city communities: Challenges and opportunities. Palliat Support Care 2013; 12:369-78. [DOI: 10.1017/s1478951513000230] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Social and economic barriers can hinder access to quality palliative and end-of-life care for patients living in inner-city communities. Using a community-based participatory research (CBPR) approach, we investigated the stresses associated with living with a chronic disease and barriers to access and utilization of palliative care resources experienced by low-income patients and caregivers in five inner-city communities.Methods:Four focus groups (N = 33) were conducted with community stakeholders, including healthcare professionals (social workers and nurses), persons living with chronic illnesses (e.g., HIV/AIDS, cardiovascular disease, and cancer), and caregivers. Focus group responses were analyzed using thematic analyses.Results:Patients' and caregivers' stresses centered around five themes: lack of family support, communication barriers with healthcare professionals, minority stress, caregiver burden, and lack of spiritual support. The community stakeholders identified resources and services to improve access to care and the quality of life of underserved, low-income populations living with chronic illnesses.Significance of Results:A CBPR approach enabled us to develop an interdisciplinary and culturally sensitive intervention to begin addressing the palliative and end-of-life needs of the patients and caregivers of the inner-city community.
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Thomas RE, Wilson D, Sheps S. A literature review of randomized controlled trials of the organization of care at the end of life. Can J Aging 2011; 25:271-93. [PMID: 17001589 DOI: 10.1353/cja.2007.0011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We searched nine electronic databases for randomized controlled trials (RCTs) about care at the end of life and found 23 RCTs. We assessed their quality using the criteria of the Cochrane Collaboration. The RCTs researched three themes: (a) the effect of providing palliative care through dedicated community teams on quality of life, on the management of symptoms, on satisfaction with care, on the duration of the palliative period, and on place of death; (b) the effects of specific palliative care interventions-advanced planning of care for the end of life, patient-held records, providing quality-of-life data to patients and physicians, grief education for relatives, palliative care education for nurses, and palliative care for patients with dementia; and (c) the costs of palliative compared to conventional care. We identify difficulties in conducting research on palliative care and solutions and discuss future possible research themes.
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Affiliation(s)
- Roger E Thomas
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, T2N 1M7, Canada.
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Kahana B, Kahana E, Deimling G, Sterns S, VanGunten M. Determinants of altered life perspectives among older-adult long-term cancer survivors. Cancer Nurs 2011; 34:209-18. [PMID: 21522060 PMCID: PMC5497845 DOI: 10.1097/ncc.0b013e3181fa56b0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND In the recent literature on cancer survivorship, positive changes are emphasized in the aftermath of trauma. However, there is insufficient research on older-adult survivors and more complex transformations. OBJECTIVE Consistent with nursing researchers' views about the duality of cancer survivor experiences, this research examined both positive and negative posttraumatic transformations (PTTs) among long-term survivors. Demographic, stress, and appraisal-related predictors of transformations were considered. METHODS Using cross-sectional survey design, interviews were conducted with 288 survivors of breast, colorectal, and prostate cancer. The sample, obtained from a hospital tumor registry, was 58% female, 33% African American, and 67% white (mean age, 72.5 [SD, 7.6] years). Demographic characteristics, cumulative stress exposure, appraisals of stress, and self-reported PTTs were measured. RESULTS Most respondents reported diverse transformations attributed to their illness experience. Demographic characteristics and stress appraisals were more strongly associated with PTT outcomes than was cumulative stress exposure. Appraisals of the cancer experience as stressful, as generating worry, and as stigmatizing were significantly associated with diverse PTT outcomes. CONCLUSION Many long-term older cancer survivors report PTT reflecting altered perspectives on life. Posttraumatic transformations are related to the view that cancer is a continuing worrisome and stigmatizing experience. IMPLICATIONS FOR PRACTICE Nurses have a unique opportunity to discuss with patients the potentially life-changing nature of the cancer experience in a manner that allows for understanding and acceptance of complex changes, incorporating benefit finding along with acknowledgement of loss and suffering. This type of discussion can enhance cancer survivors' mental health.
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Affiliation(s)
- Boaz Kahana
- Department of Psychology, Cleveland State University, Chester Avenue, E. 23rd Street, Cleveland, OH 44115, USA.
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Wasteson E, Brenne E, Higginson IJ, Hotopf M, Lloyd-Williams M, Kaasa S, Loge JH. Depression assessment and classification in palliative cancer patients: a systematic literature review. Palliat Med 2009; 23:739-53. [PMID: 19825894 DOI: 10.1177/0269216309106978] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The objective of this study was to review the literature on depression in palliative cancer care in order to identify which assessment methods and classification systems have been used in studies of depression. Extensive electronic database searches in PubMed, CancerLit, CINAHL, PsychINFO, EMBASE and AgeLine as well as hand search were carried out. In the 202 included papers, 106 different assessment methods were used. Sixty-five of these were only used once. All together, the Hospital Anxiety and Depression Scale (HADS) was the most commonly used assessment method. However, there were regional differences and while the HADS dominated in Europe it was quite seldom used in Canada or in the USA. Few prevalence and intervention studies used assessment methods with an explicit reference to a diagnostic system. There were in total few case definitions of depression. Among these, the classifications were in general based on cut-off scores (77%) and not according to diagnostic systems. The full range of the DSM-IV diagnostic criteria was seldom assessed, i.e. less than one-third of the assessments in the review took into account the duration of symptoms and 18% assessed consequences and impact upon patient functioning. A diversity of assessment methods had been used. Few studies classified depression by referring to a diagnostic system or by using cut-off scores. Evidently, there is a need for a consensus on how to assess and conceptualize depression and related conditions in palliative care.
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Affiliation(s)
- Elisabet Wasteson
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), N-7006 Trondheim, Norway.
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Foster C, Scott I, Addington-Hall J. Who visits mobile UK services providing cancer information and support in the community? Eur J Cancer Care (Engl) 2009; 19:221-6. [PMID: 19552731 DOI: 10.1111/j.1365-2354.2008.01007.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
People can access a variety of sources of information and support when they have questions about cancer according to their needs. There are various sources of information and support for cancer beyond the health-care setting. In this study, we set out to assess reasons for visiting two mobile cancer information and support services in the UK during 2006. Data were collected about each visitor by staff on the mobile services. The two mobiles travelled to 109 UK locations over a 7-month period. Fifty-nine per cent of visitors were women. Thirty-one per cent of visitors had (had) cancer; very few were still undergoing treatment. For 95% of visitors the visit had been spontaneous rather than pre-planned, and 89% of visits lasted <15 min. Most visitors required information or support for themselves, but a third requested information for someone else. A quarter of enquiries were about cancer prevention and early detection (e.g. screening, genetic testing, lifestyle). The mobiles appear to serve an important function in providing information and support in the community where visitors can drop in for an informal conversation with trained members of staff to ask questions and receive support in relation to cancer.
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Affiliation(s)
- C Foster
- Macmillan Research Unit, School of Health Sciences, University of Southampton, Southampton, UK.
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Abstract
Abstract In this paper, we explore the role of the internet as a resource for self-managing problems experienced by people affected by cancer. To do this, we draw on our observations of a UK online discussion forum used by people affected by cancer. We explored online contributions to the online discussion forum to identify examples of how people used the internet to seek and share information and support in the context of cancer to support their self-management of problems. Our findings show that of those registering on an online discussion forum only a minority (18%) contributed posts. Few people contributed to the online discussion forum more than five times although a minority of contributors participated numerous times. Examples of emotional and informational support exchanged in the online discussions are described. Benefits of contributing to the online discussions were noted. In conclusion, the online discussion forum can provide a useful resource for people to seek and share experiences, information and support with others in similar situations.
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Affiliation(s)
- Claire Foster
- Macmillan Research Unit, School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Liz Roffe
- Macmillan Research Unit, School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
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Naylor MD. Advancing the science in the measurement of health care quality influenced by nurses. Med Care Res Rev 2007; 64:144S-69S. [PMID: 17406016 DOI: 10.1177/1077558707299257] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A robust set of quality measures is essential to provide consumers with a vehicleto evaluate nurses' contributions to the care of hospitalized patients, providers, and systems with a set of nursing processes and outcomes to guide quality improvement, and insurers with indicators to reward hospitals for high quality nursing services. The processes employed by the Nursing Care Performance Measures Steering Committee convened by the National Quality Forum (NQF) in 2004 resulted in the endorsement of 15 indicators of health care quality influenced by nurses and contributed to the identification of significant gaps in measurement and priority areas for future research. This critical review of the state of the science related to health care processes and outcomes that reflect nurses' contributions to the quality of care for hospitalized patients is intended to push the boundaries in the measurement of nursing performance. Specific recommendations for future research and measure development are presented.
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Affiliation(s)
- Mary D Naylor
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania, USA
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Abstract
PURPOSE/OBJECTIVES To analyze the development of gero-oncology research through a critical review of nursing and other relevant research as well as the present state of practice. DATA SOURCES Journal articles, book chapters, and personal experience. DATA SYNTHESIS Cancer in older adults is viewed through two investigative perspectives. The assumptions, questions, theoretical frames, and research design that follow from these investigative perspectives do not adequately meet the need to examine the interplay of responses to aging, cancer, and nursing practice. The mismatch of need, knowledge, and resources marks older adults with cancer as a special population in need of far more sophisticated research. With the synthesis of a new perspective, gero-oncology nursing research becomes age focused, more precisely shaping theoretical, methodologic, and analytic approaches. CONCLUSIONS Uniform attachment of chronologic age or other simple age-related variables to investigations, which is the primary consideration of age-related research, is irrelevant for older adults who are diagnosed with, treated for, live with, survive, and die from cancer. Shaping the next phase of gero-oncology research with a focus on age precisely integrates theoretical, methodologic, and analytic approaches through language specific to older adults and cancer. IMPLICATIONS FOR NURSING Shifting perspectives in gero-oncology nursing research will better inform future practice.
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Hudson P. Home-based support for palliative care families: challenges and recommendations. Med J Aust 2003; 179:S35-7. [PMID: 12964935 DOI: 10.5694/j.1326-5377.2003.tb05576.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2003] [Accepted: 07/28/2003] [Indexed: 11/17/2022]
Abstract
Providing adequate supportive services for the families of palliative care patients is a core principle of palliative care. Caring for a patient with terminal illness at home involves a considerable commitment on the part of family caregivers, and attention must be given to the caregiver's needs as well as those of the patient. Although a home death may be preferred by patients and promoted by healthcare agencies as a cost-effective option, it may be an ideal that is not often realised. Enhanced supportive care strategies can ameliorate the challenges facing families of palliative care patients cared for at home. All health professionals need to improve the standard of family-centred palliative care, and more evidence-based approaches are required.
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Affiliation(s)
- Peter Hudson
- School of Nursing and Centre for Palliative Care, University of Melbourne, Level 1, 723 Swanston Street, Melbourne, VIC 3053.
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Abstract
BACKGROUND Clinical Nurse Specialists (CNS) play a major role in the delivery of specialist palliative care services to patients with advanced cancer, in hospital, hospice and community settings across the United Kingdom. A major component of their work focuses on the delivery of emotional care and support to patients and their families. AIM This paper critically examines the literature on emotional care and support for patients with advanced cancer requiring palliative care. The aim is to increase understanding of how CNSs and patients interact and work together to produce emotionally supportive relationships. METHODS A literature search was performed using the CINAHL, MEDLINE and ASSIA CD-ROM databases and combinations of the key words: 'emotional support', 'emotional care', 'end of life', 'palliative', 'terminal illness', 'advanced cancer', 'Clinical Nurse Specialist', 'emotional labour'. Additional relevant articles were identified from the reference lists of papers identified by the literature search. FINDINGS The literature revealed a lack of clarity about the terms used to describe emotional care and support. However, at the same time, there is a taken for granted assumption that a shared understanding of these terms exists. Developing supportive nurse-patient relationships involves a complex process, one that consists of getting to 'know the patient' through the effective use of communication skills, in a variety of health care contexts. The costs of engaging in 'emotion work' are highlighted. CONCLUSIONS Existing research fails to recognize that emotional care and support as a concept is not a fixed, stable entity learnt through experience and socialization, but is moulded by the process of social interaction and by specific contexts and theoretical perspectives. Further methodologically sound research is needed to explore what happens when emotional care and support are delivered in different care settings, obtaining the views of both parties involved. Implications for the practice of CNSs are discussed.
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Affiliation(s)
- Julie Skilbeck
- Sheffield Palliative Care Studies Group, University of Sheffield and Trent Palliative Care Centre, Sheffield, UK.
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Mok E, Chan F, Chan V, Yeung E. Perception of empowerment by family caregivers of patients with a terminal illness in Hong Kong. Int J Palliat Nurs 2002; 8:137-45. [PMID: 11923742 DOI: 10.12968/ijpn.2002.8.3.10250] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study is to provide an in-depth description of the nurse-facilitated empowering experiences of family caregivers of terminally ill patients in Hong Kong. Data were collected through in-depth interviews with 24 family caregivers of patients with terminal cancer. Grounded theory strategies served as the basis for data collection and analysis. Data were analysed in terms of the strategies, consequences, and interactions involved in the empowering experience. Themes included establishing an engaged relationship; providing information, knowledge and skills; affirming self-worth; and giving reassurance that the patient is under good care. The consequences of empowerment included a trusting relationship, having confidence to carry out caregiving tasks, acceptance of patient's death, sustained self-worth and feeling peace at heart. The focus of empowering experiences was related to the quality of life of the dying patients. Family caregivers require information, education, encouragement and support, and nurses are in an ideal position to meet this need. Fundamental in the empowering process is the formation of a trusting relationship and as a result the caregivers feeling they are not being abandoned or left alone in the caring process. The results of this study can help nurse interact more effectively with family caregivers, giving them direction for effective nursing practice when caring for patients with a terminal illness.
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Affiliation(s)
- Esther Mok
- Department of Nursing and Health Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Abstract
BACKGROUND Families are increasingly replacing skilled health care workers in the delivery of unfamiliar complex care to their relatives with cancer, despite other obligations and responsibilities that characterize their lives. METHODS The authors review the needs of cancer caregivers and describe intervention strategies not only presented in the literature, but also implemented in their own program of research to address those needs during the palliative phase of cancer. RESULTS Research suggests that developing interventions that teach caregivers to become proficient in the physical and psychological aspects of patient care will benefit both patients and caregivers. CONCLUSIONS Despite the fact that a cancer diagnosis can cause major changes in family roles and functioning,as well as increased responsibility for complex care being absorbed by family caregivers, data supporting the effectiveness of caregiver interventions have been limited.
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Affiliation(s)
- R McCorkle
- School of Nursing, Yale University, New Haven, Conn. 06536-0740, USA.
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Bradley EH, Cherlin E, McCorkle R, Fried TR, Kasl SV, Cicchetti DV, Johnson-Hurzeler R, Horwitz SM. Nurses' use of palliative care practices in the acute care setting. J Prof Nurs 2001; 17:14-22. [PMID: 11211378 DOI: 10.1053/jpnu.2001.20255] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study examines the reported use of palliative care practices by nurses caring for terminally ill patients in the acute care setting. Randomly selected nurses (n = 180) from six randomly selected hospitals in Connecticut completed a self-administered questionnaire. Factors associated with use of palliative care practices were examined by using bivariate and multivariate analyses. Most nurses surveyed (88.5%) reported using palliative care practices when caring for their terminally ill patients. Factors associated with greater use included greater knowledge about hospice, having practiced nursing for less than 10 years, and having had hospice training in the past 5 years. A substantial proportion of nurses reported that they never discuss hospice (51.7 per cent of nurses) and prognosis (26.6 per cent of nurses) with their terminally ill patients. Educational preparation (bachelor's degree versus less education) was not associated with greater use of palliative care practices. Palliative care practices are commonly used by nurses in the acute care setting. However, many report having limited training and substantial gaps in knowledge about hospice among this group of nurses, suggesting greater attention to palliative care and hospice may be warranted in nursing educational programs.
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Affiliation(s)
- E H Bradley
- Department of Epidemiology and Public Health, Yale University School of Medicine, 60 College Street, New Haven, CT, 06520-8034 USA
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McCorkle R, Strumpf NE, Nuamah IF, Adler DC, Cooley ME, Jepson C, Lusk EJ, Torosian M. A specialized home care intervention improves survival among older post-surgical cancer patients. J Am Geriatr Soc 2000; 48:1707-13. [PMID: 11129765 DOI: 10.1111/j.1532-5415.2000.tb03886.x] [Citation(s) in RCA: 241] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT Changes in the healthcare system have resulted in shortened hospital stays, moving the focus of care from the hospital to the home. Patients are discharged post-operatively with ongoing needs, and whether they receive nursing care post-hospitalization can influence their recovery and survival. Little information is available about the factors that influence outcomes, including the survival of older cancer patients after cancer surgery. OBJECTIVE To compare the length of survival of older post-surgical cancer patients who received a specialized home care intervention provided by advanced practice nurses (APNs) with that of patients who received usual follow-up care in an ambulatory setting. We also assessed potential predictors of survival in terms of depressive symptoms, symptom distress, functional status, comorbidities, length of hospital stay, age of patient, and stage of disease. DESIGN A randomized controlled intervention study. SETTING Discharged older cancer patients after surgery at a Comprehensive Cancer Center in southeastern Pennsylvania. PATIENTS Three hundred seventy-five patients aged 60 to 92, newly diagnosed with solid cancers, were treated surgically between February 1993 and December 1995. One hundred ninety patients were randomized to the intervention groups and 185 to the usual care group. INTERVENTION The intervention was a standardized protocol that consisted of standard assessment and management post-surgical guidelines, doses of instructional content, and schedules of contacts. The intervention lasted 4 weeks and consisted of three home visits and five telephone contacts provided by APNs. Both the patients and their family caregivers received comprehensive clinical assessments, monitoring, and teaching, including skills training. MAIN OUTCOME MEASURE Time from enrollment of patients into the study until death or last date known alive at the end of November 1996. RESULTS During the 44-month follow-up period, 93 (24.8%) of 375 patients died. Forty-one (22%) of those who died were patients in the specialized home care intervention group, compared with 52 (28%) in the usual care group. Stage of disease at diagnosis differed between the two groups at baseline (38% late stage patients in the intervention group compared with 26% in the control group, P = .01), so stratified analysis was performed. Overall, the specialized home care intervention group was found to have increased survival (P = .002 using stratified log-rank test). Among early stage patients only, there was no difference in survival between the intervention and control groups. Among late stage patients, there was improved survival in the intervention group. For example, 2-year survival among late stage intervention group cases was 67% compared with 40% among control cases. When Cox's proportional hazard model was used to adjust for significant baseline covariates, the relative hazard of death in the usual care group was 2.04 (CI: 1.33 to 3.12; P = .001) after adjusting for stage of disease and surgical hospitalization length of stay. CONCLUSIONS This is the first empirical study of post-surgical cancer patients to link a specialized home care intervention by advanced practice nurses with improved survival. Additional research is needed to test home care interventions aimed at maintaining quality of life outcomes and their effects on survival of post-surgical cancer patients.
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Affiliation(s)
- R McCorkle
- Center for Excellence in Chronic Illness Care, School of Nursing, Yale University, New Haven, Connecticut 06536-0740, USA
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