Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Randomized Controlled Trial of Patient Navigation for Newly Diagnosed Cancer Patients: Effects on Quality of Life CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. A comprehensive geriatric intervention detects multiple problems in older breast cancer patients. Psychometric properties of the patient activation measure among multimorbid older adults. Remote patient–provider communication and quality of life: empirical test of a dialogic model of cancer care Effect of nurse case management on the treatment of older women with breast cancer. A specialized home care intervention improves survival among older post-surgical cancer patients. Healthcare Utilization in Women After Abdominal Surgery for Ovarian Cancer Older women with breast cancer: perceptions of the effectiveness of nurse case managers. How do nurse case managers care for older women with breast cancer? Coping with radiation therapy: effects of a nursing intervention on coping ability for women with breast cancer. Age-Related Differences in Quality of Life in Cancer Patients: A Pilot Study of a Cancer Care Coordination/Home-Telehealth Program Expanding access to cancer screening and clinical follow-up among the medically underserved. The Impact of Specialized Oncology Nursing on Patient Supportive Care Outcomes Multicenter randomized trial of centralized nurse-led telephone-based care coordination to improve outcomes after surgical resection for colorectal cancer: the CONNECT intervention.
In a r and omized controlled design , this study tested the efficacy of a theoretically based uncertainty management intervention delivered to older long-term breast cancer survivors . The sample included 509 recurrence-free women ( 360 Caucasian , 149 African-American women ) with a mean age of 64 years ( S.D.=8.9 years ) who were 5 - 9 years post-treated for breast cancer . Women were r and omly assigned to either the intervention or usual care control condition . The intervention was delivered during four weekly telephone sessions , in which study nurses guided cancer survivors in the use of audiotaped cognitive-behavioral strategies to manage uncertainty about recurrence , and a self-help manual design ed to help women underst and and manage long-term treatment side effects and other symptoms . Treatment outcome data on uncertainty management were gathered at pre-intervention and 10-months afterward . Repeated measures MANOVA evaluating treatment group , ethnic group , and treatment by ethnic interaction effects indicated that training in uncertainty management result ed in improvements in cognitive reframing , cancer knowledge , patient-health care provider communication , and a variety of coping skills . Results are discussed in terms of the importance of theory-based interventions for cancer survivors that target triggers of uncertainty about recurrence and in terms of ethnic differences in response to the intervention Background : Patient navigation is a promising intervention to ameliorate cancer health disparities . This study objective was to measure patient navigation effects on cancer-specific quality of life ( QOL ) among patients with newly diagnosed cancer . Methods : A r and omized controlled trial of patient navigation was conducted in Rochester , NY . Patients with breast cancer and colorectal cancer were r and omly assigned to receive a patient navigation intervention or usual care .  QOL was measured at baseline and four subsequent time points , using the vali date d Functional Assessment of Cancer Therapy ( FACT-B , FACT-C ) instruments . Results : Among 319 r and omized patients ( 165 patient navigation , 154 control ) , median age was 57 years and 32.5 % were from minority race/ethnicity groups .  Patient navigation and control groups were comparable on baseline factors , except home ownership versus renting ( more home ownership among controls , P = 0.05 ) and race ( more whites among controls , P = 0.05 ) . Total and subscale FACT scores did not differ between groups when analyzed as a change from baseline to 3 months , or at various time points . The emotional well-being subscale change from baseline approached significance ( better change among patient navigation group , P = 0.05 ) . Time trends of QOL measures did not differ significantly between groups . Adjustment for baseline patient factors did not reveal a benefit of patient navigation on QOL . Conclusions : In this r and omized trial of patient navigation , there was no statistically significant effect on disease-specific QOL . Impact : These results suggest that patient navigation may not affect QOL during cancer treatment , that social/medical support are adequate in this study 's setting , or that the trial failed to target patients likely to experience QOL benefit from patient navigation . Cancer Epidemiol Biomarkers Prev ; 21(10 ) ; 1682–90 . © 2012 AACR Overwhelming evidence shows the quality of reporting of r and omised controlled trials ( RCTs ) is not optimal . Without transparent reporting , readers can not judge the reliability and validity of trial findings nor extract information for systematic review s. Recent method ological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects . Such systematic error is seriously damaging to RCTs , which are considered the gold st and ard for evaluating interventions because of their ability to minimise or avoid bias . A group of scientists and editors developed the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to improve the quality of reporting of RCTs . It was first published in 1996 and up date d in 2001 . The statement consists of a checklist and flow diagram that authors can use for reporting an RCT . Many leading medical journals and major international editorial groups have endorsed the CONSORT statement . The statement facilitates critical appraisal and interpretation of RCTs . During the 2001 CONSORT revision , it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports . A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement . After an expert meeting in January 2007 , the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement . This up date improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition , such as selective outcome reporting bias . This explanatory and elaboration document-intended to enhance the use , underst and ing , and dissemination of the CONSORT statement-has also been extensively revised . It presents the meaning and rationale for each new and up date d checklist item providing examples of good reporting and , where possible , references to relevant empirical studies . Several examples of flow diagrams are included . The CONSORT 2010 Statement , this revised explanatory and elaboration document , and the associated website ( www.consort-statement.org ) should be helpful re sources to improve reporting of r and omised trials UNLABELLED Studies of comprehensive geriatric assessment ( CGA ) have shown the importance of follow-up for effectiveness , but this has not been tested in an oncology clinic . In this pilot study , we enrolled 15 early breast cancer patients , aged 70 and older . They received a multidisciplinary CGA every 3 months and structured follow-up from the SAOP nurse practitioner , dietitian , social worker , and pharmacist according to risk . Total follow-up was 6 months . Median age of evaluable patients was 79 years ( range 72 - 87 ) .  Median number of comorbidities by Cumulative Index Rating Scale-Geriatric ( CIRS-G ) was 5 ( 3 - 9 ) at baseline . Ten patients were at pharmacological risk , five at psychosocial risk , and eight at nutritional risk . Patients presented on average six problems initially , and three new problems during follow-up . The intervention directly influenced oncological treatment in four cases . It ensured continuity/coordination of care in seven cases . Success rate in addressing problems was 87 % . Mean Functional Assessment of Cancer Treatment-Breast ( FACT-B ) scores improved from 110.5 ( S.D. 16.7 ) to 116.3 ( S.D. 16.5 ) ( t=0.025 ) . Function and independence were maintained . CONCLUSIONS Older patients with early breast cancer have a high prevalence of comorbidity . A CGA with follow-up has potential for improving the treatment and prognosis of these patients and is feasible in an academic oncology setting OBJECTIVES The Patient Activation Measure ( PAM ) quantifies the extent to which people are informed about and involved in their health care . Objectives were to determine the psychometric properties of PAM among multimorbid older adults and evaluate a theoretical , four-stage model of patient activation . Methods . A cross-sectional analysis was used to assess the psychometric properties of PAM . Internal consistency was assessed using Cronbach α . Construct validity was evaluated using general linear modeling to compute associations between PAM scores and health-related behaviors , functional status , and health care quality . Latent class analysis was used to evaluate the theoretical four-stage structure of patient activation . STUDY SETTING Participants in a r and omized trial of Guided Care ( N = 855 ) , a model of comprehensive health care for older adults with chronic conditions that put them at risk of using health services heavily during the coming year . PRINCIPAL FINDINGS Higher PAM activation scores and stage were positively associated with higher functional status , health care quality , and adherence to some health behaviors . Latent class analysis supported the multistage theory of patient activation . CONCLUSIONS The PAM is a reliable , valid , and potentially clinical ly useful measure of patient activation for multimorbid older adults We examined the feasibility of a Cancer Care Dialogues Model , with daily telehealth interactions between patients at home and their care coordinator , who acted as an adjunct to the oncologist . The patient and the care coordinator used a home messaging device , connected via the ordinary telephone network . Thirty-four patients with a new diagnosis of cancer and whose treatment plan included chemotherapy taken at a single clinic were enrolled and followed for six months . The home messaging device collected information daily on common symptoms associated with chemotherapy . On average , the patients had the home messaging device for 120 days ( range 30–180 ) . The mean cooperation rate was 84 % ( range 4–100 ) . No variables were significantly associated with patient cooperation in the dialogues over time . The health-related quality of life ( HRQL ) mean score at baseline was 73.9 ( SD 15.4 ) , and the mean score at six months was 78.4 ( SD 14.5 ) . After adjusting for demographic and clinical factors , there was a 6.5-point increase in HRQL score between the baseline and end of treatment , which represented an important clinical difference . Management of nervousness/worry over time through cancer care dialogues is important in maintaining HRQL and can be assisted by remote home messaging OBJECTIVES To evaluate the effect of nurse case management on the treatment of older women with breast cancer . DESIGN R and omized prospect i ve trial . SETTING Sixty surgeons practicing at 13 community and two public hospitals in southeast Texas . PARTICIPANTS Three hundred thirty-five women ( 166 control and 169 intervention ) aged 65 and older newly diagnosed with breast cancer . INTERVENTION Women seeing surgeons r and omized to the intervention group received the services of a nurse case manager for 12 months after the diagnosis of breast cancer . MEASUREMENTS The primary outcome was the type and use of cancer-specific therapies received in the first 6 months after diagnosis . Secondary outcomes were patient satisfaction and arm function on the affected side 2 months after diagnosis . RESULTS More women in the intervention group received  breast-conserving surgery  ( 28.6 % vs 18.7 % ; P=.031 ) and  radiation therapy  ( 36.0 % vs 19.0 % ; P=.003 ) . Of women undergoing breast-conserving surgery , greater percentages in the case management group received  adjuvant radiation  ( 78.3 % vs 44.8 % ; P=.001 ) and axillary dissection ( 71.4 % vs 44.8 % ; P=.057 ) . Women in the case management group were also more likely to receive more breast reconstruction surgery ( 9.3 % vs 2.6 % , P=.054 ) , and women in the case management group with advanced cancer were more likely to receive chemotherapy ( 72.7 % vs 30.0 % , P=.057 ) . Two months after surgery , higher percentages of women in the case manager group had normal arm function ( 93 % vs 84 % ; P=.037 ) and were more likely to state that they had a real choice in their treatment ( 82.2 % vs 69.9 % , P=.020 ) . Women with indicators of poor social support were more likely to benefit from nurse case management .  CONCLUSION Nurse case management results in more appropriate management of older women with breast cancer CONTEXT Changes in the healthcare system have result ed 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 r and omized 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 r and omized to the intervention groups and 185 to the usual care group .  INTERVENTION The intervention was a st and ardized protocol that consisted of st and ard 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 assessment s , 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 aim ed at maintaining quality of life outcomes and their effects on survival of post-surgical cancer patients Background : Women undergoing surgery for ovarian cancer are severely ill and are high users of health services . Contributing to these increased utilization rates are the multiple modalities used to treat ovarian cancer and the complications and side effects from those treatments . Objective : The purpose of this study was to evaluate the effectiveness of an intervention provided by advanced practice nurses and a psychiatric consultation-liaison nurse on patients ' self-report of healthcare utilization compared with an attention control intervention in women undergoing surgery for a suspected diagnosis of ovarian cancer . Methods : A two-group , experimental , longitudinal design was used to compare women who were assigned r and omly to the intervention group or to an attention control group at baseline within 48 hours after surgery and 1 , 3 , and 6 months after surgery .  Healthcare utilization was measured as the number of self-reported inpatient admissions and outpatient visits , including emergency room visits , oncology outpatient visits , and primary care visits .  Nurse interventions consisted of 16 contacts : symptom management , counseling , education , direct nursing care , coordination of re sources , and referrals . The attention control interventions consisted of nine contacts that included instructions on use of a symptom management toolkit and strategies on how to manage symptoms . Results : There were no differences in hospitalizations and oncology outpatient visits between the two groups . The main finding of this study was a significant difference in the number of primary care visits between the two groups . Women in the attention control group went to their primary care providers more often than the intervention group . The women who reported more visits also reported more depressive symptoms . In addition , a trend was found in the number of emergency room visits between the two groups . The intervention group visited the emergency room more often because the nurse instructed patients to go when they recognized symptoms that needed urgent care after hours . Discussion : Women in the intervention group appropriately used the emergency room to manage their problems after hours , whereas more women in the attention control group reported significantly more primary care visits . These findings highlight the need for healthcare providers representing various disciplines to coordinate services across specialties , especially for women who have depressive symptoms BACKGROUND There are many challenges that an older woman and her family face when diagnosed with breast cancer . Utilizing community-based nurse case managers may influence the older client and her family to adapt to the many challenges associated with the diagnosis and treatment of breast cancer . PURPOSE The purpose of this qualitative study is to describe how older breast cancer clients perceive community-based nurse case managers . From findings generated , recommendations were developed to improve the practice of community-based nurse case managers . METHOD A r and omized prospect i ve trial to evaluate the effect of nurse case management  on the treatment of 106 older women with breast cancer provided data for this content analysis . Older women ( > 65 years of age ) newly diagnosed with breast cancer cared for by 60 surgeons practicing at 13 community and 2 public hospitals in southeast Texas were invited to participate . DISCUSSION Community-based nurse case managers made a positive impact on older women with breast cancer by helping in managing coexisting medical conditions , providing support , providing education , giving assistance with activities of daily living ( ADLs ) , and helping to navigate through the health care system . To increase their effectiveness , it was recommended that nurse case managers communicate well , be well educated about breast cancer , have st and ard gerontology nurse case management training , and integrate multiple support systems when caring for older clients with breast cancer . CONCLUSION There are unique challenges that an older woman and her family face when diagnosed with breast cancer . Utilizing community-based nurse case managers may influence the client and her family to adapt to the many challenges associated with the diagnosis and treatment of breast cancer . Community-based nurse case managers can make a positive difference on the outcomes of older women with breast cancer PURPOSE / OBJECTIVES To describe how  nurse case managers  care for older women with breast cancer . DESIGN A r and omized , prospect i ve trial . SETTING Thirteen community hospitals and two public hospitals in southeastern Texas . SAMPLE 335 older women aged 60 - 89 years newly diagnosed with breast cancer and being cared for by 60 surgeons . Most participants were Caucasian . A total of 166 women were in the control group , and 159 were in the intervention nurse case management group .  METHODS The nurses implemented multiple nursing interventions in each nursing process phase over a period of 12 months . MAIN RESEARCH VARIABLES Independent variables were participants ' demographic characteristics , depressive symptomatology , and cognitive impairment . Nurse case management contact was a dependent variable . FINDINGS In each nursing phase , a greater number of nurse case management contacts were made in the first quarter . Bivariate analysis illustrated statistical differences among race , income , education , and living alone with respect to the mean amount of nurse case management . Multivariate analysis revealed that age , income , living alone , and stage of cancer predicted more nurse case management contact . CONCLUSIONS Nurse case managers may play a role in helping older women with breast cancer achieve positive health outcomes . IMPLICATION S FOR NURSING Based on the findings of this study , nurses can develop specific nursing interventions to meet the needs of older women with breast cancer . Nurses can use the Model of Nurse Case Management to plan and manage care for older women with breast cancer A r and omized study was carried out to investigate whether a nursing intervention , using Orem 's self-care theory as a framework , would affect the coping ability of women with breast cancer during and following radiation therapy .  The intervention consisted of promoting of behaviours to support the patient to restore , maintain or increase their abilities to interact with the situation and adapt to the dem and s of radiation treatment . The control and experimental groups both consisted of 67 patients . The Wheel Question naire was used to evaluate the effect of the intervention . Our results showed that the intervention provided patients older than 59 years the ability to cope with the treatment ( df = 2 , F = 3.463 , P = > 0.05 ) . The present study supports the idea that individual interventions aim ed at improving well-being helps patients . It also highlights the fact that individual approaches to improving well-being are needed . Such interventions should be directed to patients at risk for poor adjustment , such as those older than 50 years of age The cancer care dialogues model emphasizes daily telehealth interactions between patients and a care coordinator ( a registered nurse serving as a liaison to the oncologist ) to assist patients in the management of common chemotherapy-related symptoms at home . We examined the impact of the dialogues on age-related differences in health-related quality of life ( HRQOL ) among newly diagnosed cancer patients receiving chemotherapy .  We assessed HRQOL among 34 patients , including 15 older adults ( 65 years or older ) and 19 younger adults who were followed for 6 months . Older patients consistently reported better HRQOL scores over the treatment period . In multivariate analysis , older patients reported 10.35 points higher in HRQOL ( P = .007 ) . In addition , patients who reported no nervousness while undergoing chemotherapy had an 8.60-point increase in HRQOL scores ( P = .012 ) . The dialogues model can make important improvement in symptom management and HRQOL , especially in older adults receiving chemotherapy .  Older and younger adults with cancer may benefit equally in cancer treatment in a setting with appropriately managed symptoms . The dialogues model offers promising potential for promoting nurses ' better underst and ing of both the patient needs as the patient receives treatment and innovative technologies in patient management Blacks have the highest cancer incidences and mortality rates in the United States . Higher mortality rates appear due to higher incidence in some sites and to later-stage diagnoses in others . To address these problems , exp and ed cancer screening in an inner-city public hospital and a patient navigator intervention were proposed . Patient navigators acted as patient advocates for patients with abnormal screening findings . One thous and thirty-four females and 102 males were screened from July 1990 through November 1992 ; seven breast cancers and one cervical cancer were found .  Patient navigators were significantly more likely to have seen patients with suspicious findings than patients with non-suspicious findings . However , even among those with suspicious findings , almost 70 % were not seen by a patient navigator . Of those navigated , 87.5 % completed recommended breast biopsies , compared with 56.6 % of the non-navigated patients . Among those with a biopsy , navigated patients did so in significantly less time than those not navigated . Navigation is one of three phases proposed to reduce cancer mortality among medically underserved population Meeting the supportive care needs of cancer patients remains a challenge to cancer care systems around the world . Despite significant improvements in the organization of medical care of patients with cancer , numerous surveys of cancer population s demonstrate that significant proportions of patients fail to have their supportive care needs met . One possible solution is the introduction of a care coordinator role using oncology nursing to help ensure that patients ’ physical , psychological , and social support needs are addressed . Although having face validity , there is little empirical evidence on the effects of nurse-led supportive care coordinator roles on patient reported supportive care outcomes . In this article the authors present the results of a prospect i ve longitudinal cohort study of 113 patients referred to a community-based specialist oncology nursing program .  Using vali date d instruments they found significant improvements in patient-reported outcomes in key supportive care domains : unmet needs , quality of life , and continuity of care , as well as a shift in patterns of health re source utilization from acute care setting s to the community over the course of the intervention . The results of this study are important in supporting the design and development of controlled trials to examine provider roles in the coordination of supportive cancer care PURPOSE To investigate the effectiveness of a central ized , nurse-delivered telephone-based service to improve care coordination and patient-reported outcomes after surgery for colorectal cancer . PATIENTS AND METHODS Patients with a newly diagnosed colorectal cancer were r and omly assigned to the CONNECT intervention or usual care . Intervention-group patients received st and ardized calls from the central ly based nurse 3 and 10 days and 1 , 3 , and 6 months after discharge from hospital . Unmet supportive care needs , experience of care coordination , unplanned readmissions , emergency department presentations , distress , and quality of life ( QOL ) were assessed by question naire at 1 , 3 , and 6 months . RESULTS Of 775 patients treated at 23 public and private hospitals in Australia , 387 were r and omly assigned to the intervention group and 369 to the control group . There were no significant differences between groups in unmet supportive care needs , but these were consistently low in both groups at both follow-up time points . There were no differences between the groups in emergency department presentations ( 10.8 % v 13.8 % ; P = .2 ) or unplanned hospital readmissions ( 8.6 % v 10.5 % ; P = .4 ) at 1 month . By 6 months , 25.6 % of intervention-group patients had reported an unplanned readmission compared with 27.9 % of controls ( P = .5 ) . There were no significant differences in experience of care coordination , distress , or QOL between groups at any follow-up time point . CONCLUSION This trial failed to demonstrate substantial benefit of a central ized system to provide st and ardized , telephone follow-up for postoperative patients with colorectal cancer . Future interventions could investigate a more tailored approach
Patient navigation ( PN ) and patient activation ( PA ) interventions are widely used to help patients with cancer to manage the disease and the care trajectory .
However , the usability and impact of these interventions on older patients and their well-being are unclear .
This study aims to show which PN and PA interventions are being used and what impact they have .
The types of impact varied substantially , but there was scant attention to the quality of life .