scholarly journals The Effects of an Oncology Nurse-Led, Primary Palliative Care Intervention on Illness Understanding Among Patients with Advanced Cancer: A Secondary Analysis of the CONNECT Randomized Clinical Trial (SCI906)

2021 ◽  
Vol 61 (3) ◽  
pp. 672
Author(s):  
Lauren Sigler ◽  
Andrew Althouse ◽  
Teresa Thomas ◽  
Robert Arnold ◽  
Thomas Smith ◽  
...  
2021 ◽  
Author(s):  
Lauren E. Sigler ◽  
Andrew D. Althouse ◽  
Teresa H. Thomas ◽  
Robert M. Arnold ◽  
Douglas White ◽  
...  

PURPOSE: Patients with advanced cancer often have unrealistic expectations about prognosis and treatment. This study assessed the effect of an oncology nurse-led primary palliative care intervention on illness expectations among patients with advanced cancer. METHODS: This study is a secondary analysis of a cluster-randomized trial of primary palliative care conducted at 17 oncology clinics. Adult patients with advanced solid tumors for whom the oncologist would not be surprised if died within 1 year were enrolled. Monthly visits were designed to foster realistic illness expectations by eliciting patient concerns and goals for their medical care and empowering patients and families to engage in discussions with oncologists about treatment options and preferences. Baseline and 3-month questionnaires included questions about life expectancy, treatment intent, and terminal illness acknowledgment. Odds of realistic illness expectations at 3 months were adjusted for baseline responses, patient demographic and clinical characteristics, and intervention dose. RESULTS: Among 457 primarily White patients, there was little difference in realistic illness expectations at 3 months between intervention and standard care groups: 12.8% v 11.4% for life expectancy (adjusted odds ratio [aOR] = 1.15; 95% CI, 0.59 to 2.22; P = .684); 24.6% v 33.3% for treatment intent (aOR = 0.76; 95% CI, 0.44 to 1.27; P = .290); 53.6% v 44.7% for terminal illness acknowledgment (aOR = 1.28; 95% CI, 0.81 to 2.00; P = .288). Results did not differ when accounting for variation in clinic sites or intervention dose. CONCLUSION: Illness expectations are difficult to change among patients with advanced cancer. Additional work is needed to identify approaches within oncology practices that foster realistic illness expectations to improve patient decision making.


2014 ◽  
Vol 32 (18_suppl) ◽  
pp. LBA9513-LBA9513 ◽  
Author(s):  
J Nicholas Dionne-Odom ◽  
Andres Azuero ◽  
Kathleen Lyons ◽  
Zhongze Li ◽  
Tor Tosteson ◽  
...  

LBA9513 Background: Family caregivers of individuals with advanced cancer experience significant burden and diminished QOL; few interventions have been found to reduce these outcomes. Methods: Randomized clinical trial conducted from 10/11/2010 to 9/5/2013 of immediate versus delayed (initiated 12 weeks after randomization) entry patients (n=207) and caregivers (n=122) into ENABLE (Educate, Nurture, Advise, Before Life Ends), a phone-based concurrent oncology palliative care intervention. QOL (Caregiver Quality of Life-Cancer, lower scores=better QOL), depression (Center for Epidemiological Study-Depression) and burden (Montgomery Borgatta Caregiver Burden Scale; subjective burden [SB], objective burden [OB]; demand burden [DB]) measures were collected at baseline, 6, 12, 18, and 24 weeks, and every 12 weeks until patient death or study completion. Results: Estimated treatment effects (immediate minus delayed) for caregivers from randomization to 12 weeks were (mean [SE]): -3.1 [2.3] for QOL (P=.17), -4.1 [1.3] for depression (P=.003), -1.0 [0.4] for SB (P=.02), 0.3 [0.6] for OB (P=.60), and -0.5 [0.6] for DB (P=.39). Estimated treatment effects (immediate minus delayed) from intervention initiation to 12 weeks were (mean [SE]): -6.4 [3.4] for QOL (P=.06), -7.4 [2] for depression (P<.001), -1.0 [0.6] for SB (P=.08), -0.6 [0.7] for OB (P=.44), and -0.5 [0.8] for DB (P=.50). Estimated treatment effects (immediate minus delayed) measured backwards from the time of patient’s death were (mean [SE]): of -4.9 [2.6] for QOL (P=.07), -3.8 [1.5] for depression (P=.02), -1.1 [0.4] for SB (P=.01), -0.6 [0.6] for OB (P=.26), and -0.7 [0.6] for DB (P=.22). Conclusions: Caregivers in the immediate group had lower depression, SB, and trends towards better QOL in comparisons up to 12 weeks, following initiation of the intervention in both groups, and in the terminal decline analysis. These results suggest that concurrent oncology palliative care should be initiated as early as possible to maximize benefit to caregivers. Clinical trial information: NCT01245621.


2019 ◽  
Vol 22 (12) ◽  
pp. 1583-1588 ◽  
Author(s):  
David L. O'Riordan ◽  
Megan A. Rathfon ◽  
Denah M. Joseph ◽  
Jane Hawgood ◽  
Michael W. Rabow ◽  
...  

BMC Medicine ◽  
2017 ◽  
Vol 15 (1) ◽  
Author(s):  
Patrick D. Hoek ◽  
Henk J. Schers ◽  
Ewald M. Bronkhorst ◽  
Kris C. P. Vissers ◽  
Jeroen G. J. Hasselaar

Author(s):  
Yael Schenker ◽  
Andrew D. Althouse ◽  
Margaret Rosenzweig ◽  
Douglas B. White ◽  
Edward Chu ◽  
...  

2019 ◽  
Vol 8 (4) ◽  
pp. 381-389 ◽  
Author(s):  
Vittorio Franciosi ◽  
Giuseppe Maglietta ◽  
Claudia Degli Esposti ◽  
Giuseppe Caruso ◽  
Luigi Cavanna ◽  
...  

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