Developing an Evidence-Based, Nurse-Led Psychoeducational Intervention With Peer Support in Gynecologic Oncology.

BACKGROUND: The physical and psychosocial impact of radiotherapy for gynecologic cancer requires complex interventions to address treatment-related, psychosocial, and psychosexual and survivorship needs. A multidisciplinary approach is required to address these needs, but standard practice is varied and lacks a sound evidence base. OBJECTIVE: The aim of this study was to describe the process of development and pilot testing of a novel evidence-based, complex psychoeducational intervention aiming to improve psychosocial outcomes for gynecologic-oncology patients treated curatively with radiotherapy. METHODS: The intervention combines tailored nursing consultations with telephone peer support pretreatment, midtreatment, end of treatment, and posttreatment. The UK Medical Research Council framework for developing complex interventions was used to produce an evidence-based, feasible, and acceptable intervention. RESULTS: Intervention manuals and study materials were informed by literature reviews of best-available evidence, relevant theory, and iterative consumer and expert consultations. The nurse manual specified content for consultations providing self-care information, coaching tailored to individual needs, and multidisciplinary care coordination. The peer manual described phone consultations aimed at providing psychosocial support and encouraging adherence to self-care strategies. Three peers and 1 nurse underwent rigorous skills and knowledge-based intervention delivery training. The intervention was pilot tested with 6 patients. Qualitative feedback led to minor design and content changes. CONCLUSIONS: The intervention was found to be feasible, relevant, and acceptable to participants and clinicians and is currently being tested in a national randomized controlled trial (PeNTAGOn). IMPLICATIONS FOR PRACTICE: The Medical Research Council framework is useful in developing nursing interventions. The specific methods and strategies described are useful for designing future complex studies targeting patient supportive care.

Can a tailored telephone intervention delivered by volunteers reduce the supportive care needs, anxiety and depression of people with colorectal cancer? A randomised controlled trial.

OBJECTIVE: The objective was to assess the effectiveness of a volunteer-delivered tailored telephone-based intervention in reducing prevalence of unmet supportive care needs, elevated levels of anxiety and depression among people with colorectal cancer over a 9-month period. METHODS: There were 653 participants who completed the baseline questionnaire and were randomised to usual care (n = 341) or intervention (n = 306). Three follow-up questionnaires were completed at 3-monthly intervals (response rates: 93%, 87%, 82%, respectively). All four questionnaires contained the Supportive Care Needs Survey (SCNS), Hospital Anxiety and Depression Scale (HADS) and checklists for colorectal cancer symptoms and use of support services. The intervention consisted of trained volunteers providing emotional support, service referral and information and was delivered after completion of each of the first three questionnaires. Primary outcomes were prevalence of moderate to high SCNS needs and elevated levels (scores of 8+) of HADS anxiety and depression. RESULTS: Over the study period, SCNS needs decreased similarly for both groups, and prevalence of elevated depression did not change for either group. There was a greater reduction in the prevalence of elevated anxiety in the intervention than usual care group (p < 0.01), with the intervention group decrease mainly occurring between baseline and the first follow-up survey (p < 0.01). However, the prevalence of elevated anxiety was similar between the two groups at each follow-up point. CONCLUSIONS: The intervention had no effect on supportive care needs or depression, although it may be associated with a greater reduction in anxiety. Future research should test the intervention with patients closer to diagnosis.

Development and pilot testing of a nurse-led posttreatment support package for bowel cancer survivors.

BACKGROUND: Colorectal cancer (CRC) is the most common cancer affecting both men and women in Australia. The illness and related treatments can cause distressing adverse effects, impact on emotional and psychological well-being, and adversely affect social, occupational, and relationship functioning. Current models of follow-up fail to address the complex needs arising after treatment completion. Strategies to better prepare and support survivors are urgently required. OBJECTIVES: This study aimed to develop and pilot test an innovative supportive care program for people with potentially curative CRC. METHODS: The SurvivorCare intervention was developed by a multidisciplinary team using 3 key principles: (1) promote patient involvement and engagement; (2) address the specific needs of individual patients, and (3) use evidence-based strategies to promote well-being and reduce treatment sequelae. It also addressed 4 essential components of survivorship planning, defined by the US Institute of Medicine. Ten survivors completed questionnaires and satisfaction interviews before and after receiving the intervention. RESULTS: SurvivorCare comprises survivorship educational materials (booklet, DVD, and question prompt list), a tailored survivorship care plan, a tailored nurse-led end-of-treatment consultation, and 3 follow-up telephone calls. Pilot data demonstrated that survivors considered the intervention appropriate, relevant, and useful. CONCLUSIONS: SurvivorCare is a well-received, comprehensive intervention that will now be evaluated in a randomized controlled trial aiming to reduce distress and unmet needs and improve quality of life in CRC survivors. IMPLICATIONS FOR PRACTICE: If SurvivorCare is shown to be effective, it will be possible to quickly and broadly disseminate this model of care.

The views of bowel cancer survivors and health care professionals regarding survivorship care plans and post treatment follow up.

GOALS OF WORK: Increasing numbers of people survive cancer beyond diagnosis and treatment. Many survivors have ongoing needs and they may encounter fragmented, poorly coordinated follow up care. Survivorship care plans (SCP) have been promoted as a key aspect of survivorship care. This study aimed to survey key stakeholders in the care of people with colorectal cancer (survivors, primary care providers and hospital-based healthcare professionals) regarding follow-up and SCP. PATIENTS AND METHODS: In study 1, cancer survivors completed a questionnaire regarding their follow-up and experiences during survivorship. Participants' primary care physicians completed a phone interview regarding proposed SCP elements. A subgroup of survivors reviewed a sample SCP and participated in a phone interview regarding this. In study 2, healthcare professionals working with colorectal cancer patients completed a questionnaire regarding follow-up and proposed elements of a SCP. MAIN RESULTS: Twenty survivors completed the questionnaire, 14 primary care providers completed a phone interview and 12 survivors reviewed the sample SCP. Ninety-five healthcare professionals (30 medical professionals and 65 nurses) completed the questionnaire. There was strong support for core elements of the SCP. Additionally, nurses and survivors expressed support for supportive care and psychosocial elements. There was lack of consensus regarding who should prepare and discuss the SCP. CONCLUSIONS: There is strong support for the development and use of SCPs for bowel cancer survivors. There is some variation in opinion regarding ideal content of the SCP, who might prepare it, and how it might be discussed and utilised. IMPLICATIONS FOR CANCER SURVIVORS: Overcoming identified barriers to implementing SCPs for bowel cancer survivors is necessary for high quality cancer care.