ABSTRACT
BACKGROUND: The Symptom Navi Program (SNP) is a nurse-led intervention supporting basic symptom self-management for patients with any cancer diagnosis. The SNP has been accepted by patients and healthcare professionals alike. OBJECTIVE: The aims of this study were to pilot the SNP and evaluate patient-reported symptom outcomes, nursing support for symptom management, and patient safety. METHODS: Using a cluster-randomized design, we randomized centers to the intervention (SNP) or control group (usual care). Adult patients starting first-line systemic cancer treatment were included. The primary outcome was the change in symptom interference with daily functions from treatment onset to 16 weeks. Secondary outcomes included changes in symptom severity, symptom burden, self-efficacy, and perceived symptom management support and patient safety. We used linear and logistic mixed-effects models to pilot-test differences in mean changes between groups. The trial was registered with ClinicalTrials.gov (NCT03649984). RESULTS: Changes in symptom interference with daily functions did not differ (mean difference at 16 weeks: -0.50; 95% confidence interval, -1.38 to 0.38; P = 0.25) between SNP (3 centers, 49 patients) and control (5 centers, 85 patients) as for all other outcomes. No adverse events were reported. CONCLUSIONS: Our preliminary findings did not indicate an effect of the SNP on patient-reported symptom outcomes, self-efficacy, or symptom management support. Inadequate power and SNP components (eg, insufficient training, low number of follow-up consultations) may be attributed to the lack of an observed effect. IMPLICATIONS FOR PRACTICE: The SNP training content and intervention procedures merit reconsideration.
Subject(s)
Self-Management , Adult , Humans , Nurse's Role , Outpatients , Pilot Projects , Self EfficacyABSTRACT
PURPOSE: The Symptom Navi© Programme (SN©P) is a structured nurse-led intervention supporting symptom self-management in cancer patients. We describe the development and evaluation of the intervention, implementation strategy, and the evaluation of nurse training for the Symptom Navi© Pilot Study. METHODS: The intervention was developed using multiple methods (e.g. literature synthesis, focus groups) to produce SN©P information leaflets (SN©Flyers in French and German) and standardised training for nurses to deliver semi-structured consultations. We evaluated the SN©P using online surveys, focus groups, interviews, and the Item-Content Validity Index (I-CVI). Nurse training was evaluated in relation to content, acceptability, and confidence in implementing the SN©P. We examined the association between scored on the Work-related Sense of Coherence (Work-SoC) scale and nurses' confidence in implementing the SN©P. Thematic analysis was used to analyse qualitative data. Quantitative data was descriptively analysed and the Kendall Tau test was employed for correlations. RESULTS: Patients and health care professionals confirmed that SN©Flyers and semi-structured consultations facilitated symptom self-management. Nurses considered training content/format acceptable and appropriate and felt confident in implementing the SN©P. Overall Work-SoC scores were correlated with nurses' confidence in implementing the SN©P (rπ = .47, p = .04). CONCLUSIONS: Health care professionals and cancer patients perceived the SN©P as a useful support. Successful implementation of the SN©P depends on centre-specific factors including time, resources and workflow. CLINICAL TRIAL REGISTRY: NCT03649984 and SNCTP000002381.
Subject(s)
Neoplasms/nursing , Nurse's Role , Oncology Nursing/education , Oncology Nursing/methods , Outpatients/education , Patient Education as Topic/methods , Self-Management/education , Adult , Female , Focus Groups , Humans , Male , Middle Aged , Pilot Projects , Surveys and QuestionnairesABSTRACT
Support self-management of symptoms in cancer therapies:The Symptom-Navi-Program Abstract. Background: Cancer patients experience a variety of symptoms associated with their disease and treatment. Many patients express uncertainty how to self-manage these symptoms. We developed the Symptom-Navi-Program (SNP) to support cancer patients' symptom self-management. The SNP comprises concise information leaflets, Symptom-Navi-Flyers (SNF), with content tailored to the needs of patients and nurse-led semi-structured consultations. AIM: The aim of the study was to to explore if patients experienced with the SNP with a focus on the perceived usefulness. METHOD: In a qualitative study, we conducted ten semi-structured interviews with cancer patients undergoing treatment. The interviews conduct and data analysis was based on thematic analysis as defined by 1-2Braun and Clarke (2006). RESULTS: Overall, patients described the SNP as a helpful facilitator for their self-management of symptoms. They highlighted its usefulness in an emotionally challenging situation. Nurse-led education and SNF tailored to the individual situation were experienced as self-management empowering elements. Consequently, patients experienced to know and have more choices in their symptom management strategies. Patients also described to use SNF to inform their relatives. CONCLUSIONS: Patients experience the SNP as a promising tool to facilitate their symptom self-management. Its implementation in clinical practice will now be further evaluated.
Subject(s)
Neoplasms/therapy , Nurse-Patient Relations , Self Care/psychology , Humans , Nursing Evaluation Research , Patient Education as Topic , Qualitative ResearchABSTRACT
INTRODUCTION: Self-management interventions show promising results on symptom outcomes and self-management behaviours. The Symptom Navi© Programme (SN©P) is a nurse-led intervention supporting patients' symptom self-management during anticancer treatment. It consists of written patient information (Symptom Navi© Flyers (SN©Flyers)), semistructured consultations and a training manual for nurses. METHODS AND ANALYSIS: This pilot study will evaluate the implementation of the SN©P based on the Reach Effectiveness-Adoption Implementation Maintenance framework at Swiss outpatient cancer centres. We will use a cluster-randomised design and randomise the nine participating centres to the intervention or usual care group. We expect to include 140 adult cancer patients receiving first-line systemic anticancer treatment. Trained nurses at the intervention clusters will provide at least two semistructured consultations with the involvement of SN©Flyers. Outcomes include patients' accrual and retention rates, patient-reported interference of symptoms with daily functions, symptom burden, perceived self-efficacy, quality of nursing care, nurse-reported facilitators and barriers of adopting the programme, nurses' fidelity of providing the intervention as intended, and patients' safety (patients timely reporting of severe symptoms). We will use validated questionnaires for patient-reported outcomes, focus group interviews with nurses and individual interviews with oncologists. Linear mixed models will be used to analyse patient-reported outcomes. Focus group and individual interviews will be analysed by thematic analysis. ETHICS AND DISSEMINATION: The Symptom Navi© Pilot Study has been reviewed and approved by Swiss Ethic Committee Bern (KEK-BE: 2017-00020). Results of the study will be disseminated in peer-reviewed journal and at scientific conferences. TRIAL REGISTRATION NUMBER: NCT03649984; Pre-results.
Subject(s)
Neoplasms/nursing , Nurse-Patient Relations , Pamphlets , Patient Education as Topic/methods , Self Care/methods , Focus Groups , Humans , Multicenter Studies as Topic , Neoplasms/psychology , Outpatients , Patient Reported Outcome Measures , Pilot Projects , Randomized Controlled Trials as Topic , Self Care/psychology , Surveys and QuestionnairesABSTRACT
Background: Short informations with graphic elements may support self management of symptoms. Enhancing self-management is a key element of cancer care. Since 2011 different organisations have been developing patient education handouts, the so called symptom navi with three different graphical variants and slightly different text. Aim: To lay ground for a Swiss-wide standard of the symptom navi, we evaluated (a) the utility of the sheets and (b) the preference for the graphical layout and c) complexity of provided text with patients, their relatives, and health professionals. Methods: We conducted three focus groups with 14 patients and one relative, and an online-survey with 16 health professionals. Descriptive data analysis were combined with thematic analysis of qualitative data. Results: Overall, the symptom navi were well received by patients and health professionals. All participants welcomed the conciseness of information and requested information was easy to find. The structure of the symptom navi supported the readability and facilitated the self-assessment of a patients' condition. Smileys to support the evaluation of symptom burden was the most favoured graphic layout. For patients, the graduation of the severity of symptoms with different colours supported their feelings of safety. However, symptom navi do not substitute personal contact and counselling. Conclusions: The most favoured graphical layout will now be further developed and refined. A future evaluation will investigate the content validity of the symptom navi.
