Receptivity to a Nurse-Led Symptom Management Intervention Among Highly Symptomatic Patients With Cancer.
Receptivity to a Nurse-Led Symptom Management Intervention Among Highly Symptomatic Patients With Cancer.
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DOI：
10.1093/jnci/djab172
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发表时间：
2022-03-08
期刊：
影响因子：
--
通讯作者：
Cheville AL
中科院分区：
文献类型：
--
作者：
Wintheiser GA;Ruddy KJ;Herrin J;Rahman PA;Pachman DR;Leppin AL;Rutten LJF;Lee MK;Griffin JM;Tofthagen C;Chlan LL;Ridgeway JL;Mitchell SA;Cheville AL
与癌症及其治疗相关的症状负担会对患者的生活质量和生存率产生负面影响。以症状为中心的协作护理模式（CCM）干预措施可以改善结果，但前提是患者参与其中。我们评估了严重症状性肿瘤患者对远程护士领导的CCM干预的接受性。在一项作为美国国家癌症研究所IMPACT联盟（E2 C2，NCT 03892967）一部分进行的实用性、随机分组、阶梯楔形试验中，接受癌症治疗的患者被要求对他们的睡眠障碍、疼痛、焦虑、情绪困扰、疲劳和身体功能限制进行评分。向报告至少1种重度症状（≥7/10）的患者提供与护士症状护理经理（RN SCM）的电话咨询。最初，患者必须“选择加入”才能接到电话，但后来修改了协议，因此如果他们不想接到电话，他们必须“选择退出”。我们评估了选择加入与选择退出框架和患者特征对RN SCM呼叫接受性的影响。所有统计检验均为双侧检验。在记录了至少1种重度症状的1204项症状评估（来自864例患者）中，469项（39.0%）表明可接受RN SCM电话呼叫。选择退出期（比值比[OR] = 1.61，95%置信区间[CI] = 1.12至2.32，P = .01），在三级护理中心接受护理（OR = 3.59，95%CI = 2.18 - 5.91，P <0.001）和有严重疼痛（OR = 1.80，95%CI = 1.24 - 2.62，P = 0.002）的患者在统计学上更愿意接听电话。许多严重症状患者不接受RN SCM电话呼叫。需要更好地了解拒绝的原因和改善患者接受性的策略。
The symptom burden associated with cancer and its treatment can negatively affect patients’ quality of life and survival. Symptom-focused collaborative care model (CCM) interventions can improve outcomes, but only if patients engage with them. We assessed the receptivity of severely symptomatic oncology patients to a remote nurse-led CCM intervention. In a pragmatic, cluster-randomized, stepped-wedge trial conducted as part of the National Cancer Institute IMPACT Consortium (E2C2, NCT03892967), patients receiving cancer care were asked to rate their sleep disturbance, pain, anxiety, emotional distress, fatigue, and limitations in physical function. Patients reporting at least 1 severe symptom (≥7/10) were offered phone consultation with a nurse symptom care manager (RN SCM). Initially, patients had to “opt-in” to receive a call, but the protocol was later modified so they had to “opt-out” if they did not want a call. We assessed the impact of opt-in vs opt-out framing and patient characteristics on receptiveness to RN SCM calls. All statistical tests were 2-sided. Of the 1204 symptom assessments (from 864 patients) on which at least 1 severe symptom was documented, 469 (39.0%) indicated receptivity to an RN SCM phone call. The opt-out period (odds ratio [OR] = 1.61, 95% confidence interval [CI] = 1.12 to 2.32, P = .01), receiving care at a tertiary care center (OR = 3.59, 95% CI = 2.18 to 5.91, P < .001), and having severe pain (OR = 1.80, 95% CI = 1.24 to 2.62, P = .002) were associated with statistically significantly greater willingness to receive a call. Many severely symptomatic patients were not receptive to an RN SCM phone call. Better understanding of reasons for refusal and strategies for improving patient receptivity are needed.
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影响因子：
4
作者：
Mooney KH;Beck SL;Wong B;Dunson W;Wujcik D;Whisenant M;Donaldson G
通讯作者：
Donaldson G
影响因子：
2.8
作者：
Knowles, Gillian;Sherwood, Linda;Preston, Elizabeth
通讯作者：
Preston, Elizabeth
影响因子：
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作者：
Cheville, Andrea L.;Alberts, Steven R.;Clark, Matthew M.
通讯作者：
Clark, Matthew M.
影响因子：
2.7
作者：
Aysola, Jaya;Tahirovic, Emin;Volpp, Kevin
通讯作者：
Volpp, Kevin
影响因子：
25.8
作者：
Panagioti, Maria;Bower, Peter;Coventry, Peter A.
通讯作者：
Coventry, Peter A.