CONTINUING CARE OF CANCER PATIENTS CONCRETE NEEDS

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The proposed study will investigate the barriers confronted by cancer patients and their families that impede obtaining concrete services that enable them to cope with the treatment and consequences of the disease. The study has two stages: (I) a descriptive study, and (II) an intervention program. In Stage I we will determine the prevalence of both resolved and unresolved concrete needs of cancer outpatients who are receiving treatment for recurrent, metastatic, high grade, or unresectable disease. A cross-sectional quota sample of 200 outpatients will be selected, 50 from each of four disease sites: breast, colon, lung and gynecological. These patients will be at different stages in the disease process and vary in their functional capacities, permitting us to relate the prevalence of resolved and unresolved concrete needs to site and stage of disease and to performance status. Data will be collected through hospital records, patient and family interviews. In determining met and unmet needs both professional assessments and the perceptions of the patient and family (subjective judgments) will be considered. The reasons why needs go unmet will be ascertained, so that existing mechanisms for the resolution of concrete problems can be evaluated. We expect that the Stage I research will demonstrate that patients' lack of knowledge about services available to them is a major obstacle to their obtaining the assistance they need. Therefore, in Stage II, we will develop and implement an educational intervention consisting of a videotape presentation and booklet followed by a discussion on kinds of services and how to access them. Another quota sample of 200 experimental and 200 control subjects will be selected (50 patients with breast, colon, lung and gynecological cancers in each group). Those in the experimental group will receive the intervention between the sixth and eighth week of treatment. A month later--their third month of treatment--experimental subjects and a family member will be interviewed. Control subjects will also be interviewed at the end of their third month of treatment. Again, met and unmet concrete needs will be assessed, using the instruments developed in Stage I. The two groups will be compared to see if the intervention enhanced the ability of patients and families to recognize and anticipate their needs and to resolve them effectively.