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J Palliat Med. 2015 Nov;18(11):962-9. doi: 10.1089/jpm.2015.0113. Epub 2015 Aug 25.

An Advanced Practice Nurse Coordinated Multidisciplinary Intervention for Patients with Late-Stage Cancer: A Cluster Randomized Trial.

Author information

1
1 School of Nursing, Yale University , New Haven, Connecticut.
2
2 School of Public Health, Yale University , New Haven, Connecticut.
3
3 Divinity School, Yale University , New Haven, Connecticut.
4
4 Smilow Cancer Hospital at Yale-New Haven , New Haven, Connecticut.
5
5 School of Medicine, Yale University , New Haven, Connecticut.

Abstract

BACKGROUND:

Early palliative care provided through a palliative care consultative service is effective in enhancing patient outcomes. However, it is unknown whether the integration of palliative care as part of routine comprehensive cancer care improves patients' self-reported clinical outcomes.

OBJECTIVE:

The objective of this study was to evaluate the effects of a multidisciplinary coordinated intervention by advanced practice nurses at the clinic level on outcomes with patients newly diagnosed with late-stage cancer.

METHODS:

A clustered, randomized, controlled trial design was used. Four disease-specific multidisciplinary clinics were randomized to the 10-week intervention (gynecologic and lung clinics) or to enhanced usual care (head and neck and gastrointestinal clinics). Patient primary outcomes (symptoms, health distress, depression, functional status, self-reported health) were collected at baseline and one and three months, and secondary outcomes were collected one and three months postbaseline. General linear mixed model analyses with a covariance structure of within-subject correlation was used to examine the intervention's effect.

RESULTS:

The sample included 146 patients with newly diagnosed late-stage cancers. We found no differences between the two groups on the primary patient-reported outcomes at one and three months postbaseline; however, physical and emotional symptoms remained stable or significantly improved from baseline for both groups. Overall, secondary outcomes remained stable within the groups.

CONCLUSION:

In this translational study, we demonstrated that if patients newly diagnosed with late-stage cancer were managed by disease-specific multidisciplinary teams who palliated their symptoms, providing whole-patient care, patient outcomes remained stable or improved.

PMID:
26305992
PMCID:
PMC4638201
DOI:
10.1089/jpm.2015.0113
[Indexed for MEDLINE]
Free PMC Article

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