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The effect of nurse-led enhanced supportive care as an early primary palliative care approach for patients with advanced cancer : a randomized controlled trial
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BACKGROUND: Nurses play an important role in providing palliative care. However, few studies have evaluated the effectiveness of nurse-led primary palliative care.
OBJECTIVE: To evaluate the effect of nurse-led enhanced supportive care as an early primary palliative care approach for advanced cancer patients.
DESIGN: Randomized controlled trial.
SETTING(S): This study was conducted at Yonsei Cancer Center in Seoul, Korea.
PARTICIPANTS: Advanced cancer patients initiating palliative chemotherapy (N = 258) and their family caregivers (N = 120) were enrolled and completed 3-month (n = 182 patients, n = 79 caregivers) and 6-month (n = 141 patients, n = 60 caregivers) follow-up assessments.
METHODS: Participants were randomly assigned to the intervention or control group (1:1). The intervention group received nurse-led enhanced supportive care, which included symptom management and coping enhancement counseling before each chemotherapy cycle (baseline to 3 months) and was delivered by trained nurses. The control group received symptom monitoring. Family caregivers only participated in the evaluation. The primary outcomes were quality of life (EORTC-QLQ C30), symptoms (ESAS), and coping (Brief COPE) at 3 months. The secondary outcomes were quality of life, symptoms, and coping at 6 months. Self-efficacy for coping with cancer (CBI-3.0 K), and depression among cancer patients and family caregivers (HADS-D) at 3 and 6 months were also evaluated. The data were analyzed using linear mixed models.
RESULTS: The intervention group reported beneficial effects in the following outcomes: 1) Quality of life [role functioning domain at 3 months (1.01 ± 2.34 vs. -8.37 ± 2.07; p = .003 [-15.57, -3.18]; adjusted p = .044), 2) coping [active coping at 3 months (0.27 ± 0.16 vs. -0.34 ± 0.14; p = .006 [-1.04, -0.18]; adjusted p = .044), and self-distraction (0.22 ± 0.17 vs. -0.42 ± 0.15; p = .004 [-1.08, -0.20]; adjusted p = .044) at 3 months]; 3) self-efficacy in coping with cancer [maintaining activity and independence at 3 months (1.45 ± 0.47 vs. -0.31 ± 0.42; p = .006 [-2.99, -0.52]; adjusted p = .044)]. The intervention was not effective in reducing symptoms and depression of patients or depression of caregivers (adjusted p > .05).
CONCLUSIONS: Nurse-led enhanced supportive care as an early primary palliative care approach has demonstrated effectiveness in improving the role functioning domain of quality of life, use of coping strategies, and self-efficacy in maintaining activity and independence among advanced cancer patients. Nurse-led early primary palliative care should be delivered by trained nurses and incorporated into routine oncology practice.
REGISTRATION: Registered at ClinicalTrials.gov, NCT04407013, on May 29, 2020, https://www.
CLINICALTRIALS: gov/ct2/show/study/NCT04407013. The protocol version is ESC 1.0.
TWEETABLE ABSTRACT: The integration of nurse-led early primary palliative care into routine oncology practice for patients with advanced cancer is recommended.
http://dx.doi.org/10.1016/j.ijnurstu.2025.105102
Voir la revue «International journal of nursing studies, 168»
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