Abstract Context Palliative care, including symptom management and attention to quality of life (QOL) concerns, should be addressed throughout the trajectory of a serious illness such as lung cancer. ...Objectives This study tested the effectiveness of an interdisciplinary palliative care intervention for patients with Stage I–IV non–small cell lung cancer (NSCLC). Methods Patients undergoing treatments for NSCLC were enrolled in a prospective, quasi-experimental study whereby the usual care group was accrued first followed by the intervention group. Patients in the intervention group were presented at interdisciplinary care meetings, and appropriate supportive care referrals were made. They also received four educational sessions. In both groups, QOL, symptoms, and psychological distress were assessed at baseline and 12 weeks using surveys which included the Functional Assessment of Cancer Therapy–Lung and the Lung Cancer Subscale, the 12-item Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being, and the Distress Thermometer. Results A total of 491 patients were included in the primary analysis. Patients who received the intervention had significantly better scores for QOL (109.1 vs. 101.4; P < 0.001), symptoms (25.8 vs. 23.9; P < 0.001) spiritual well-being (38.1 vs. 36.2; P = 0.001), and lower psychological distress (2.2 vs. 3.3; P < 0.001) at 12 weeks, after controlling for baseline scores, compared to patients in the usual care group. Patients in the intervention group also had significantly higher numbers of completed advance care directives (44% vs. 9%; P < 0.001), and overall supportive care referrals (61% vs. 28%; P < 0.001). The benefits were seen primarily in the earlier stage patients vs. those with Stage IV disease. Conclusion Interdisciplinary palliative care in the ambulatory care setting resulted in significant improvements in QOL, symptoms, and distress for NSCLC patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Reducing Patient Barriers to Pain and Fatigue Management Borneman, Tami, RN, MSN, CNS, FPCN; Koczywas, Marianna, MD; Sun, Virginia Chih-Yi, RN, MSN, ANP ...
Journal of pain and symptom management,
03/2010, Volume:
39, Issue:
3
Journal Article
Peer reviewed
Open access
Abstract Context Pain and fatigue are recognized as critical symptoms that impact the quality of life of cancer patients. The barriers to pain and fatigue relief have been classified into three ...categories: patient, professional, and system barriers. Objectives The overall objective of this trial as to test the effects of the “Passport to Comfort” intervention on reducing barriers to pain and fatigue management for ambulatory care cancer patients. Methods This quasi-experimental, comparative study uses a Phase 1 control group of usual care followed sequentially by a Phase 2 intervention group in which educational and system-change efforts were directed toward improved pain and fatigue management. A sample of 187 cancer patients with breast, lung, colon, or prostate cancers, and a pain and/or fatigue rating of 4 or more (moderate to severe), were recruited. Patients in the intervention group received four educational sessions on pain/fatigue assessment and management, whereas patients in the control group received usual care. Pain and fatigue barriers and patient knowledge were measured at baseline, one month, and three months post-accrual. Results Patients in the intervention group experienced significant improvements in pain and fatigue measures immediately postintervention, and these improvements were sustained over time. Conclusion The “Passport to Comfort” intervention was effective in reducing patient barriers to pain and fatigue management as well as in increasing patient knowledge regarding pain and fatigue. This intervention demonstrates innovation by translating the evidence-based guidelines for pain and fatigue as developed by the National Comprehensive Cancer Network into practice.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To describe current practices of incontinence care in nursing homes (NHs) provided by certified nurse assistants (CNAs), and to evaluate the feasibility and acceptability of an integrated ...incontinence care product, the One Step Incontinence System (OSIS) in the NH setting. While the ultimate purpose of OSIS is to encourage more consistent skin cleansing and thus reduce perineal dermatitis and risk of pressure ulcers, this study reports an initial feasibility test of OSIS.
Controlled trial at two NH sites, with one ward at each site assigned to intervention with OSIS and one ward at each site assigned to a control condition with a box of wipes placed at the bedside (BW).
Two NHs (one community and one Veterans Administration) in the Los Angeles area.
24 incontinent NH residents and 61 CNAs.
OSIS integrates an adult brief and two cleansing/protective wipes into a single item by way of a waterproof pouch that is removed at the time of incontinence care. The OSIS briefs were placed on the intervention wards in the same location(s) and adjacent to regular adult briefs.
Structured observations of incontinence care episodes were performed by trained research staff at baseline on all wards, and at follow-up with either the intervention (OSIS) or control condition (BW) in place. Observations included resident location, thoroughness and duration of incontinence care, and materials used. In addition, CNAs' opinions of their preferred incontinence care materials and their experience using OSIS were obtained by self-administered survey.
Use of OSIS resulted in significantly greater frequency of use of cleansing wipes (97% of episodes) compared to the baseline (77% of episodes) and BW conditions (41% of episodes). In 59% of the observed episodes in the BW condition, the box of wipes was actually missing from the bedside, or completely absent from the patient's room and had to be replaced. The two wipes that were incorporated with OSIS were used for perineal skin cleansing immediately when providing incontinence care. There was a significant reduction in the percentage use of and number of cloth towels used during incontinence care with OSIS (53% of episodes, 0.8 towels) compared to baseline (67%, 1.1 towels) and BW conditions (82%, 1.2 towels; p=.002 and p=.012, respectively). CNAs were significantly less often interrupted by the need to find supplies during OSIS condition (13%) compared to baseline (23%) and BW (36%; p= .005). There were no significant differences between conditions in the thoroughness of observed cleansing. The average observed time for incontinence care from putting on gloves to fastening the clean adult brief (T1) and between uncovering the resident to fastening a clean adult brief (T2) decreased significantly within both groups (OSIS and BW) at follow-up (all p-values <.05), but there were no significant differences in T1 and T2 between groups at follow-up. CNAs were more likely to report that they felt that OSIS facilitated skin cleansing compared to the BW.
We successfully implemented a trial of an innovative adult brief that encouraged skin cleansing during incontinence care. The system was easily and effectively incorporated into the nursing home, was used by CNAs whenever available (97% of the time), and was favored by CNAs. Patterns of incontinence care differed at follow-up with OSIS compared to BW, with fewer linens used, fewer wipes used, and less CNA interruption during care, which may result in greater privacy and comfort for residents.
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