Regular phone calls from specially trained nurses improved quality of life and reduced depression in rural patients with advanced cancer. However, the calls didn’t reduce cancer symptoms or time in the hospital.
While patients in the telephone based-palliative care program did live slightly longer than patients who received regular care, the difference wasn’t significant.
Shortly after they were diagnosed with a life-threatening cancer, 322 study patients at Norton Cotton Comprehensive Cancer Center in Dartmouth, New Hampshire were randomly assigned to a telephone-based palliative care program or a control group of usual oncology care.
Advanced practice nurses made four initial educational calls to the patients based on the Charting Your Course intervention developed at Norris Cotton and Dartmouth Medical School. Charting Your Course focuses on helping patients and families cope with physical, emotional, financial, and spiritual issues by focusing on:
- Communications & Social Support
- Symptom Management
- Advance Care Planning
After the initial calls, nurses called about once a month to offer help with problem solving, communications with doctors and nurses, managing symptoms, and finding help in the community.
Patients and their family caretakers were also invited to a monthly group shared medical appointment (SMA) led by a certified palliative care physician and nurse practitioner to discuss their symptoms and any related problems such as insurance or social services needs. SMA’s gave patients more time for in-depth discussions than their usual clinical care appointments.
When they first began the study, both patients in the active intervention group and a control group who received ordinary care completed questionnaires about their quality of life, how difficult their symptoms were, and how depressed they felt. Questionnaires were repeated one month later and then every three months until the patient died or the study ended.
Analysis of the results found that patients who got phone calls did have better quality of life and were less likely to be depressed. However, they rated symptoms such as pain, being active, nausea, depression, anxiety, drowsiness, appetite, sense of well-being, and shortness of breath as being as intense as did those who were receiving regular oncology care. They had as many hospitalizations, ER visits, and days in intensive care as the control group.
Marie Bakitas, DNSc, APRN, and her team concluded,
Compared with participants receiving usual oncology care, those receiving a nurse-led, palliative care–focused intervention addressing physical, psychosocial, and care coordination provided concurrently with oncology care had higher scores for quality of life and mood, but did not have improvements in symptom intensity scores or reduced days in the hospital or ICU or emergency department visits.
SOURCE: Bakitas et al., Journal of the American Medical Association, Volume 302, Number 7, August 19, 2009.
Help for Patients
Project ENABLE (Educate, Nurture, Advise, Before Life Ends), of which the telephone intervention is a part, developed a book of helpful information about palliative care to enable patients and families to have a more active role in managing their lives with cancer. ENABLE is a project of the Dartmouth-Hitchcock Medical Center.
Charting Your Course: An Intervention for People and Families Living with Cancer can be downloaded from the DHMC Palliative Care Service website.
While the book is designed to be used with either weekly meetings with a trained ENABLE nurse educator or as part of the telephone interviews, it contains excellent information and activities for all patients and families beginning when cancer that is expected to end in death is first diagnosed.
Worksheets and examples can be used to identify problems and find solutions.
- The book explains how palliative care works to improve quality of life and help patients manage their symptoms.
- Help is provided to identify problems to be solved, set goals, and weigh strategies to meet those goals.
- Specific steps are described to help build a support network and communicate with supporters and medical professionals.
- Very detailed information is provided for identifying and managing symptoms such as loss of appetite, nausea, constipation, diarrhea, fatigue, fever, mouth sores, and pain. What patients can do themselves, what help caregivers can provide, and when to get professional support is clearly and specifically outlined. Emotional symptoms such as anger, depression, and anxiety are also included.
- Guides to dealing with advanced care planning and unfinished business are part of the book, with worksheets and lists of questions to ask.
- Additional resources are part of each section and included at the end.