Intervention to Improve Psychological Functioning for Newly Diagnosed Patients With Cancer

Susan M. Rawl

Barbara A. Given

Charles Given

Victoria L. Champion

Sharon L. Kozachik

Debra L. Barton

Christine L. Emsley

Stephen D. Williams

ONF 2002, 29(6), 967-975. DOI: 10.1188/02.ONF.967-975

Purpose/Objectives: To test the effects of a computer-based nursing intervention designed to provide patients and family caregivers with concrete, objective information on symptom management; provide education about disease and treatment; coordinate medical resources; and provide emotional support and counseling.

Design: Two-site, randomized clinical trial.

Settings: A large, urban, midwestern, tertiary-cancer center and a community-based cancer center in a medium-sized midwestern city.

Sample: 109 patients newly diagnosed with breast, colon, or lung cancer who were receiving chemotherapy; 54 received standard care, and 55 participated in the intervention group.

Methods: Outcome data were collected via structured telephone interviews at three time points: baseline, midway through the intervention, and one month postinter-vention. The intervention consisting of nine visits, five in person and four by telephone, was conducted over 18 weeks by advanced practice oncology nurses.

Main Research Variables: Psychosocial functioning, anxiety, and depression.

Findings: Patients who received the intervention had significantly less depression between baseline and the midway point, as well as less anxiety and greater improvement in the role-emotional and mental health subscales of the Medical Outcomes Study 36 Short Form.

Conclusions: Cancer-care nursing interventions can decrease psychosocial morbidity and improve quality of life for newly diagnosed patients with cancer undergoing treatment. Additional research is needed to understand who benefited most from the intervention.

Implications for Nursing: This nurse-directed intervention resulted in improved mental health for patients; however, physical subscales were not changed. Further work is needed to determine why depression and mental health were affected yet physical health and symptoms did not differ between groups. Results support the important role of nurses in addressing mental health issues in patients and families experiencing cancer.

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    References

    Braden, C.J., Mishel, M.H., & Longman, A.J. (1998). Self-help intervention project. Women receiving breast cancer treatment. Cancer Practice, 6, 87-98.

    Cella, D.F., Sarafian, B., Snider, P.R., Yellen, S.B., & Winicour, P. (1993). Evaluation of a community-based cancer support group. Psycho-Oncology, 2, 123-132.

    Collins, C., Given, B., Given, C.W., & King, S. (1988). Interviewer training and supervision. Nursing Research, 37, 122-124.

    Fawzy, F.I. (1999). Psychosocial interventions for patients with cancer: What works and what doesn't. European Journal of Cancer, 35, 1559-1564.

    Fawzy, F.I., Cousins, N., Fawzy, N.W., Kemeny, M.E., Elashoff, R., & Morton, D. (1990). A structured psychiatric intervention for cancer patients. I. Changes over time in methods of coping and affective disturbance. Archives of General Psychiatry, 47, 720-725.

    Fawzy, F.I., & Fawzy, N.W. (1994). A structured psychoeducational intervention for cancer patients. General Hospital Psychiatry, 16, 149-192.

    Ferrell, B.R., Grant, M., Funk, B., Otis-Green, S., & Garcia, N. (1998). Quality of life in breast cancer. Part II: Psychological and spiritual well-being. Cancer Nursing, 21, 1-9.

    Ferrell, B.R., Grant, M.M., Funk, B., Otis-Green, S., & Garcia, N. (1997). Quality of life in breast cancer survivors as identified by focus groups. Psycho-Oncology, 6, 13-23.

    Given, B., & Given, C.W. (1992). Patient and family caregiver reaction to new and recurrent breast cancer. Journal of the American Medical Women's Association, 47, 201-206.

    Given, C.W., Given, B.A., & Stommel, M. (1994). The impact of age, treatment, and symptoms on the physical and mental health of cancer patients. A longitudinal perspective. Cancer, 74(Suppl. 7), 2128-2138.

    Jemal, A., Thomas, A., Murray, T., & Thun, M. (2002). Cancer statistics- 2002. CA: A Cancer Journal for Clinicians, 52, 23-47.

    Johnson, J.E. (1996). Coping with radiation therapy: Optimism and the effect of preparatory interventions. Research in Nursing and Health, 19, 3-12.

    Johnson, J.E., Fieler, V.K., Jones, L.S., Wlasowicz, G.S., & Mitchell, M.L. (1997). Self-regulation theory: Applying theory to your practice. Pittsburgh, PA: Oncology Nursing Society.

    Johnson, J.E., Fieler, V.K., Wlasowicz, G.S., Mitchell, M.L., & Jones, L.S. (1997). The effects of nursing care guided by self-regulation theory on coping with radiation therapy. Oncology Nursing Forum, 24, 1041-1050.

    Kurtz, M.E., Given, B., Kurtz, J.C., & Given, C.W. (1994). The interaction of age, symptoms, and survival status on physical and mental health of patients with cancer and their families. Cancer, 74(Suppl. 7), 2071-2078.

    Maguire, G.P., Tail, A., Brooke, M., Thomas, C., Howat, J.M., Sellwood, R.A., et al. (1980). Psychiatric morbidity and physical toxicity associated with adjuvant chemotherapy after mastectomy. BMJ, 281, 1179-1180.

    McCorkle, R., Benoliel, J.Q., Donaldson, G., Georgiadou, F., Moinpour, C., & Goodell, B. (1989). A randomized clinical trial of home nursing care for lung cancer patients. Cancer, 64, 1375-1382.

    Meyer, T.J., & Mark, M.M. (1995). Effects of psychosocial interventions with adult cancer patients: A meta-analysis of randomized experiments. Health Psychology, 14, 101-108.

    Radloff, L.S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.

    Schag, C.A., & Heinrich, R.L. (1989). Anxiety in medical situations: Adult cancer patients. Journal of Clinical Psychology, 45(1), 20-27.

    Spiegel, D., Bloom, J.R., Kraemer, H.C., & Gottheil, E. (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet, 2, 888-891.

    Spiegel, D., Bloom, J.R., & Yalom, I. (1981). Group support for patients with metastatic cancer. A randomized outcome study. Archives of General Psychiatry, 38, 527-533.

    Spielberger, C., Gorsuch, A., & Lushene, R. (1970). The state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.

    Spielberger, C.D., Gorsuch, R., Lushene, R., Vagg, P., & Jacobs, G. (1983). Manual for the state-trait anxiety inventory (Form Y) (Vol. 4). Palo Alto, CA: Consulting Psychologists Press.

    Stewart, A., & Ware, J. (1993). Measuring functioning and well-being: The medical outcomes study approach. Durham, NC: Duke University Press.

    Ware, J.E., Snow, K.K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey: Manual and interpretation guide. Boston: The Health Institute, New England Medical Center.