Nurse-Delivered Symptom Assessment for Individuals With Advanced Lung Cancer.
Marie Flannery, Karen F Stein, David W Dougherty and 3 others
PMID 30118448WHAT IT FOUND
Weekly structured phone symptom assessment did not show improvement in quality of life or distress versus usual care in advanced lung cancer.
Retention and delivering all planned calls were poor, so this does not support changing practice.
Key findings
01No statistically significant differences were found between usual care and intervention arms on quality-of-life scores or distress.
02Overall retention was 62%, and intervention participants received a mean of 5.5 of the planned 8 calls.
03Participants who completed the exit interview rated the calls easy or very easy, and all but one would recommend participating.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It was a pilot feasibility study, not designed to establish efficacy. Only 28 of 45 participants completed more than one outcome assessment. Retention was lower in the intervention arm (57%) than usual care (73.3%), though not statistically significant. Intervention participants received a mean of 5.5 of the planned 8 calls, so the full dose was not delivered. Outcome data collectors were supposed to be blinded, but many participants disclosed they were receiving extra calls. The interventionists were not experienced oncology nurses. p-values were not adjusted for multiple testing because the efficacy aim was exploratory. Participants who stayed had lower distress and less severe symptoms than those who withdrew, so results may apply mainly to more stable patients. Acceptability was only assessed in participants who completed the exit interview; those who withdrew early did not provide acceptability data.
Declared interests
No conflicts of interest were reported.
The easy way to misread this
Do not read the higher quality-of-life means in the intervention arm as proof the assessment works. The trial was a small pilot, no outcome differences reached significance, and the planned dose was not delivered.