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Text
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URL Address
<a href="http://doi.org/10.1001/jama.2009.1198" target="_blank" rel="noreferrer">http://doi.org/10.1001/jama.2009.1198</a>
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Title
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Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial
Publisher
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Jama
Date
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2009
Subject
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Female; Humans; Male; Aged; Middle Aged; Treatment Outcome; Length of Stay; Patient Participation; Affect; Sickness Impact Profile; Patient Education as Topic; Emergency Service; quality of life; Hospital/utilization; Adaptation; Psychological; patient care team; Terminally Ill/psychology; social support; Health Services/utilization; Hospitalization/statistics & numerical data; Intensive Care Units/utilization; Intervention; Interventions; Kaplan-Meiers Estimate; Neoplasms/mortality/nursing/psychology/therapy; Outcomes; Palliative Care/methods
Creator
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Bakitas M; Lyons KD; Hegel MT; Balan S; Brokaw FC; Seville J; Hull JG; Li Z; Tosteson TD; Byock IR; Ahles TA
Description
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CONTEXT: There are few randomized controlled trials on the effectiveness of palliative care interventions to improve the care of patients with advanced cancer. OBJECTIVE: To determine the effect of a nursing-led intervention on quality of life, symptom intensity, mood, and resource use in patients with advanced cancer. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial conducted from November 2003 through May 2008 of 322 patients with advanced cancer in a rural, National Cancer Institute-designated comprehensive cancer center in New Hampshire and affiliated outreach clinics and a VA medical center in Vermont. INTERVENTIONS: A multicomponent, psychoeducational intervention (Project ENABLE [Educate, Nurture, Advise, Before Life Ends]) conducted by advanced practice nurses consisting of 4 weekly educational sessions and monthly follow-up sessions until death or study completion (n = 161) vs usual care (n = 161). MAIN OUTCOME MEASURES: Quality of life was measured by the Functional Assessment of Chronic Illness Therapy for Palliative Care (score range, 0-184). Symptom intensity was measured by the Edmonton Symptom Assessment Scale (score range, 0-900). Mood was measured by the Center for Epidemiological Studies Depression Scale (range, 0-60). These measures were assessed at baseline, 1 month, and every 3 months until death or study completion. Intensity of service was measured as the number of days in the hospital and in the intensive care unit (ICU) and the number of emergency department visits recorded in the electronic medical record. RESULTS: A total of 322 participants with cancer of the gastrointestinal tract (41%; 67 in the usual care group vs 66 in the intervention group), lung (36%; 58 vs 59), genitourinary tract (12%; 20 vs 19), and breast (10%; 16 vs 17) were randomized. The estimated treatment effects (intervention minus usual care) for all participants were a mean (SE) of 4.6 (2) for quality of life (P = .02), -27.8 (15) for symptom intensity (P = .06), and -1.8 (0.81) for depressed mood (P = .02). The estimated treatment effects in participants who died during the study were a mean (SE) of 8.6 (3.6) for quality of life (P = .02), -24.2 (20.5) for symptom intensity (P = .24), and -2.7 (1.2) for depressed mood (P = .03). Intensity of service did not differ between the 2 groups. CONCLUSION: 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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00253383.
2009
Identifier
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<a href="http://doi.org/10.1001/jama.2009.1198" target="_blank" rel="noreferrer">10.1001/jama.2009.1198</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2009
Adaptation
Affect
Aged
Ahles TA
Backlog
Bakitas M
Balan S
Brokaw FC
Byock IR
Emergency Service
Female
Health Services/utilization
Hegel MT
Hospital/utilization
Hospitalization/statistics & numerical data
Hull JG
Humans
Intensive Care Units/utilization
Intervention
Interventions
JAMA
Journal Article
Kaplan-Meiers Estimate
Length Of Stay
Li Z
Lyons KD
Male
Middle Aged
Neoplasms/mortality/nursing/psychology/therapy
Outcomes
Palliative Care/methods
Patient Care Team
Patient Education as Topic
Patient Participation
Psychological
Quality Of Life
Seville J
Sickness Impact Profile
Social Support
Terminally Ill/psychology
Tosteson TD
Treatment Outcome