Palliative Care Intervention for Lung Cancer Patients
|Program Title||Palliative Care Intervention for Lung Cancer Patients|
|Purpose||Designed to enhance the quality of life for individuals with cancer. (2015)|
|Program Focus||Psychosocial - Coping|
|Population Focus||Cancer Survivors|
|Age||Adults (40-65 years), Older Adults (65+ years), Young Adults (19-39 years)|
|Race/Ethnicity||Alaskan Native, American Indian, Asian, Black, not of Hispanic or Latino origin, Hispanic or Latino, White, not of Hispanic or Latino origin|
|Setting||Clinical, Rural, Suburban, Urban/Inner City|
|Funded by||NCI (Grant number(s): P01-CA136396 )|
|User Reviews||(Be the first to write a review for this program)|
Palliative care can help improve the quality life (QOL) of patients with lung cancer, regardless of disease stage. (Based on the size, location, and progression of the tumor, patients are assigned a stage of cancer: occult [hidden stage], Stage 0, Stage I, Stage II, Stage IIIA, Stage IIIB, and Stage IV.) Palliative care aims to assist lung cancer patients by managing pain and other symptoms; providing emotional support; coordinating services to assist with financial, legal, and other needs; and exploring faith in the search for peace or acceptance.
The intervention has three key components. First, a nurse meets with the patients to complete a comprehensive baseline assessment that includes QOL, symptoms, and psychological distress. This assessment is used to create a personalized palliative care plan that includes four domains of QOL: physical, psychological, social, and spiritual. Second, the patients’ cases are presented at a weekly meeting of the interdisciplinary team (IDT), which includes nurses, palliative medicine physicians, thoracic surgeons, medical oncologists, a geriatric oncologist, a pulmonologist, a social worker, a chaplain, a dietitian, and a physical therapist. Using the comprehensive QOL assessment as a guide, the IDT makes recommendations for consultations or referrals for palliative care and supportive care services. All recommendations are approved and managed by the treating oncologist. Last, patients receive four nurse-led, one-on-one educational sessions addressing the QOL domains. The sessions are tailored to individual patients in that patients select the session topics to discuss from a list of options. Patients receive an educational manual containing information on all the QOL domains. During these sessions, the nurse also discusses the palliative and supportive care resources the IDT recommended.
The nurses who complete the baseline assessments and deliver the educational sessions have at least 20 years of experience in oncology. Palliative Care Intervention for Lung Cancer Patients is designed to be implemented in conjunction with Palliative Care Intervention for Caregivers of Lung Cancer Patients. This caregiver intervention aims to improve quality of life, psychological distress, and caregiver burden for family caregivers of lung cancer patients.
The Implementation Guide is a resource for implementing this program. It provides important information about the staffing and functions necessary for administering this program in the user's setting. Additionally, the steps needed to carry out the research-tested program, relevant program materials, and information for evaluating the program are included. The Implementation Guide can be viewed and downloaded in the Products page.
-- Approximately 20–30 minutes for completing the baseline assessment
-- Approximately 15 minutes per patient for presentation at one IDT meeting
-- Approximately 30 minutes for each education session
-- Palliative Care for Patients Living With Lung Cancer [patient manual]
-- PC1 Interdisciplinary Care Plan
For costs associated with this program, please contact the developer, Betty Ferrell. (See products page on the RTIPs website for developer contact information.)
About the Study
Of the 491 total patients who completed the baseline assessment (219 in the usual care group and 272 in the intervention group), 78% were White (including Latino), 13% were Asian, 6% were Black/African American, 2% were Native Hawaiian/other Pacific Islander, 1% were of more than one race, and less than 1% were American Indian/Alaska Native. About half (46%) were younger than 65 years old, 34% were 65–74 years, and the remainder were 75 years and older. Sixty-five percent were married or had partners, and 35% were single, separated, widowed, or divorced. Almost half of participants (47%) made more than $50,000 per year, 36% of participants made less, and the remaining preferred not to answer.
Significant baseline differences existed between the study groups on the variables of age, employment, religion, and receipt of surgery as a cancer treatment. Further, age, race, living situation, religion, income, and smoking history differed significantly between the early- and late-stage patients.
The study’s primary outcomes were quality of life, lung cancer symptoms, spiritual well-being, and psychological distress. Outcomes were measured using the following instruments:
-- QOL was measured with the Functional Assessment of Cancer Therapy―Lung (FACT-L), a 27-item tool addressing physical, social/family, emotional, and functional well-being domains. The total score ranges from 0 to 140, with higher scores representing better QOL.
-- Disease-specific symptoms were measured using the Lung Cancer Subscale (LCS) of the FACT-L. The total score ranges from 0 to 32, with higher scores representing fewer symptoms.
-- Spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy―Spirituality subscale (FACIT-Sp-12). Twelve items focus on sense of meaning, peace, and faith in illness. The total score ranges from 0 to 48, with higher scores representing better spiritual well-being.
-- Psychological distress was measured using the Distress Thermometer (DT). The total score ranges from 0 to 10, with higher scores representing more distress.
Data were collected using these instruments at baseline and 6, 12, 24, 36, and 52 weeks follow-up, with late-stage patients participating in follow-up assessments only up to 24 weeks. The data used in the primary analyses were collected at the 12-week follow-up.
- At 12-week follow-up, patients in the intervention group had better QOL compared with patients in the usual care group (p<.001). Early-stage patients in the intervention group had higher QOL than those in the usual care group (p<.001). However, no significant differences between intervention and usual care groups were found among late-stage patients.
- At 12-week follow-up, patients in the intervention group had fewer lung cancer symptoms compared with patients in the usual care group (p<.001). Early-stage patients in the intervention group had fewer symptoms than those in the usual care group (p=.003). However, no significant differences between intervention and usual care groups were found among late-stage patients.
- At 12-week follow-up, patients in the intervention group had better spiritual well-being compared with patients in the usual care group (p=.001). Early-stage patients in the intervention group had better spiritual well-being than those in the usual care group (p=.001). However, no significant differences between intervention and usual care groups were found among late-stage patients.
- At 12-week follow-up, patients in the intervention group had less psychological distress compared with patients in the usual care group (p<.001). Early-stage patients in the intervention group had less psychological distress than those in the usual care group (p=.001). However, no significant differences between intervention and usual care groups were found among late-stage patients.
Ferrell B, Sun V, Hurria A, Cristea M, Raz DJ, Kim JY, Reckamp K, Williams AC, Borneman T, Uman G, Koczywas M. (2015). Interdisciplinary Palliative Care for Patients With Lung Cancer. Journal of Pain and Symptom Management, 50 (6), 758-767.
Sun V, Grant M, Koczywas M, Freeman B, Zachariah F, Fujinami R, Ferraro CD, Uman G, Ferrell B. (2015). Effectiveness of an interdisciplinary palliative care intervention for family caregivers in lung cancer. Cancer, 121 (20), 3737-3745.
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