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.
Project ENABLE II
|Program Title||Project ENABLE II|
|Purpose||Designed to enhance the quality of life for cancer survivors. (2009)|
|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, Pacific Islander, White, not of Hispanic or Latino origin|
|Setting||Clinical, Community, Home-based, Rural, Suburban, Urban/Inner City|
|Funded by||NCI (Grant number(s): R01CA101704)|
|User Reviews||(Be the first to write a review for this program)|
Required resources to implement the program include the following:
- ENABLE II Intervention Outline
- ENABLE II Nurse Educator Intervention Manual
- ENABLE II Charting Your Course Patient Manual
- Fidelity Checklist
- National Comprehensive Cancer Network (NCNN) Distress Thermometer
- OPTIONAL: Shared Medical Appointment (SMA) Tools:
- Coordination of the SMAs
- Shared Medical Appointment Evaluation Form
- SMA-GMA Reliability Checklist
For costs associated with this program, please contact the developer, Marie Bakitas. (See products page on the RTIPs website for developer contact information.)
Patients recruited for the study were newly diagnosed with advanced cancer (prognosis of approximately 1 year of life expectancy). Diagnoses included gastrointestinal tract, lung, genitourinary tract, or breast cancer. Upon return of the baseline assessment, patients and their caregivers were randomly assigned, stratified by disease and blocked within strata, to receive the intervention or usual care. Participants assigned to usual care were allowed to use all oncology and supportive services without restrictions, including referral to palliative care services.
The study included 322 participants, 161 in the intervention group and 161 in the control group. The average age of the participants was 65.1 years. The sample was 58.1% male and 85.4% White; race data were missing for 13.4% of the sample.
Quality of life was measured using the Functional Assessment of Chronic Illness Therapy for Palliative Care. This 46-item tool measures physical, emotional, social, and functional well-being in addition to concerns relevant to persons with life-threatening illness (e.g., feeling peaceful, reconciling with others). Scores for this tool range from 0 to 184, and higher scores indicate better quality of life. Mood was measured using the Center for Epidemiological Studies Depression Scale (CES-D), a 20-item measure with scores from 0 to 60. A score of 16 or higher generally indicates a clinically significant level of depressed mood. Measures were assessed at baseline, 1 month, and every 3 months thereafter until the participants death or study completion.
- Longitudinal intention-to-treat analyses found that over time, participants in the intervention group had higher quality of life scores on average compared with participants in the control group (p=.02).
- Longitudinal intention-to-treat analyses found that over time, participants in the intervention group reported having lower mood scores (indicating less depressed mood) on average compared with participants in the control group (p=.02).
- Although there was a trend toward lower symptom intensity over time in the intervention group compared with the control group, the difference was not significant.
Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J, Hull JG, Li Z, Tosteson TD, Byock IR, Ahles TA. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. 302 (7), 741-749.
Maloney C, Lyons KD, Li Z, Hegel M, Ahles TA, Bakitas M. (2013). Patient perspectives on participation in the ENABLE II randomized controlled trial of a concurrent oncology palliative care intervention: benefits and burdens. Palliative Medicine, 27 (4), 375-383.
Bakitas M, Lyons KD, Hegel MT, Ahles T. (2012). Oncologists' perspectives on concurrent palliative care in a National Cancer Institute-designated comprehensive cancer center. Palliative Medicine, 8 , 1-9.
O'Hara RE, Hull JG, Lyons KD, Bakitas M, Hegel MT, Li Z, Ahles TA. (2010). Impact on caregiver burden of a patient-focused palliative care intervention for patients with advanced cancer. Palliative & Supportive Care, 8 (4), 395-404.
Bakitas M, Lyons KD, Hegel MT, Balan S, Barnett KN, Brokaw FC, Byock IR, Hull JG, Li Z, McKinstry E, Seville JL, Ahles TA. (2009). The project ENABLE II randomized controlled trial to improve palliative care for rural patients with advanced cancer: baseline findings, methodological challenges, and solutions. Palliative & Supportive Care, 7 (1), 75-86.
Lyons KD, Bakitas M, Hegel MT, Hanscom B, Hull J, Ahles TA. (2009). Reliability and validity of the Functional Assessment of Chronic Illness Therapy-Palliative care (FACIT-Pal) scale. Journal of Pain and Symptom Management, 37 (1), 23-32.
Bakitas MA, Lyons KD, Dixon J, Ahles TA. (2006). Palliative care program effectiveness research: developing rigor in sampling design, conduct, and reporting. Journal of Pain and Symptom Management, 31 (3), 270-284.
Bakitas M, Ahles TA, Skalla K, Brokaw FC, Byock I, Hanscom B, Lyons KD, Hegel MT; ENABLE project team. (2008). Proxy perspectives regarding end-of-life care for persons with cancer. Cancer, 112 (8), 1854-1861.
Bakitas M, Stevens M, Ahles T, Kirn M, Skalla K, Kane N, Greenberg ER; Project Enable Co-Investigators. (2004). Project ENABLE: a palliative care demonstration project for advanced cancer patients in three settings. Journal of Palliative Medicine, 7 (2), 363-372.
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