Care Management by Oncology Nurses To Address Palliative Care Needs: A Pilot Trial To Assess Feasibility, Acceptability, and Perceived Effectiveness of the CONNECT Intervention

Abstract

Background: Specialty palliative care is not accessible for many patients with advanced cancer. There is a need to find alternative palliative care strategies in oncology clinics. Objective: The objective of the study was to assess the feasibility, acceptability, and perceived effectiveness of an oncology nurse-led care management approach to improve primary palliative care. Methods: The study design was a single-arm pilot trial of the Care Management by Oncology Nurses (CONNECT) intervention, in which registered oncology nurses receive specialized training and work closely with oncologists to (1) address symptom needs; (2) engage patients and caregivers in advance care planning; (3) provide emotional support; and (4) coordinate care. The subjects were 23 patients with advanced cancer, 19 caregivers, and 5 oncologists from a community oncology clinic in western Pennsylvania. Feasibility was assessed through enrollment rates, outcome assessment rates, and visit checklists. Patients, caregivers, and oncologists completed three-month assessments of acceptability and perceived effectiveness. Results: The consent-to-approach rate was 86% and enrolled-to-consent rate, 77%. CONNECT was implemented according to protocol for all participants. No participants withdrew after enrollment. Four patients died during the study; three-month outcome assessments were completed with all remaining participants (83%). Patients and caregivers reported high satisfaction with CONNECT and perceived the intervention as helpful in addressing symptoms (85%), coping (91%), and planning for the future (82%). Oncologists unanimously agreed that CONNECT improved the quality of care provided for patients with advanced cancer. Conclusion: An oncology nurse-led care management intervention is feasible, acceptable, and was perceived to be effective for improving provision of primary palliative care. A randomized trial of CONNECT is warranted.

Self-management, self-management support needs and interventions in advanced cancer: a scoping review

“…Advanced cancer was defined by stage (III/IV),35–37 by presence of metastases (bone,38 39 organs/lymph nodes,40 recurrence or progression of cancer33 41 and by life expectancy or prognosis) 42–44. Other criteria included presence of symptoms such as pain,39 45 fatigue,40 anxiety,46 dyspnoea,32 37 or multiple concurrent symptoms,47 functional status scores,32 48–50 type of treatment being received, scheduled to be received or completed (palliative care,51–53 radiotherapy,32 54 chemotherapy55 56 and surgery57 58), timing of advanced cancer diagnosis8 35 and potential for intensive care unit admission 48…”

An Advanced Practice Nurse Coordinated Multidisciplinary Intervention for Patients with Late-Stage Cancer: A Cluster Randomized Trial

“…26 Two other nurse-led intervention studies that included late-stage patients resulted in nonsignificant QOL outcomes; symptoms were not reported in either of these studies. 27,28 A recent study by Schenkle's team 29 demonstrated that palliative care management by specialty trained oncology nurses was feasible and acceptable to patients. Their intervention contained similar essential components to ours and showed promise as one approach of integrating early palliative care into comprehensive oncology care.…”

A cluster randomized trial of a primary palliative care intervention (CONNECT) for patients with advanced cancer: Protocol and key design considerations

“…Enrolling caregivers allows measurement of caregiver outcomes and also facilitates follow-up contact with patients who have high morbidity. Based on our pilot work, we expect that the majority of patient participants will be able to identify a caregiver [20]. However, we do not exclude patients unable to identify a caregiver because we expect that this group also has significant palliative care needs.…”

“…In prior work, our team developed a primary palliative care intervention called CONNECT ( C are management by O ncology N urses to address supportive care needs) [20]. The CONNECT intervention is led by oncology clinic nurses who receive specialized training and administrative support to provide symptom management and emotional support, engage patients and families in advance care planning, and coordinate appropriate care using evidence-based care management strategies.…”

“…We designed CONNECT to be an approach that can be widely adopted in oncology practices. In a single-site, single-arm pilot trial, the CONNECT intervention was feasible, acceptable, and perceived as effective by patients, caregivers and oncologists [20]. We therefore designed a cluster randomized trial to test the impact of CONNECT on patient, caregiver, and healthcare utilization outcomes, currently funded by the National Cancer Institute.…”