Development of a Symptom Management Intervention

Abstract

Background Little is known about cancer patient and family caregiver preferences for the content and format of non-pharmacologic interventions. Revising interventions based on patient and caregiver feedback before implementation may improve intervention feasibility and acceptability, especially in the context of advanced cancer. Objectives To obtain feedback from advanced, symptomatic lung cancer patients and their family caregivers on the content and format of a non-pharmacologic symptom management intervention under development. The intervention blended evidence-based cognitive-behavioral and emotion-focused strategies to reduce physical and psychological symptoms. Methods Semi-structured qualitative interviews were conducted with 21 advanced, symptomatic lung cancer patients and caregivers. Participants reviewed handouts regarding intervention components and provided feedback. Results Patients and caregivers desired intervention components that addressed the patient’s high symptom burden such as education regarding treatment side-effects and the provision of various coping tools. Offering interventions with a brief or flexible length and delivering them via telephone were other suggestions for enhancing intervention acceptability. Participants also preferred an equal focus on patient and caregiver concerns and a more positive intervention framework. Conclusions Intervention preferences of advanced lung cancer patients and caregivers underscore the severity of the disease and treatment process and the need to adapt interventions to patients with high symptom burden. These preferences may be incorporated into future intervention trials to improve participant recruitment and retention. Implications for Practice Nurses can modify interventions to meet the needs of advanced, symptomatic lung cancer patients and caregivers. For example, flexibility regarding intervention content and length may accommodate those with significant symptoms.

Pilot Study of a Communication Coaching Telephone Intervention for Lung Cancer Caregivers

“…In line with lung cancer patient and caregiver preferences for intervention delivery, the telephone intervention was acceptable. 21 As more and more supportive care is being delivered to caregivers by phone, and caregivers also desire more support by phone, there is a need for both clinicians and research personnel to develop better phone skills to improve interactions with caregivers.…”

“…A recent qualitative study with lung cancer patients and caregivers revealed a desire for educational interventions that focus on adverse effects and the provision of various coping skills. 21 Similarly, in a palliative care intervention study for lung cancer caregivers, which had a significantly positive impact on caregiver quality of life, symptom management strategies were a top priority across the four educational sessions of the quality of life intervention. 26 Findings in this pilot study suggest that caregiver education should include attention to communication skills in order to combine both knowledge needs for symptom management as well as communication skills to aid in coping with symptom management responsibilities.…”

Coping Skills Practice and Symptom Change: A Secondary Analysis of a Pilot Telephone Symptom Management Intervention for Lung Cancer Patients and Their Family Caregivers

“…Patient inclusion criteria included: 1) age ≥ 18 years; 2) at least 3 weeks post-diagnosis of lung cancer; 3) at least moderate severity for one or more symptoms at recruitment, including: anxiety, depressive symptoms, pain, fatigue, or breathlessness; 4) a consenting family caregiver; and 5) adequate English fluency. Patient exclusion criteria included: 1) significant psychiatric or cognitive impairment; 2) previously providing feedback on the intervention; 23 3) current participation in another psychosocial study; or 4) receiving hospice care. Caregiver inclusion criteria included: 1) age ≥ 18 years; 2) living with the patient or visiting regularly; and 3) adequate English fluency.…”

“…Caregiver inclusion criteria included: 1) age ≥ 18 years; 2) living with the patient or visiting regularly; and 3) adequate English fluency. Caregiver exclusion criteria included: 1) current participation in another psychosocial study; 2) previously providing feedback on the intervention; 23 or 3) significant psychiatric or cognitive impairment.…”

What Matters Most to Lung Cancer Patients? A Qualitative Study in Italy and Belgium to Investigate Patient Preferences

“…This could be attributable to the fact that the scopes of these studies differ greatly. Most of them have an emphasis on a particular goal, such as a specific patient group ( Hirose et al, 2005 ; Hirose et al, 2009 ; Schmidt et al, 2017 ), specific treatment ( Peeters et al, 2012 ) or specific interest in characteristics such as emotional wellbeing ( Mosher et al, 2017 ). In contrast, the present qualitative study aimed to identify patient-relevant lung cancer treatment characteristics across different therapies (including newer types of therapies such as immunotherapies) according to advanced lung cancer patients.…”