Effectiveness of a Psychosocial Care Quality Improvement Strategy to Address Quality of Life in Patients With Cancer

Abstract

IMPORTANCEMany patients with cancer who would benefit from psychosocial care do not receive it. Implementation strategies may favor the integration of psychosocial care into practice and improve patient outcomes. OBJECTIVE To evaluate the effectiveness of the Humanization in Cancer Care (HuCare) Quality Improvement Strategy vs standard care as improvement of at least 1 of 2 domains (emotional or social function) of patient health-related quality of life at baseline and 3 months. A key secondary aim included investigation of the long-term effect. DESIGN, SETTING, AND PARTICIPANTS HuCare2 was a multicenter, incomplete, stepped-wedge cluster randomized clinical trial, conducted from May 30, 2016, to August 28, 2019, in three 5-center clusters of cancer centers representative of hospital size and geographic location in Italy. The study was divided into 5 equally spaced epochs. Implementation sequence was defined by a blinded statistician; the nature of the intervention precluded blinding for clinical staff. Participants included consecutive adult outpatients with newly diagnosed cancer of any type and stage starting medical cancer treatment. INTERVENTIONS The HuCare Quality Improvement Strategy comprised (1) clinician communication training, (2) on-site visits for context analysis and problem-solving, and (3) implementation of 6 evidence-based recommendations. MAIN OUTCOMES AND MEASURES The primary outcome was the difference between the means of changes of individual scores in emotional or social functions of health-related quality of life detected at baseline and 3-month follow-up (within each group) and during the postintervention epoch compared with control periods (between groups). Long-term effect of the intervention (at 12 months) was assessed as a secondary outcome. Intention-to-treat analysis was used. RESULTS A total of 762 patients (475 [62.3%] women) were enrolled (400 HuCare Quality Improvement Strategy and 362 usual care); mean (SD) age was 61.4 (13.1) years. The HuCare Quality Improvement Strategy significantly improved emotional function during treatment (odds ratio [OR],1.13; 95% CI, 1.04-1.22; P = .008) but not social function (OR, 0.99; 95% CI, 0.89-1.09; P = .80).Effect on emotional function persisted at 12 months (OR, 1.05; 95% CI, 1.00-1.10; P = .04). CONCLUSIONS AND RELEVANCEIn this trial, the HuCare Quality Improvement Strategy significantly improved the emotional function aspect of health-related quality of life during cancer treatment and at 12 months, indicating a change in clinician behavior and in ward organization. These (continued) Key Points Question Does an implementation strategy integrating psychosocial care into cancer centers improve at least 1 of 2 domains (emotional or social function) of health-related quality of life? Findings This stepped-wedge cluster randomized clinical trial included 762 patients with cancer at high risk for reduced quality of life. Health-related quality of life score improved from baseline to 3 months among participants in the Humanization in Cancer Care ...

Implementation of Best Practices in Pancreatic Cancer Care in the Netherlands

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Screening for Distress in Oncological Patients: The Revised Version of the Psychological Distress Inventory (PDI-R)

“…In the last decades, psychological research in medical and oncological settings constantly increased focusing on observed outcomes of psychological care (Mannarini et al, 2013;Caminiti et al, 2017Caminiti et al, , 2021. In this context, the construct of psychological distress has rapidly gained popularity (Mitchell, 2010;Wise et al, 2013;Riba et al, 2019;Marconi et al, 2020).…”

“…An observational research design was used to investigate the psychological distress experienced by oncological outpatients during the first few weeks between the diagnosis of cancer and the first psychological clinical session-in line with the procedure provided by the HuCARE study protocol (Passalacqua et al, 2016;Marconi et al, 2020;Caminiti et al, 2021;.…”

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Patients’ expectations of and experiences with psychosocial care needs in perioperative nursing: a descriptive study

“…Meeting the psychosocial care needs of patients is essential for ensuring their optimal safety, recovery, and positive experiences [ 1 ]. Interventions improving psychosocial care, such as clinician communication training and on-site visits for context analysis and problem-solving, have been demonstrated to be effective to reduce suffering [ 2 ] and improve quality of life [ 3 ] in patients with dementia or cancer. Furthermore, the effectiveness of psychosocial techniques to decrease post-operative pain and improve perioperative clinical care in orthopedic surgery has been reported in a meta-analysis [ 4 ].…”