Feasibility of a Nurse-Coordinated Intervention to Support Self-Management of Multiple Co-Occurring Cancer Symptoms.

Abstract

Background: Symptom management guidelines are primarily written for single cancer symptoms despite patients experiencing multiple co-occurring symptoms. Coordinating recommendations across guidelines based on patients' self-report of symptom clusters may facilitate efficient multisymptom self-management.

Objective: The aim of this study was to evaluate the feasibility of a nurse-coordinated approach to multisymptom management among patients receiving chemotherapy.

Intervention/methods: Forty-one adults receiving cancer chemotherapy and experiencing ≥2 symptoms were recruited to this pilot randomized controlled trial. Participants self-reported symptom cluster experiences weekly, over 2 cycles of chemotherapy. All participants received usual care during the first cycle on study, and half were randomized to enhanced care during the second cycle. A nurse interventionist reviewed participants' symptom cluster self-reports to understand symptom relationships and etiology, selected 1 or more guideline-based self-management strategies to treat multiple symptoms, and provided participants with weekly self-management instructions.

Results: Recruitment (85%) and retention (83%) met feasibility criteria. Nurse interventionists successfully coordinated a treatment plan with fewer self-management strategies than symptoms for 84% of participants' symptom cluster reports. Coordination challenges included complex multisymptom etiology, prioritizing among self-management strategies, and symptoms with no guideline-recommended treatments. Most participants (≥72%) reported satisfaction with the intervention and study procedures.

Conclusions: Nurse coordination of management strategies for clustered symptoms is feasible and acceptable, and merits further intervention development.

Implications for practice: Eliciting patients' self-reports of symptom clusters provides important insights to drive management recommendations. Drawing on this knowledge and using evidence-based guidelines, oncology nurses may identify self-management strategies that are effective across multiple co-occurring symptoms to reduce patients' symptom and self-management burden.