护士主导的增强支持性护理作为晚期癌症患者早期初级姑息治疗方法的效果：一项随机对照试验

IF 7.5 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2025-05-01 DOI:10.1016/j.ijnurstu.2025.105102

Yun Young Choi , Bomi Hong , Sun Young Rha , Sungkun Cho , Hye Sun Lee , Jiyeon Lee

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引用次数: 0

摘要

护士在提供姑息治疗方面发挥着重要作用。然而，很少有研究评估护士主导的初级姑息治疗的有效性。

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The effect of nurse-led enhanced supportive care as an early primary palliative care approach for patients with advanced cancer: A randomized controlled trial

Background

Nurses play an important role in providing palliative care. However, few studies have evaluated the effectiveness of nurse-led primary palliative care.

Objective

To evaluate the effect of nurse-led enhanced supportive care as an early primary palliative care approach for advanced cancer patients.

Design

Randomized controlled trial.

Setting(s)

This study was conducted at Yonsei Cancer Center in Seoul, Korea.

Participants

Advanced cancer patients initiating palliative chemotherapy (N = 258) and their family caregivers (N = 120) were enrolled and completed 3-month (n = 182 patients, n = 79 caregivers) and 6-month (n = 141 patients, n = 60 caregivers) follow-up assessments.

Methods

Participants were randomly assigned to the intervention or control group (1:1). The intervention group received nurse-led enhanced supportive care, which included symptom management and coping enhancement counseling before each chemotherapy cycle (baseline to 3 months) and was delivered by trained nurses. The control group received symptom monitoring. Family caregivers only participated in the evaluation. The primary outcomes were quality of life (EORTC-QLQ C30), symptoms (ESAS), and coping (Brief COPE) at 3 months. The secondary outcomes were quality of life, symptoms, and coping at 6 months. Self-efficacy for coping with cancer (CBI-3.0 K), and depression among cancer patients and family caregivers (HADS-D) at 3 and 6 months were also evaluated. The data were analyzed using linear mixed models.

Results

The intervention group reported beneficial effects in the following outcomes: 1) Quality of life [role functioning domain at 3 months (1.01 ± 2.34 vs. − 8.37 ± 2.07; p = .003 [− 15.57, − 3.18]; adjusted p = .044), 2) coping [active coping at 3 months (0.27 ± 0.16 vs. − 0.34 ± 0.14; p = .006 [− 1.04, − 0.18]; adjusted p = .044), and self-distraction (0.22 ± 0.17 vs. − 0.42 ± 0.15; p = .004 [− 1.08, − 0.20]; adjusted p = .044) at 3 months]; 3) self-efficacy in coping with cancer [maintaining activity and independence at 3 months (1.45 ± 0.47 vs. − 0.31 ± 0.42; p = .006 [− 2.99, − 0.52]; adjusted p = .044)]. The intervention was not effective in reducing symptoms and depression of patients or depression of caregivers (adjusted p > .05).

Conclusions

Nurse-led enhanced supportive care as an early primary palliative care approach has demonstrated effectiveness in improving the role functioning domain of quality of life, use of coping strategies, and self-efficacy in maintaining activity and independence among advanced cancer patients. Nurse-led early primary palliative care should be delivered by trained nurses and incorporated into routine oncology practice.

Registration

Registered at ClinicalTrials.gov, NCT04407013, on May 29, 2020, https://www.clinicaltrials.gov/ct2/show/study/NCT04407013. The protocol version is ESC 1.0.

Tweetable abstract: The integration of nurse-led early primary palliative care into routine oncology practice for patients with advanced cancer is recommended.

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来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).