Nurse-led Telephone Intervention Research Articles

A proof-of-concept study of iCope: A nurse-led psychoeducational telephone intervention for women attending a rapid diagnostic centre for breast abnormality.

The period between the initial discovery of a suspicious breast lesion and a confirmed diagnosis is a time of significant psychological distress, heightened anxiety, and uncertainty for many women. This proof of concept (PoC) study explored the clinical outcomes and acceptability of iCope, a nurse-led psycho-educational telephone intervention aimed to assist with uncertainty, anxiety and coping in women going through a Rapid Diagnostic Centre (RDC) offering quick diagnosis of breast cancer (same day to three-day post-investigation). Guided by the Uncertainty Theory, and using a one-arm pretest-posttest design, two brief 15-minute telephone sessions were delivered by a nurse prior to the women's day of testing at the RDC and three days after the receipt of their results. Six women completed measures of anxiety, uncertainty, and coping before the clinic visit, three days and three weeks after receiving their test results. Results show that the implementation of the telephone intervention was challenging, yet may offer potential for positive impact. That is, trends of decreased uncertainty and anxiety in participants over time were noted. Considering the difficulty observed in the recruitment and delivering the two interventions in the timeline planned, feasibility testing is recommended before the conduct of a large-scale study.

A proof-of-concept study of iCope: A nurse-led psycho-educational telephone intervention for women attending a rapid diagnostic centre for breast abnormality

Entre la découverte d’une lésion suspecte dans un sein et la confirmation du diagnostic, de nombreuses femmes vivent de l’incertitude, une anxiété accrue et une grande détresse psychologique. La présente étude de validation de principe évalue les résultats cliniques et l’acceptabilité de l’approche iCope, une intervention téléphonique de psychoéducation menée par des infirmières dont le but est d’aider à renforcer la capacité d’adaptation, de calmer l’anxiété et de réduire l’incertitude des femmes suivies dans un centre de diagnostic rapide (CDR) afin d’obtenir, le jour même ou dans les trois jours suivants, les résultats de leur dépistage du cancer du sein. Une infirmière faisait un bref appel téléphonique de 15 minutes avant la journée d’examens, puis trois jours après la réception des résultats., L’approche était fondée sur la théorie de l’incertitude et adoptait un format d’étude pré-test/post-test à une seule branche. Six femmes ont répondu aux questionnaires de mesure de l’anxiété, de l’incertitude et de la capacité d’adaptation avant leur visite à la clinique, puis trois jours, et enfin trois semaines après avoir reçu le diagnostic. Selon les résultats de l’étude, la mise en œuvre des interventions téléphoniques n’est pas simple, mais elle pourrait avoir des effets positifs, c’est-à-dire qu’on a observé une certaine diminution de l’anxiété et de l’incertitude au fil du temps. Étant donné les difficultés à recruter des participantes et à tenir les deux interventions selon le calendrier prévu, une étude de faisabilité est recommandée avant de mener une étude à grande échelle.

Author commentary on Marco Antonio Alvarez-Gonzalez et al.

Marco Antonio Alvarez-Gonzalez et al. Educational nurse-led telephone intervention shortly before colonoscopy as a salvage strategy after previous bowel preparation failure: a multicenter randomized trial

Benefit of a nurse-led telephone-based intervention prior to the first urogynecology outpatient visit: a randomized-controlled trial

Introduction and hypothesisTriage has become a valid tool to reduce workload during the first consultation in a specialized clinic. A nurse-led telephone intervention prior to the first urogynecologic visit reduces visit duration and increases patients’ and physicians’ satisfaction.MethodsAll patients scheduled for their very first visit were recruited. They were randomized into an intervention group (prior contact by a specialized urogynecology nurse) and a control group (no contact). The intervention included a questionnaire about history and symptoms. Patients were prompted to complete a bladder diary. Primary outcome was duration of the consultation; secondary outcomes were patients’ and physicians’ satisfaction with the intervention.ResultsFifty-five patients were allocated to the intervention group and 53 to the control group with no difference regarding age, BMI, parity, menopausal status and primary diagnosis. Mean duration of the telephone call was 10.8 min (SD 4.4). The consultation was significantly shorter in the intervention group than in the control group (mean difference: 4 min and 8 s, p = 0.017). In the intervention group, 79% of the patients found the consultation quality “excellent,” 86% would return, and 77% would recommend our clinic to a relative or friend compared with 68%, 67% and 66%, respectively, in the control group. Physicians were “very satisfied” or “satisfied” with the patient preparation.ConclusionsA nurse-led intervention reduces the duration of the first uroynecologic consultation and is associated with high patient and physician satisfaction. Further research should evaluate whether it also decreases the number of follow-up visits and further referrals.

CN74 - Providing a nurse-led telephone intervention for patients treated with oral anticancer medication: Symptom management and adherence monitoring

BackgroundMany interventions to improve a safe use of oral anti-cancer agents have been reported during the last decade. Frequently, these interventions involve nurse-led follow-up, but there is limited data to suggest the proportion of adherence and toxicity related to treatment that nurses can detect. MethodsCAPRI, a randomized phase III trial comparing: an intervention combining Nurse Navigators (NNs) and a mobile application vs. Standard of care in cancer patients treated with oral anticancer agents was initiated in 2016 at Gustave Roussy (Villejuif, France). Nurses conduct regular telephone follow-up (1/week for the 1st month, 2/month for the following 3 months, then 1/3 weeks). During follow-up, they assess adherence, symptoms and supportive care needs. PROMS (Patient Reported Outcome Measure) (e.g. pain, appetite) are also recorded by the patient via the mobile application. A coding grid was developed to extract from the nurses intervention reports the information identified during follow-up and to categorize the actions implemented by them. All regular follow-ups over a 24-month period were studied. ResultsNurses carried out 2279 regular follow-ups concerning 237 patients, of which 1880 could be carried out (patient available). They detected treatment-related symptoms/toxicities (or worsening) in 582 (31%) of the regular follow-ups involving 193 patients. Interventions performed in these situations are advice given to the patient (55%), advice or indications after the oncologist’s request (23%), referral to a primary care professional (14%) or to a health facility (8%). Twenty-six regular follow-ups concerning 18 patients identified adherence issues. Actions implemented by nurses encompassed: patient advice (n=14), request for advice from the referring oncologist (n=10), introduction of a homecare nurse (n=2). ConclusionsClose and proactive nurse-led follow-up might help not only detecting and managing toxicities, but also identifying adherence issues in cancer patients receiving oral anti-cancer agents. Clinical trial identification2016-A00254-47. Legal entity responsible for the studyGustave Roussy. FundingFondation Philanthropia - Lombard Odier, Agence Nationale de la Recherche IHU-MMO, ARS Ile de France, Novartis, AstraZeneca. DisclosureAll authors have declared no conflicts of interest.

Impact of two nurse-led interventions targeting diet among breast cancer survivors: Results from a randomized controlled trial.

Breast cancer is the most common neoplasm among women worldwide. Improvements in early detection and treatment have resulted in improved survival rates; however, the continuation of unhealthy behaviours after diagnosis can increase the risk of second primary tumours. The aim of the study was to evaluate the effectiveness of two nurse-led health education interventions aiming at improving dietary behaviours among women diagnosed with breast cancer. Participants (n=492) were included in a double-blind randomized controlled trial with three arms: a control group received usual care; women in the first intervention group received a booklet containing dietary advice; women in the second intervention group received the same booklet plus a tailored telephone intervention delivered by a trained nurse. One year after the intervention, women in both intervention groups were more likely to adhere to the recommendation of decreasing the consumption of animal fats compared with the control group (OR:5.0; 95% CI:1.5-16.9 and OR:6.6; 95% CI:2.0-22.6, respectively). Moreover, compared with the control group, the adjusted probability of eating the recommended amount of fruit and vegetables was higher in the second intervention group (OR:2.7; 95% CI:1.4-5.3). In summary, the booklet containing dietary advice for breast cancer survivors, either alone or supplemented with a nurse-led telephone intervention, was effective in promoting adherence to diet recommendations.

Trial of Optimal Personalised Care After Treatment-Gynaecological Cancer (TOPCAT-G): A Randomized Feasibility Trial.

This study aimed to evaluate the feasibility of completing a parallel-group randomized controlled trial to compare usual follow-up care for women who have completed treatment of gynecological cancer against a nurse-led telephone intervention, known as Optimal Personalised Care After Treatment-Gynaecological. The unblinded trial aimed to recruit patients who had completed treatment of cervical, endometrial, epithelial ovarian, or vulval cancer within the previous 3 months at 3 North Wales hospitals. We randomized participants to either usual hospital-based follow-up or specialist nurse-led telephone education, empowerment, and structured needs assessment follow-up. The primary outcomes assessed the feasibility of running a larger trial including patient eligibility, recruitment and retention rates, and outcome measure completion. Secondary outcomes were generic and health-related quality of life and a patient self-report health service use (Client Service Receipt Inventory) data collected at 3 time points (baseline, 3 months, and 6 months). Of the 58 women screened, 44 were eligible (76%) and 24 (55%) were recruited and randomized (12:12 to control and intervention, respectively). One participant was lost to follow-up. Recruited participants had a mean (SD) age of 60 (11.2) years and were approximately 5 months from their initial diagnosis (mean [SD], 159 [58] days). Seventeen (71%) of the participants had an endometrial cancer diagnosis. All outcome measure completion rates exceeded 96%. Although not a core feasibility objective, analyses of outcome measures indicated positive changes in quality of life and well-being within the Optimal Personalised Care After Treatment-Gynaecological group; exploratory cost consequence analysis indicated that the nurse-led intervention had a mean total service use cost of £27 per patient (bootstrapped 95% confidence interval, -£290 to £240) lower than did the standard care group. Eligibility, recruitment, and retention rates as well as outcome measure completion showed that the trial is feasible.

Impact of a nurse led telephone intervention on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized clinical trial

BackgroundChildren suffering from rheumatic disease are faced with multidimensional challenges that affect their quality of life and family dynamics. Symptom management and monitoring of the course of the disease over time are important to minimize disability and pain. Poor disease control and anticipation of the need for treatment changes may be prompted by specialist medical follow-up and regular nurse-led consultations with the patient and families, in which information and support is provided. The purpose of this study was to evaluate the impact of a nurse-led telephone intervention or Telenursing (TN) compared to standard care (SC) on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their parents.MethodsA multicentered, randomized, longitudinal, crossover trial was conducted with pediatrics outpatients newly diagnosed with inflammatory rheumatic diseases. Participants were randomly assigned to two groups TN and SC for 12 months and crossed-over for the following 12 months. TN consisted of providing individualized affective support, health information and aid to decision making. Satisfaction (primary outcome) and health outcomes were assessed with the Client Satisfaction Questionnaire-8 and the Juvenile Arthritis Multidimensional Assessment Report, respectively. A mixed effect model, including a group x time interaction, was performed for each outcome.ResultsSatisfaction was significantly higher when receiving TN (OR = 7.7, 95% CI: 1.8–33.6). Morning stiffness (OR = 3.2, 95% CI: 0.97–7.15) and pain (OR = 2.64, 95% CI: 0.97–7.15) were lower in the TN group. For both outcomes a carry-over effect was observed with a higher impact of TN during the 12 first months of the study. The other outcomes did not show any significant improvements between groups.ConclusionTN had a positive impact on satisfaction and on morning stiffness and pain of children with inflammatory rheumatic diseases and their families. This highlights the importance of support by specialist nurses in improving satisfaction and symptom management for children with inflammatory rheumatisms and their families.Trial registrationClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012).

Trial of Optimal Personalised Care After Treatment for Gynaecological cancer (TOPCAT-G): a study protocol for a randomised feasibility trial.

BackgroundGynaecological cancers are diagnosed in over 1000 women in Wales every year. We estimate that this is costing the National Health Service (NHS) in excess of £1 million per annum for routine follow-up appointments alone. Follow-up care is not evidence-based, and there are no definitive guidelines from The National Institute for Health and Care Excellence (NICE) for the type of follow-up that should be delivered. Standard care is to provide a regular medical review of the patient in a hospital-based outpatient clinic for a minimum of 5 years. This study is to evaluate the feasibility of a proposed alternative where the patients are delivered a specialist nurse-led telephone intervention known as Optimal Personalised Care After Treatment for Gynaecological cancer (OPCAT-G), which comprised of a protocol-based patient education, patient empowerment and structured needs assessment.MethodsThe study will recruit female patients who have completed treatment for cervical, endometrial, epithelial ovarian or vulval cancer within the previous 3 months in Betsi Cadwaladr University Health Board (BCUHB) in North Wales. Following recruitment, participants will be randomised to one of two arms in the trial (standard care or OPCAT-G intervention). The primary outcomes for the trial are patient recruitment and attrition rates, and the secondary outcomes are quality of life, health status and capability, using the EORTC QLQ-C30, EQ-5D-3L and ICECAP-A measures. Additionally, a client service receipt inventory (CSRI) will be collected in order to pilot an economic evaluation.DiscussionThe results from this feasibility study will be used to inform a fully powered randomised controlled trial to evaluate the difference between standard care and the OPCAT-G intervention.Trial registration ISRCTN45565436.

Evaluation of a Nurse-Led Educational Telephone Intervention to Support Self-Management of Patients With Chronic Obstructive Pulmonary Disease: A Randomized Feasibility Study

This randomized, two armed feasibility study in a UK General Practice Surgery investigated the feasibility of introducing a nurse-led educational telephone intervention for patients with chronic obstructive pulmonary disease (COPD) to reinforce their understanding and use of their self-management plan. Methods: 73 patients were randomly allocated to a control group which received standard care including a self-management plan or an intervention group which received in addition, two scheduled telephone calls over six weeks from a practice nurse. Calls were tailored to the needs of the patient, but provided education about the use of their plan to manage exacerbations, use of health services and emergency medication. The primary endpoint to be tested was the impact of symptoms assessed by the COPD Assessment Tool (CAT) at baseline and 12 weeks. Secondary endpoints were self-reported exacerbations, emergency visits and service satisfaction. Results: Follow-up CAT data was available for 69 of the 73 randomized patients. CAT scores in the intervention group decreased significantly showing improvement between time 1 and 2 (Time 1 = 15.56 vs 12.44 at Time 2, Mean difference: 3.12, CI 1.52 –4.72, p <0.05) with no significant change in the control group. A significant difference between the CAT scores of the intervention and control groups was found at time 2 adjusting for baseline CAT scores at time 1 (−2.38 (−4.40 to −0.36) p <0.05.) No significant change was found in exacerbations between the groups at time 2. Satisfaction ratings did not vary significantly between the intervention and control groups over time. Conclusion: A nurse-led telephone intervention is feasible in primary care and may help to improve patients’ health and well-being.

Is a nurse-led telephone intervention a viable alternative to nurse-led home care and standard care for patients receiving oral capecitabine? Results from a large prospective audit in patients with colorectal cancer

Home care nursing has been shown to be a valuable service for patients receiving oral chemotherapy; however, associated costs can be high and telephone-based services may be more cost-effective options. This prospective audit explored the usefulness of a nurse-led telephone intervention for supporting cancer patients treated with Capecitabine, comparing historical findings from a randomised trial evaluating a home-based intervention over standard care with a modified nurse-led telephone follow-up intervention. Self-reported toxicity and service use were assessed in 298 patients who received nurse-led telephone follow-up, compared with historical data from 164 patients (81 receiving standard care and 83 home care intervention). Findings suggested that nurse-led telephone follow-up can potentially lead to reduced toxicity (chest pain, vomiting, oral mucositis, nausea, insomnia) when compared with standard care, and that it has a similar impact on the management of some symptoms when compared with home care (i.e. vomiting, oral mucositis), although it was not as effective as the home care intervention for other toxicities (diarrhoea and insomnia). These encouraging findings need to be explored further using a randomised trial design before we reach any conclusions. Further research should also include a health economics study to assess the cost-effectiveness of the telephone-based services for patients receiving oral chemotherapy.