Coaching

Coaching

PEP Topic 
Anxiety
Description 

Coaching involves interventions to educate, encourage, and prepare patients to communicate with providers about concerns. Coaching may involve the use of tools such as checklists or prompt sheets. Coaching interventions enable patients to practice communicating.

Likely to Be Effective

Research Evidence Summaries

Shields, C.G., Ziner, K.W., Bourff, S.A., Schilling, K., Zhao, Q., Monahan, P., . . . Champion, V. (2010). An intervention to improve communication between breast cancer survivors and their physicians. Journal of Psychosocial Oncology, 28, 610–629.

doi:10.1080/07347332.2010.516811
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Study Purpose:

To compare a coaching intervention that uses a prompt sheet with usual care to improve cancer provider and survivor communication about survivor worries

Intervention Characteristics/Basic Study Process:

The study involved a telephone coaching session using a prompt sheet and a nurse guiding a participant in prioritizing concerns to be addressed at an upcoming oncologist visit.

Sample Characteristics:

  • The sample was comprised of 44 survivors with breast cancer (100% female).
  • Mean survivor age was 44.1 years.
  • Mean age at diagnosis was 38.5 years; 20% were diagnosed at stage I, 53% at stage II, and 27% at stage III.
  • Mean time since diagnosis was 5.5 years.
  • All were disease-free at the time of enrollment.
  • All survivors had undergone chemotherapy.
  • The sample was 95% white.

Setting:

  • Outpatient setting
  • University cancer center in Indiana

Phase of Care and Clinical Applications:

  • Long-term follow-up phase
  • Late effects/survivorship

Study Design:

A randomized controlled trial design was used.

Measurement Instruments/Methods:

  • Breast Cancer Self-Efficacy Scale: 14-item scale with a five-point Likert-type response developed for the study (Cronbach’s alpha = 0.84, content validity confirmed by 12 breast cancer survivors, 4 clinical experts, and 2 cancer research experts)
  • Spielberger State-Trait Anxiety Inventory (STAI)–State subscale
  • Center for Epidemiological Studies Depression Scale (CES-D)
  • Concerns About Recurrence Scale (CARS)

Results:

Most concerns centered around current symptoms, long-term effects of treatment, and recurrence of cancer. The prompt sheet and coaching did not have a significant effect on depression, anxiety, or worries. Survivor questions communicated worry about symptoms and long-term side effects experienced by young breast cancer survivors.

Conclusions:

Self-efficacy may be a significant predictor of survivors’ state of anxiety and depression.

Limitations:

  • Study findings are limited by sample demographics (mostly white, highly educated women).
  • The study had no blinding or attentional control.
  • The study’s lack of direct observation of communication between the survivor and oncologist limits the understanding of how the prompt sheet changed and/or facilitated communication.

Nursing Implications:

This type of intervention may help survivors to think about their concerns prior to an office visit and organize their thoughts for the visit so that priority issues can be addressed. Whether this has an impact on outcomes has not been supported. Findings suggest that self-efficacy is predictive of role concerns and emotional outcomes such as state anxiety and depression.

White, V.M., Macvean, M.L., Grogan, S., D'Este, C., Akkerman, D., Ieropoli, S., . . . Sanson-Fisher, R. (2012). Can a tailored telephone intervention delivered by volunteers reduce the supportive care needs, anxiety and depression of people with colorectal cancer? A randomised controlled trial. Psycho-Oncology, 21, 1053–1062.

doi: 10.1002/pon.2019
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Study Purpose:

To assess the effectiveness of a volunteer-delivered, tailored telephone-based intervention in reducing unmet supportive care needs and elevated levels of anxiety and depression among people with colorectal cancer

Intervention Characteristics/Basic Study Process:

The intervention utilized a checklist of unmet needs that patients with colorectal cancer completed. Specially trained volunteers then followed up with patients, by means of telephone consultation, to review needs and devise an action plan.

Sample Characteristics:

  • The study reported on a sample of 653 patients with colorectal cancer.
  • Mean patient age was 64.57 years (SD = 9.2 years).
  • The sample was 40.5% female and 59.5% male.
  • Of sample patients, 78% were married; 49% had undergone chemotherapy, 89% had undergone surgery, and 10% had undergone radiotherapy; and almost 90% had at least a high school education.

Setting:

  • Outpatient setting
  • Australia

Phase of Care and Clinical Applications:

Transition phase of care

Study Design:

Randomized controlled trial

Measurement Instruments/Methods:

  • Supportive Care Need Survey (SCNS)
  • Hospital Anxiety and Depression Scale (HADS)
  • Nine-item colorectal cancer symptom checklist (developed for study)
  • Eleven-item questionnaire on the use of supportive care services (developed for study)
  • Medical Outcome Study Social Support Survey (MOS-SSS)

Results:

  • The prevalence of elevated anxiety decreased over time in the intervention group (p < 0.01).
  • Compared to the control group, the intervention group reported a greater use of services (p < 0.01).

Conclusions:

This study suggests that a volunteer-delivered, telephone-based intervention is plausible and acceptable to patients with cancer and that the intervention was effective in getting patients to use available services. This approach was associated with reduced anxiety over time, but did not have an impact on depression or prevalence of unmet needs as identified by the patients.

Limitations:

  • The study design lacked an attentional control.
  • The study did not include discussion regarding supportive services utilized and whether they met patients’ unmet needs.
  • The intervention was delivered to patients three to four months postdiagnosis, and the highest period of unmet needs may actually be sooner in the treatment trajectory.

Nursing Implications:

Tailoring support and interventions to only those patients with unmet needs might be a better allocation of resources while producing significant results.


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