Supportive Care/Support Interventions

Supportive Care/Support Interventions

PEP Topic 
Anxiety
Description 

Supportive care involves the provision of emotional support informally or through structured interventions. Support interventions include activities such as general counseling related to emotional and other issues, active listening, and presence. Supportive interventions may be provided by healthcare professionals or may be structured as peer group support. Interventions can be one-on-one individualized sessions, support group sessions, or specific interventions with caregivers, families, etc. Support interventions may be provided via telephone, physical presence, or online groups that may be either refereed by a professional or unrefereed. Expressive writing for emotional disclosure can be seen as a specific type of supportive intervention; however, it is not grouped in the intervention of supportive care. Expressive writing, as a very specific approach, is evaluated in PEP resources as its own type of intervention. Supportive care/support interventions have been evaluated in patients with cancer for anxiety, caregiver strain and burden, chemotherapy-induced nausea and vomiting, and depression.

Effectiveness Not Established

Research Evidence Summaries

Ando, M., Morita, T., Okamoto, T., & Ninosaka, Y. (2008). One-week Short-Term Life Review interview can improve spiritual well-being of terminally ill cancer patients. Psycho-Oncology, 17, 885-890.

doi:10.1002/pon.1299
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Study Purpose:

To assess the efficacy of a Short-Term Life Review process on spiritual well- being, anxiety, depression, suffering, and happiness in terminally ill patients with cancer

Intervention Characteristics/Basic Study Process:

The intervention was Short-Term Life Review completed with a psychologist, who then created an album based on the participant’s interview. In the first part, participants reviewed their life, and in the second, they reevaluated, reconstructed, and appreciated their life. In the second session, the album was reviewed with the participant.

Sample Characteristics:

  • The study reported on a sample of 30 patients with cancer.
  • Mean patient age was 74 years (SD = 9.1).
  • The sample was 73.3% female and 26.7% male.
  • Multiple tumor sites were represented.
  • Of the sample, 90% had no specific religious affiliation, and 96.7% were married.
  • Mean time from interview to death was 67 days.

Setting:

  • Single site
  • Inpatient setting
  • Japan

Phase of Care and Clinical Applications:

  • Patients were undergoing the end-of-life phase of care.
  • The study has clinical applicability for end-of-life and palliative care.

Study Design:

A prospective pre/post-test design was used.

Measurement Instruments/Methods:

  • Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being (FACIT-Sp) – Japanese version
  • Hospital Anxiety and Depression Scale (HADS) – Japanese version
  • Numeric rating scales for suffering (0–6) and happiness (1–7)

Results:

Anxiety and depression scores significantly decreased (p = 0.001).

Conclusions:

The Short-Term Life Review process is feasible for terminally ill patients and appears to be beneficial to reduce anxiety and depression, reduce suffering, and improve happiness.

Limitations:

  • Statistical significance may not impart sufficient clinical significance for such an intensive intervention.
  • The study did not have a control group.

Nursing Implications:

  • Cultural differences may affect efficacy; further study is required.
  • The intervention was completed by a trained psychologist and required a large time investment to create the album.

Badger, T., Segrin, C., Dorros, S.M., Meek, P., & Lopez, A.M. (2007). Depression and anxiety in women with breast cancer and their partners. Nursing Research, 56, 44–53.

doi: 10.1097/00006199-200701000-00006
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Intervention Characteristics/Basic Study Process:

This intervention provided telephone-delivered psychosocial interventions.

One group received six weeks of telephone-delivered counseling (TIP-C) sessions based on interpersonal psychotherapy/counseling principles, covering the following topics.

  • Cancer education
  • Social support
  • Awareness and management of anxiety symptoms
  • Role transitions

These phone calls averaged 34 minutes.

A second group received six weeks of telephone-delivered, self-managed exercise protocol information. The exercise protocol consisted of engaging in regular, low-impact exercise (e.g., walking for a prescribed number of minutes at least four times per week). These phone calls averaged 11 minutes.

A third group received six weeks of attention control (AC) printed information about breast cancer with brief weekly phone calls averaging seven minutes. This group did not receive counseling or encouragement to exercise.

Data were collected at baseline (T1), one week after the final call (T2), and one month after the final call (T3).

Sample Characteristics:

  • The study reported on a convenience sample of 96 women with breast cancer and 96 partners (N = 192).
  • Participants were randomized to three groups, stratified by stage and treatment.
    • Group 1 consisted of 38 women and 38 partners.
    • Group 2 consisted of 21 women and 19 partners.
    • Group 3 consisted of 33 women and 30 partners.
  • There were no significant differences between groups for treatment, stage, history of depression, participation in support groups or counseling, and use of antidepressants or antianxiety medications.

Study Design:

The study used an experimental design: three-wave repeated measures with a between-subjects factor (treatment group).

Measurement Instruments/Methods:

  • Positive and Negative Affect Schedule (PANAS) PLUS
  • Index of Clinical Stress to make eight-item composite index of anxiety
  • Instruments used have established reliability and validity.

Results:

Both telephone counseling and exercise conditions helped to significantly reduce anxiety in women and their partners (p < 0.001). The AC group did not evidence the same improvement in decreased anxiety, and their partners’ anxiety scores increased. The authors reported mixed-model ANOVA significant effect for time (p = 0.001), no significant main effect for treatment group, and significant group x time interaction (p = 0.01).

Nursing Implications:

The intervention required special training needs of a psychiatric nurse counselor with oncology expertise to deliver the telephone counseling sessions. These 34-minute (on average) phone calls per weekly session (x 2—one per patient and one per partner) required more than one hour per week per couple of time to deliver the intervention.

Björneklett, H.G., Lindemalm, C., Rosenblad, A., Ojutkangas, M.L., Letocha, H., Strang, P., & Bergkvist, L. (2012). A randomised controlled trial of support group intervention after breast cancer treatment: Results on anxiety and depression. Acta Oncologica, 51, 198–207.

doi:10.3109/0284186X.2011.610352
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Study Purpose:

To evaluate the effect of a support program on anxiety and depression in patients with breast cancer

Intervention Characteristics/Basic Study Process:

The intervention was a weeklong multidisciplinary residential program. The intervention took place within four months after the end of tumor treatment and ran for seven days, followed by four days of follow-up two months after the initial visit. The team consisted of oncologists, social workers, art therapists, massage therapists, a dietitian, and a mindfulness practitioner.

Sample Characteristics:

  • The study reported on a sample of 382 female patients with breast cancer; 309 completed the 12-month follow-up.
  • Mean ages in the treatment group were 54 years (range = 30–69) and 61 years (range = 34–84).
  • Mean ages in the control group were 55 years (range = 38–70) and 62 years (range = 38–83).
  • Patients were subgrouped into whether they had chemotherapy or not. Patients had either breast-conserving surgery or mastectomy. Those with breast-conserving surgery or lymph node involvement also received radiation therapy.

Setting:

  • Single site
  • Retreat center setting
  • Sweden

Phase of Care and Clinical Applications:

  • Transition phase of care
  • Late effects and survivorship

Study Design:

A randomized controlled trial design was used.

Measurement Instruments/Methods:

Hospital Anxiety and Depression Scale (HADS)–Swedish version

Results:

After 12 months, 10% in the intervention group versus 19% in the control group had a high anxiety score (p = 0.055).

Conclusions:

Support group intervention including education about the disease and psychological reactions, mixed with art and dance therapy, qigong, and relaxation, was shown to positively influence anxiety levels among patients with breast cancer over time, whereas depression levels were unaffected by the intervention.

Limitations:

  • A variety of interventions and providers were used, limiting the ability to transfer the findings to other venues.
  • Reproducibility is an issue.
  • The study had no appropriate attentional control.

Nursing Implications:

Because of costs and time constraints, the ability of this program to be replicated is suspect. The particular components of the program that provided the most effectiveness were not analyzed and therefore cannot be reproduced or further studied.

Björneklett, H.G., Rosenblad, A., Lindemalm, C., Ojutkangas, M.L., Letocha, H., Strang, P., & Bergkvist, L. (2013). Long-term follow-up of a randomized study of support group intervention in women with primary breast cancer. Journal of Psychosomatic Research, 74(4), 346–353.

doi: 10.1016/j.jpsychores.2012.11.005
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Study Purpose:

Long-term follow-up to evaluate quality of life after support group intervention in a randomized group of women with primary breast cancer presenting for postoperative radiotherapy.

Intervention Characteristics/Basic Study Process:

The current study is a long-term follow-up 5–9 years after randomization into groups. The intervention and control groups were stratified by chemotherapy or nonchemotherapy treatment. The intervention was a one-week support group with four days of follow-up two months postintervention during residential care at the Foundation of Lustgården Mälardalen. The intervention involved lectures and group discussions about the etiology of cancer, risk factors, treatment, physical and psychological effects, and coping strategies. Patients engaged in physical exercise, relaxation, Qigong, and nonverbal communication exercises, as well as art and dance therapy. All participants completed questionnaires at baseline and follow-up questionnaires at 2, 6, and 12 months postintervention. The control group participated only in routine follow-up at the Department of Oncology or the Department of Surgery.

Sample Characteristics:

  • N = 382 (final sample); 191 in intervention group and 191 in control group
  • AGE RANGE: 30–83
  • MALES: 0 %, FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Patients were newly diagnosed with primary breast cancer at the beginning of the parent study.

Setting:

  • SITE: Single site    
  • SETTING TYPE: Outpatient   
  • LOCATION: Department of Oncology at the Central Hospital in Västeräs, Sweden

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Palliative care 

Study Design:

  • Prospective randomized trial
    • Long-term follow-up comparison of test scores at baseline, 12 months, and at end

Measurement Instruments/Methods:

  • Hospital Anxiety and Depression Scale (HADS)
  • European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)
  • European Organisation for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life Questionnaire (QLQ-BR23)
  • Fatigue Questionnaire (FQ)

Results:

Fatigue symptoms improved over time, which was a significant finding in the intervention and control groups. Being upset about hair loss improved over time in the intervention group. High anxiety scores improved over time and were not significantly different between the two groups in long-term follow-up. Depression scores were high at follow-up for seven women in each group, and no significant difference was found at baseline and postintervention, adjusting for covariates. Neither group showed improvement between the 12-month follow-up and long-term follow-up. 

Conclusions:

Effects of support group intervention may provide a sense of security that can fade over time, reversing improvements in anxiety and depression. Treatment-related fatigue may improve over time. Significant improvement was found in cognitive function, body image, and future perspective, but no significant effect was found on levels of anxiety and depression.

Limitations:

  • An average of 6.5 years elapsed between the parent study and the follow-up study.
  • Participants were lost to follow-up between the parent study and the follow-up study.
  • No initial need for an intervention was conducted.

Nursing Implications:

Women who have received chemotherapy have greater symptom severity and may benefit more on global health and cognitive function fatigue, when compared to women who have not received chemotherapy. Additional research is needed to evaluate the influence of exercise and psychosocial support interventions, according to patient needs for content, duration, and an assessment of spiritual well-being using the Functional Assessment of Chronic Illness Therapy (FACIT).

Cameron, L.D., Booth, R.J., Schlatter, M., Ziginskas, D., & Harman, J.E. (2007). Changes in emotion regulation and psychological adjustment following use of a group psychosocial support program for women recently diagnosed with breast cancer. Psycho-Oncology, 16, 171–180.

doi: 10.1002/pon.1050
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Intervention Characteristics/Basic Study Process:

A 12-week structured psychosocial support group of weekly two-hour sessions was led by two facilitators using an adapted form of Cunningham’s “Healing Journey” program. The intervention included training in relaxation, guided imagery, meditation, emotional expression, and exercises promoting control beliefs and benefit-finding. The prospective design included 10 phases to recruit, and 8–11 women were recruited for each group. Data were collected at baseline and at 4 months (corresponding to the end of the intervention), 6 months, and 12 months.

Sample Characteristics:

  • The study reported on a sample of women newly diagnosed with breast cancer.
  • Women participated in one of three conditions: intervention group (n = 54), standard care group (n = 44), and decliner group who refused the intervention (n = 56).

Setting:

New Zealand

Study Design:

A quasi-experimental study design was used.

Measurement Instruments/Methods:

  • Cortauld Emotional Control Scale: emotional suppression
  • Illness Perceptions Questionnaire–Revised: perceived control
  • Perceived Risk of Recurrence: two items, 1–10 scale
  • Benefit-Finding Scale for Breast Cancer
  • Functional Assessment of Cancer Therapy (FACT): emotional well-being subscale
  • Cancer Worry: two items, 1–10 scale
  • State-Trait Anxiety Inventory: state anxiety
  • Coping Efficacy: measured five items

Results:

Repeated measures ANOVAs revealed group differences in state anxiety over the first four months. Scores decreased for intervention participants, but not the standard care or decliner participants. Anxiety decreased overall from baseline to 6 months and from baseline to 12 months. Longitudinal follow-up occurred over 12 months.

Limitations:

  • The study had no randomization.
  • The study had a high level of decliners.
  • The intervention required special training of facilitators to use the program.

Chujo, M., Mikami, I., Takashima, S., Saeki, T., Ohsumi, S., Aogi, K., et al. (2005). A feasibility study of psychosocial group intervention for breast cancer patients with first recurrence. Supportive Care in Cancer, 13, 503–514.

doi: 10.1007/s00520-004-0733-z
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Intervention Characteristics/Basic Study Process:

The intervention was a six-week structured psychosocial support group of 90 minutes led by a male psychiatrist and nurses with experience in facilitation cancer groups. Each group member received

  • 20 minutes for stress-management method and problem-solving method
  • 50 minutes for discussion on coping
  • 20 minutes for learning progressive muscle relaxation (PMR) and audiotapes to use twice a day.

Measurements were done at baseline, then immediately following the six-week intervention, then three months and six months later.

Eleven women refused to participate but were interested in group intervention and consented to answering questionnaires. These women were given materials after completion of the survey and the PMR tape.

Sample Characteristics:

  • The participants were Japanese women with first recurrence of breast cancer (recurrence within three months to one year of initial diagnosis).
  • The intervention group consisted of 28 participants (19 finished the trial); 11 women refused to participate.

Study Design:

The study design was quasi-experimental without a control group.

Measurement Instruments/Methods:

  • Profile of Mood States (POMS)
  • Impact of Event Scale–Revised
  • Mental Adjustment to Cancer Scale
  • EORTC Quality of Life Questionnaire—Cancer 30/Breast module 23 (QLQ-C30/Br23)
  • Dunnett’s test to examine changes in scores between baseline and at three and six months after the intervention

Results:

Results in the intervention group revealed significant changes in scores for tension-anxiety on POMS in the period up to three months after the intervention; no differences were noted at six months after the intervention.

Limitations:

  • The study had a nonrandomized design.
  • The study had a small sample size.

Kao, C.Y., Hu, W.Y., Chiu, T.Y., & Chen, C.Y. (2014). Effects of the hospital-based palliative care team on the care for cancer patients: An evaluation study. International Journal of Nursing Studies, 51(2), 226-235.

doi: 10.1016/j.ijnurstu.2013.05.008
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Study Purpose:

To evaluate the effects of the hospital-based palliative care team on care for patients with cancer

Intervention Characteristics/Basic Study Process:

The hospital-based palliative care team visited intervention patients “regularly” during the one-week study period. Team members including physicians, nurses, chaplains, and social workers provided advice about medications and taught patients and families skills to relieve physical symptoms, provided emotional support, and assisted with truth-telling and preparation for death. Data were collected at baseline and one week later.

Sample Characteristics:

  • N = 60
  • MEAN AGE = 57.5 years (SD = 14.62)
  • MALES: 57%, FEMALES: 43%
  • KEY DISEASE CHARACTERISTICS: Patients with advanced cancer with palliative care needs
  • OTHER KEY SAMPLE CHARACTERISTICS: Patients hospitalized in a medical center in Taiwan; unlikely to die or be discharged in 24 hours

Setting:

  • SITE: Single site
  • SETTING TYPE: Inpatient   
  • LOCATION: Taipei, Taiwan

Phase of Care and Clinical Applications:

  • PHASE OF CARE: End-of-life care
  • APPLICATIONS: Palliative care

Study Design:

Quasi-experimental study with a pretest-posttest design

Measurement Instruments/Methods:

  • Symptom Distress Scale (SDS)
  • Hospital Anxiety and Depression Scale (HADS)
  • Spiritual Well-Being Scale
  • Social Support Scale

Results:

No significant difference was seen in anxiety and depression between the control and intervention groups after one week of palliative care. Improvement was seen in edema, fatigue, dry mouth, and abdominal distention.

Conclusions:

Nurse interventions improved symptom management for the intervention group; however, in the short timeframe of this study emotional disturbances were not affected. Cultural implications are important here; death is a taboo topic in Chinese culture, and patients' understanding of their terminal disease is low and rarely discussed.

Limitations:

  • Small sample (< 100)
  • Risk of bias (no random assignment)
  • Unintended interventions or applicable interventions not described that would influence results
  • Patients were given the choice of usual care plus visits from the palliative care team versus usual care alone. The timeframe was only one week, and the number of visits and disciplines of the palliative care team were not clearly described. Nurse interventions for some physical symptoms are described very generally; no interventions for depression or anxiety are described.

Nursing Implications:

Palliative care consultation may benefit many symptoms of patients with cancer, but without clear interventions for depression and in this short timespan, little effect is apparent.

Liao, M.N., Chen, P.L., Chen, M.F., & Chen, S.C. (2010). Effect of supportive care on the anxiety of women with suspected breast cancer. Journal of Advanced Nursing, 66, 49–59.

doi: 10.1111/j.1365-2648.2009.05139.x
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Study Purpose:

To test the hypothesis that women with suspected breast cancer who received a supportive care intervention during the diagnostic phase of care would have lower anxiety than those having usual care

Intervention Characteristics/Basic Study Process:

The intervention was supportive care, emotional support, and educational information provided by nurses through three individual meetings and two telephone calls.

Sample Characteristics:

  • The study reported on a sample of 114 participants.
  • Mean participant age was 48.1 years.
  • The sample was 100% female.
  • All participants had a breast lump found through clinical examination or imaging that needed biopsy.
  • Most women had no history, experience, or family history of breast disease.
  • Most women had an education level of high school completion or beyond, were married or lived with partners, and had family or friends with whom to talk.

Setting:

  • Single site
  • Outpatient setting
  • Taiwan

Phase of Care and Clinical Applications:

Patients were undergoing the diagnostic phase of care.

Study Design:

A randomized controlled trial design was used.

Measurement Instruments/Methods:

State-Trait Anxiety Inventory (STAI)

Results:

Women in the intervention group had significantly lower state anxiety before biopsy and after learning the result compared to the control group (p = 0.008; p = 0.001).

Conclusions:

Women with suspected breast cancer who received the supportive care program had lower anxiety than those receiving routine care.

Limitations:

  • The study had no attentional control.
  • Subjects in the experimental group received more time and attention than those in the control group, so the impact of the actual supportive program design versus the impact of just increased attention cannot be determined.
  • Participants were not blinded to group assignment, which could have biased self-report results on the STAI.

Nursing Implications:

Though resulting differences between groups were statistically significant, differences in scores between groups ranged from 1.14 to 2.12 on average, in a possible 80-point scale. The clinical relevance of this small difference is questionable, and the level of anxiety indicated by scores was still severe.

Miller, D.K., Chibnall, J.T., Videen, S.D., & Duckro, P.N. (2005). Supportive-affective group experience for persons with life-threatening illness: Reducing spiritual, psychological, and death-related distress in dying patients. Journal of Palliative Medicine, 8, 333–343.

doi: 10.1089/jpm.2005.8.333
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Intervention Characteristics/Basic Study Process:

The intervention was a 75-minute supportive-affective group that met monthly offering Life-Threatening Illness Supportive-Affective Group Experience (LTI-SAGE). These groups were for education and support, not group therapy. Topics included

  • Group dynamics and expectations
  • Recognizing and asserting needs
  • Feelings and emotions
  • Symptom control
  • Living well while ill
  • Intimate relationships
  • Spiritual needs
  • Asking for help
  • End-of-life care planning/decision making
  • Legacy
  • Hope
  • Group closure.

Groups consisted of three to eight patients, with one or two group facilitators.

Two measurements were taken: baseline and 12 months

In the intervention group (n = 37), group assignment was based on diagnosis and race.

In the control group (n = 32), patients received quarterly mailings of existing, readily available self-help resource materials, with a phone call to ensure that mailings were received.

Sample Characteristics:

The study reported on a sample of 69 African American and Caucasian patients with any serious medical condition severe enough to create a limited life expectancy (not cause death within six months).

Study Design:

The study was a randomized pre/post-test trial with a longitudinal design.

Measurement Instruments/Methods:

  • Beck Depression Inventory
  • State-Trait Anxiety Inventory (STAI)
  • Death Distress Scale
  • Spiritual Well-Being Scale
  • Illness Disability Index
  • Perceived Social Support Inventory
  • Analysis of covariance
  • Statistics done in two ways: intent-to-treat basis (with the seven noncompliant patients) and also with the seven noncompliant patients removed from the intervention group

Results:

  • In the intervention group, 7 patients attended 3/12 groups and 21 patients attended 9/12 groups.
  • There were no significant statistical differences between groups in anxiety levels. The intervention group did enjoy reduced depression, increased spiritual well-being, and reduced death-related feelings of meaninglessness; p level set at 0.10.
  • STAI stats: t(40) = 0.8 with p value 0.40 at baseline
  • SSAI postintervention: p = 0.70

Limitations:

  • The study had a small sample size.
  • Not all patients were diagnosed with cancer.
  • The intervention required specially trained facilitators to teach groups.

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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