Mahendran, R., Lim, H.A., Tan, J.Y., Chua, J., Lim, S.E., Ang, E.N., & Kua, E.H. (2015). Efficacy of a brief nurse-led pilot psychosocial intervention for newly diagnosed Asian cancer patients. Supportive Care in Cancer, 23, 2203–2206.

DOI Link

Study Purpose

To determine if psychosocial interventions, led by nurses instead of mental health professionals, for patients newly diagnosed with cancer in Singapore could help ease distress, minor psychiatric morbidity, and psychosocial worry

Intervention Characteristics/Basic Study Process

This quasiexperimental study researched the benefits of a six-month nurse-led psychosocial intervention program for patients with newly diagnosed with cancer receiving chemotherapy. The program consisted of 20- to 30-minute sessions with a nurse and occurred monthly for two visits and bimonthly for two more visits. Participants were offered this intervention along with their treatment. Training of the oncology RNs at the National Cancer Institute in Singapore included personal training by a psychiatrist and a psychologist on psychoeducation for managing stress, sleep hygiene, anxiety, and depression and included resources, deep breathing exercises, muscle relaxation, and inspirational self-talk. Patients also received counseling, supportive therapy, and printed/audio education to encourage practice at home. The RN training also included simulated one-on-one sessions with feedback on performance. Demographic and medical data were collected. Primary outcomes were measured by questionnaires at baseline and at six months.

Sample Characteristics

  • N = 63
  • AGE = Older than 21 years
  • MEDIAN AGE = 51–60 years
  • MALES: 35%, FEMALES: 65%
  • CURRENT TREATMENT: Chemotherapy

Setting

  • SITE: Single site   
  • SETTING TYPE: Outpatient    
  • LOCATION: National Cancer Institute-Singapore Medical Oncology Clinic

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Study Design

  • Quasiexperimental study

Measurement Instruments/Methods

  • Distress Thermometer (DT)
  • Hospital Anxiety and Depression Scale (HADS)
  • EuroQol EQ-5D
  • Data were analyzed using SPSS, version 22.

Results

One hundred twenty-one participants were recruited. Seventy (58%) chose to participate, and the rest received treatment as usual (TAU). Sixty-three (90%) participants completed the four nurse-led sessions and were available at six months for reassessment. No significant demographic difference was reported between the intervention and TAU groups at baseline. No significant demographic difference existed between those followed up with and those lost to follow-up, but those lost to follow-up did have higher anxiety and depression scores at baseline. The intervention group had significantly increased distress, anxiety, and depression scores and lower EQ-5D scores at baseline. The intervention group participants had significantly reduced distress (p = 0.001), anxiety (p < 0.001), and depression (p < 0.001) scores, as well as greatly improved quality of life over time. Participants receiving TAU also showed a decline in anxiety and depression over time, with essentially stable distress scores.

Conclusions

A six-month intervention of psychoeducation, counseling, and behavior technique teaching improved participants’ distress, quality of life, anxiety, and depression.

Limitations

  • Small sample (< 100)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Questionable protocol fidelity
  • Subject withdrawals ≥ 10%

Nursing Implications

Program inclusion of patients helped to individualize nurse-led interventions and enhanced screening tools to capture a larger participation group and encourage completion. This showed that the psychoeducational intervention used here reduced anxiety and depression among the newly diagnosed patients. The low recruitment rate and dropout rate, however, suggest that the program may not have been practical or of interest to many patients. Greater individualization of content may be important for patient participation in this type of intervention. This program is likely to be most beneficial to individuals with higher anxiety and depression symptoms at baseline.