Rawl, S.M., Given, B.A., Given, C.W., Champion, V.L., Kozachik, S.L., Barton, D., . . . Williams, S.D. (2002). Intervention to improve psychological functioning for newly diagnosed patients with cancer. Oncology Nursing Forum, 29, 967–975.

The intervention consisted of three parts:

1. A computer-based nursing intervention that provided assistance with symptom management and information about disease and treatment
2. Emotional counseling and support
3. Coordination of services.

The research team created this computer-based intervention for 38 symptoms that may occur during chemotherapy. The computer-based nursing intervention was a menu-driven computer program that guided clinical assessment, problem identification, selection of interventions, and measurement of outcomes. It was designed based on current literature, oncology nursing practice standards, and practice guidelines for cancer symptom management. Each symptom or problem had a problem-specific list of appropriate interventions. Emotional support and counseling consisted of the nurse using active listening and teaching of active communication techniques to patients and their caregivers to enhance communication between patients, caregivers, family, and healthcare providers. The intervention occurred over 18 weeks and consisted of nine visits (five in person and four via telephone). Visits took approximately one hour. Telephone encounters took about 20 minutes.

Dyads were recruited within 56 days of chemotherapy initiation. After completion of baseline telephone interviews, dyads were randomly assigned to groups. Data were collected via telephone interviews at three time points during the six-month study: time 1 = entry into study, time 2 = nine weeks or halfway through the intervention, and time 3 = 24 weeks or one month after the intervention.

• The study reported on a sample of 109 dyads (patient and identified caregiver).
• Patients were newly diagnosed with breast, colorectal, or lung cancer and were undergoing chemotherapy.
• The intervention group had 55 dyads, and the conventional care group had 54 dyads.

A randomized controlled trial (RCT) design was used.

• Medical Outcomes Study 36–Short Form (SF-36)
• Center for Epidemiologic Studies–Depression-20 scale (CES-D-20)
• State-Trait Anxiety Inventory (STAI)–state anxiety
• Statistical analyses: t tests and repeated ANOVA for SF-36, CES-D-20, and STAI
• Reliability analyses were completed using Cronbach’s alpha for scales of each time (baseline, time 2, and time 3).

Role emotional, mental health, and mental component scores were significant for the group-by-time intervention (p = 0.1). The intervention did not have a significant effect on anxiety when examining the date from the three time points. However, a trend toward group-by-time interaction (p = 0.09) occurred between baseline and time 2, favoring the intervention group. Pair-wise comparisons of the means showed that the intervention group improved (lower anxiety scores) from baseline to time 2 (p = 0.09), whereas the standard care group remained unchanged. Time 3 data were collected approximately four weeks after completion (24 weeks following enrollment), and any effect the intervention had may have been lost by time 3. Additional analyses were performed on baseline and time 2 data only.

The study was a strong RCT with a good sample size.

• New computer-based nursing intervention was created.
• The intervention was administered by three advanced practice nurses.
• The intervention was time-intensive.