Yesilbalkan, O. U., Karadakovan, A., & Göker, E. (2009). The effectiveness of nursing education as an intervention to decrease fatigue in Turkish patients receiving chemotherapy. Oncology Nursing Forum, 36, E215–E222.

To determine whether a nurse-led educational intervention decreased the perception of fatigue in patients diagnosed with gastrointestinal (GI) cancers who were receiving chemotherapy for the first time and to determine if improvement in fatigue resulted in improvement in quality of life (QOL).

Patients received an individual educational intervention at baseline, on the tenth day after the first cycle of chemotherapy (T1), and 10 days after the second cycle (T2) based on the results of their fatigue assessments. The education program consisted of:  one-to-one education, which consisted of training and counseling about fatigue assessment and management. It was delivered by the researcher. The intervention was designed to improve patients’ knowledge of causes of fatigue and to provide them with strategies to decrease severity, including self-monitoring of fatigue levels, advice on energy conservation, distraction, increasing mobility and activity, stress management, relaxation methods, and management of factors known to cause fatigue.

• In total, 35 patients (57% women) receiving chemotherapy for GI cancer were included.
• Mean age was 49 years (standard deviation = 10.12).
• Patients had GI cancer.
• Of the patients, 91% were married.

• Single site
• Outpatient chemotherapy unit of a large University Hospital in Izmir, Turkey

The study used a descriptive, quasiexperimental design.

• Baseline demographics
• Fatigue and QOL were assessed using the Brief Fatigue Inventory (BFI), Piper Fatigue Scale (PFS), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30).
• Instruments were administered before the first cycle of chemotherapy, at T1, and at T2.
• Pre- and posttest analyses were conducted using t-tests.
• Relationships among variables were examined by calculating Pearson correlation coefficients with a statistical significance of p = 0.05.
• Variables included subjective reports of patients’ fatigue and QOL.

Patients’ mean fatigue scores showed a statistically significant decrease, and their EORTC QLQ-C30 scores were better at T1 and T2 compared with baseline.

Nurse-led educational interventions have the potential to reduce fatigue in patients with GI cancers receiving chemotherapy for the first time.

• The exclusion criteria limited the number of patients; the study had a small sample size.
• The sample only included patients with GI cancers in a single center in Turkey.
• No power calculation was performed.
• No control group was used.
• The findings could be culturally specific.
• These limitations prevented generalization. 

The administration of chemotherapy should be preceded by a formal fatigue assessment and the provision of individually tailored educational interventions to reduce the severity of fatigue and improve QOL.