Effectiveness Not Established

Natural Environment Intervention

for Cognitive Impairment

Natural environment intervention involves patient exposure to the natural environment through various activities.  This type of intervention was examined among patients with cancer for its effect on anxiety, cognitive impairment, and fatigue.

Research Evidence Summaries

Cimprich, B., & Ronis, D.L. (2003). An environmental intervention to restore attention in women with newly diagnosed breast cancer. Cancer Nursing, 26, 284–292.

Study Purpose

To determine the efficacy of a natural restorative environmental intervention in counteracting cognitive or attentional fatigue in women with newly diagnosed breast cancer

Intervention Characteristics/Basic Study Process

Patients were randomly assigned to an intervention protocol after the first assessment and before any treatment. Intervention was comprised of a home-based program involving 120 minutes of exposure to the natural environment per week. Assessments were done approximately 17 days before surgery and 19 days after surgery. Intervention included the following:

1.  Verbatim explanation of purpose and written summary in booklet form
2.  Identification and selection of preferred activities from a compiled list of possible nature activities. Each participant also received a membership to the university botanical garden.
3.  A written agreement signed by the participants stating that they would carry out the selected nature activities for at least 120 minutes per week

Sample Characteristics

  • N: Total number n = 185 recruited, 159 completed testing at both time periods, and 2 were excluded for incomplete data.   
  • MEAN AGE = 53.8 years (SD = 11.4 years; range = 27-86 years)
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Breast cancer
  • OTHER KEY SAMPLE CHARACTERISTICS: Ethnicity: 89% Caucasian, 11% non-Caucasian
  • ELIGIBILITY CRITERIA: Female patients with a confirmed new diagnosis of early stage breast cancer who had a primary treatment plan of breast-conserving surgery or mastectomy

Setting

LOCATION: Midwestern university medical center

Study Design

Longitudinal, randomized study

Measurement Instruments/Methods

  • Digit Span forward and backward test: Standard test of capacity to direct attention (CDA) mediated by auditory and verbal processing
  • Trail Making Test Parts A & B (TMT): TMT is a test of CDA requiring effective inhibition of competing responses for accurate completion of the task in a timely manner.
  • Necker Cube Pattern Control Test directly measures an individual’s ability to inhibit competing stimuli or to direct attention.
  • Symptom Distress Scale (SDS): Indicator for the degree of distress in relation to common symptoms such as pain, loss of appetite, insomnia, decreased mobility, abnormal bowel function, fatigue, loss of concentration, and changes in appearance

Results

The intervention group scored significantly better than the nonintervention group on DSF (p = 0.04), DSB (p = 0.002), TMT-A (p = 0.001), TMT-B (p = 0.02), and the total attention score (p < 0.001). Other covariates such as age, years of education, symptom distress at time 2, extent of surgery, and presence of other health problems accounted for 54% of the variance in total attention score (p < 0.001).

Conclusions

Intervention group showed greater recovery of a capacity to direct attention from the pretreatment to the preadjuvant therapy period as compared to the nonintervention group.

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