supportive care interventions

  • 文章类型: Journal Article
    在对性观念不断发展的背景下,特别是在健康和残疾领域,这项研究调查了多发性硬化症(MS)对女性性功能和生活质量的影响。进行了一项涉及130名35至50岁女性MS患者的定量研究,采用女性性功能指数(FSFI)等措施,多发性硬化症亲密关系和性行为问卷-19(MSISQ-19),和疲劳严重程度量表(FSS)。结果表明,性功能障碍越大,性生活质量越差,除了疲劳增加与性满意度下降的相关性。具体来说,平均FSFI得分为20.8(SD=9.36),83.8%的参与者出现严重疲劳(FSS评分≥36)。性功能障碍表现出强烈的,与所有FSFI分量表呈负相关(p<0.01)。受教育程度等因素(p=0.016),诊断时间(p=0.035),和治疗方案(p=0.041)也显著影响结局。研究结果强调了支持性干预措施的重要性,包括咨询,提高残疾妇女的性生活质量,特别是那些有女士的人。
    In the context of evolving perceptions of sexuality, particularly within the realm of health and disability, this study investigates the impact of multiple sclerosis (MS) on female sexual function and quality of life. A quantitative study involving 130 female MS patients aged 35 to 50 was conducted, employing measures such as The Female Sexual Function Index (FSFI), The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), and The Fatigue Severity Scale (FSS). Results indicate a significant association between greater sexual dysfunction and poorer quality of sex life, alongside the correlation of increased fatigue with diminished sexual satisfaction. Specifically, the mean FSFI score was 20.8 (SD = 9.36), with 83.8% of participants experiencing severe fatigue (FSS score ≥ 36). Sexual dysfunction demonstrated a strong, negative correlation with all FSFI subscales (p < 0.01). Factors such as education level (p = 0.016), time of diagnosis (p = 0.035), and treatment regimen (p = 0.041) also significantly influenced outcomes. Findings underscore the importance of supportive interventions, including counseling, to enhance the quality of sex life for women with disabilities, particularly those with MS.
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  • 文章类型: Journal Article
    背景:患者导航是一种基于证据的干预措施,通过直接解决对服务不足的癌症患者的护理障碍来减少癌症健康差异。癌症护理环境中患者导航计划的设计和整合的变化限制了这种干预的效用。实施科学评估框架,重新瞄准,允许对癌症护理环境中患者导航计划的有效实施进行定量和定性检查。
    方法:TheReach,有效性,收养,实施,和维护(RE-AIM)框架用于评估2018年6月至2021年10月在NCI指定的癌症中心实施以社区为中心的患者导航干预措施.使用3个月的纵向,非比较测量期,进行了单变量和双变量分析,以检查参与者水平的人口统计学和主要(即,屏障减少)和次要(即,患者报告的结果)有效性结果。使用混合方法分析来检查癌症中心环境中干预措施的采用和交付。使用过程级分析来评估干预措施的维持情况。
    结果:参与者(n=311)代表了大部分服务不足的人群,根据国家癌症研究所的定义,大多数人认为是西班牙裔/拉丁裔,家庭收入在35000元或以下,并被纳入医疗补助计划。参与者被诊断出患有多种癌症类型,大多数患有晚期癌症。干预前、干预后分析显示,干预前评估报告的障碍平均数显著减少,F(1,207)=117.62,p<.001,以及患者报告的身体健康显着增加,t(205)=-6.004,p<.001,心理健康,t(205)=-3.810,p<.001,自我效能感,t(205)=-5.321,p<.001,以及对医疗团队沟通的满意度,t(206)=-2.03,p=0.029。转诊模式和定性数据支持更多地采用干预措施并将其纳入目标设定,和一致的干预交付指标表明,随着时间的推移,干预交付具有很高的保真度。过程级数据概述了从赠款资助的以社区为中心的患者导航干预到机构资助的计划的成功过渡。
    结论:这项研究利用了实施科学评估框架,重新瞄准,评估以社区为中心的患者导航计划的实施情况。我们的分析表明在癌症护理环境中成功实施,并为可能对实施以社区为中心的患者导航计划感兴趣的其他肿瘤学环境提供了潜在的指导。
    BACKGROUND: Patient navigation is an evidence-based intervention that reduces cancer health disparities by directly addressing the barriers to care for underserved patients with cancer. Variability in design and integration of patient navigation programs within cancer care settings has limited this intervention\'s utility. The implementation science evaluation framework, RE-AIM, allows quantitative and qualitative examination of effective implementation of patient navigation programs into cancer care settings.
    METHODS: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate implementation of a community-focused patient navigation intervention at an NCI-designated cancer center between June 2018 and October 2021. Using a 3-month longitudinal, non-comparative measurement period, univariate and bivariate analyses were conducted to examine associations between participant-level demographics and primary (i.e., barrier reduction) and secondary (i.e., patient-reported outcomes) effectiveness outcomes. Mixed methods analyses were used to examine adoption and delivery of the intervention into the cancer center setting. Process-level analyses were used to evaluate maintenance of the intervention.
    RESULTS: Participants (n = 311) represented a largely underserved population, as defined by the National Cancer Institute, with the majority identifying as Hispanic/Latino, having a household income of $35,000 or less, and being enrolled in Medicaid. Participants were diagnosed with a variety of cancer types and most had advanced staged cancers. Pre-post-intervention analyses indicated significant reduction from pre-intervention assessments in the average number of reported barriers, F(1, 207) = 117.62, p < .001, as well as significant increases in patient-reported physical health, t(205) = - 6.004, p < .001, mental health, t(205) = - 3.810, p < .001, self-efficacy, t(205) = - 5.321, p < .001, and satisfaction with medical team communication, t(206) = - 2.03, p = .029. Referral patterns and qualitative data supported increased adoption and integration of the intervention into the target setting, and consistent intervention delivery metrics suggested high fidelity to intervention delivery over time. Process-level data outlined a successful transition from a grant-funded community-focused patient navigation intervention to an institution-funded program.
    CONCLUSIONS: This study utilized the implementation science evaluation framework, RE-AIM, to evaluate implementation of a community-focused patient navigation program. Our analyses indicate successful implementation within a cancer care setting and provide a potential guide for other oncology settings who may be interested in implementing community-focused patient navigation programs.
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  • 文章类型: Journal Article
    目的:描述广泛期小细胞肺癌(ES-SCLC)化疗患者中化疗诱导的骨髓抑制的负担。材料与方法:发生≥3级骨髓抑制血液学不良事件(HAEs),我们使用美国肿瘤学网络和非网络诊所的数据(2015年1月1日至2020年12月31日)评估了化疗开始后的治疗模式和医疗资源利用(HCRU).结果:在具有实验室值的患者中(网络:N=1,374/1,574;非网络:N=661/959),化疗开始后超过一半的经验≥3级HAEs(网络=56.6%;非网络=64.1%),在至少两个谱系中,大约三分之一的HAE≥3级(网络=33.0%;非网络=31.3%)。≥3级HAEs的患者有更大的剂量减少,治疗延迟和HCRU比没有治疗延迟。结论:骨髓抑制是ES-SCLC化疗患者和医疗系统的负担。
    我们的目的是描述骨髓抑制的负担,化疗的副作用是骨髓中的造血细胞受损,在广泛期小细胞肺癌(ES-SCLC)患者中。我们评估了骨髓抑制的患病率,使用2015年1月1日至2020年12月31日美国肿瘤学网络和非网络诊所的数据,化疗治疗模式和化疗开始后的门诊医疗保健使用和费用。在具有实验室值的患者中,这是确定骨髓抑制事件所必需的,超过一半的患者在化疗开始后出现一个或多个谱系的严重骨髓抑制相关不良事件,约1/3在至少2个血细胞谱系中出现严重骨髓抑制相关不良事件.严重骨髓抑制相关不良事件患者的剂量减少幅度更大,治疗延误,和医疗保健的使用和成本比没有。骨髓抑制是接受化疗和医疗保健系统治疗的ES-SCLC患者的负担。减少化疗诱导的骨髓抑制有可能减轻患者和医疗机构的负担。
    Aim: To describe the burden of chemotherapy-induced myelosuppression among chemotherapy-treated patients with extensive-stage small-cell lung cancer (ES-SCLC). Materials & methods: Occurrence of grade ≥3 myelosuppressive hematological adverse events (HAEs), treatment patterns and healthcare resource utilization (HCRU) after chemotherapy initiation were evaluated using data from The US Oncology Network and Non-network clinics (1/1/2015-12/31/2020). Results: Among patients with laboratory values (Network: N = 1,374/1,574; Non-network: N = 661/959), over half-experienced grade ≥3 HAEs after chemotherapy initiation (Network = 56.6%; Non-network = 64.1%), and approximately one-third had grade ≥3 HAEs in at least two lineages (Network = 33.0%; Non-network = 31.3%). Patients with grade ≥3 HAEs had greater dose reductions, treatment delays and HCRU than those without. Conclusion: Myelosuppression is a burden to patients with ES-SCLC treated with chemotherapy and the healthcare system.
    Our objective was to describe the burden of myelosuppression, a side effect of chemotherapy that results from damage to blood-forming cells in the bone marrow, among patients with extensive-stage small-cell lung cancer (ES-SCLC). We evaluated the prevalence of myelosuppression, chemotherapy treatment patterns and outpatient healthcare use and costs after chemotherapy initiation using data from The US Oncology Network and Non-network clinics between 1 January 2015 and 31 December 2020. Among patients with laboratory values, which were required to identify myelosuppression events, over half of patients experienced severe myelosuppression-related adverse events in one or more lineages after chemotherapy initiation, and approximately one-third experienced severe myelosuppression-related adverse events in at least two blood cell lineages. Patients with severe myelosuppression-related adverse events had greater dose reductions, treatment delays, and healthcare use and costs than those without. Myelosuppression is a burden to patients with ES-SCLC treated with chemotherapy and the healthcare system. Reduction of chemotherapy-induced myelosuppression has the potential to reduce burden on patients and healthcare organizations.
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  • 文章类型: Journal Article
    背景:支持性护理干预可以改善晚期前列腺癌幸存者的生活质量和健康结果。尽管未满足的需求普遍存在,对这一人群的支持性护理很少。
    方法:数据库PubMed,Scopus,CINAHL,和ProQuest搜索了相关文章。数据被提取,按专题矩阵组织,并根据癌症护理支持护理框架的七个领域进行分类。
    结果:搜索产生了1678篇文章,其中18项被纳入审查并得到了严格评估。大多数研究都是横断面的,非多样化样本。报道的晚期前列腺癌幸存者的支持性护理干预措施有限,有一些积极的趋势。大多数结果是以症状为中心和患者自我报告(例如,焦虑,疼痛,自我效能感)通过问卷调查或访谈进行评估。以小组形式进行的干预报告了更多结果的改善。
    结论:晚期前列腺癌患者需要额外的支持治疗干预。由于他们在照顾癌症患者方面的重要地位,护士科学家和临床医生必须合作研究和发展以患者为中心,与文化相关的支持性护理干预措施可改善该人群的生活质量和健康结果。努力必须集中在抽样上,需求领域,理论框架,指导方针,和测量仪器。
    BACKGROUND: Supportive care interventions can improve quality of life and health outcomes of advanced prostate cancer survivors. Despite the high prevalence of unmet needs, supportive care for this population is sparse.
    METHODS: The databases PubMed, SCOPUS, CINAHL, and ProQuest were searched for relevant articles. Data were extracted, organized by thematic matrix, and categorized according to the seven domains of the Supportive Care Framework for Cancer Care.
    RESULTS: The search yielded 1678 articles, of which 18 were included in the review and critically appraised. Most studies were cross-sectional with small, non-diverse samples. Supportive care interventions reported for advanced prostate cancer survivors are limited with some positive trends. Most outcomes were symptom-focused and patient self-reported (e.g., anxiety, pain, self-efficacy) evaluated by questionnaires or interview. Interventions delivered in group format reported improvements in more outcomes.
    CONCLUSIONS: Additional supportive care intervention are needed for men with advanced prostate cancer. Because of their crucial position in caring for cancer patients, nurse scientists and clinicians must partner to research and develop patient-centered, culturally relevant supportive care interventions that improve this population\'s quality of life and health outcomes. Efforts must concentrate on sampling, domains of needs, theoretical framework, guidelines, and measurement instruments.
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  • 文章类型: Journal Article
    BACKGROUND: Online information resources and support have been demonstrated to positively influence the well-being of people diagnosed with cancer. This has been explored in past literature for more common cancers; however, for rare cancers, such as neuroendocrine tumors (NETs), there are little to no support or resources available. Despite relatively good prognoses, the quality of life (QoL) of patients with NETs is significantly lower compared with samples of mixed cancer patients and the general population. Patients with NETs also typically report unclear and difficult pathways of disease management and treatment, given the heterogeneity of the diagnosis. There is a vital need to improve the availability of disease-specific information for this patient group and provide supportive care that is tailored to the unique needs of the NET patient population.
    OBJECTIVE: This study described the protocol of a study aimed to better understand the outcomes and experiences of patients diagnosed with NETs and to develop and pilot test a nurse-led online and phone-based intervention that will provide tailored supportive care targeted to NET subgroups (functioning vs nonfunctioning).
    METHODS: This is a multisite cohort with 3 phases, incorporating both quantitative and qualitative data collection. Phase 1 is a mixed methods prospective cohort study of NET patients identifying differences in patient experiences and priority of needs between NET subgroups. Phase 2 utilizes results from phase 1 to develop an online and nurse-led phone-based intervention. Phase 3 is to pilot test and evaluate the intervention\'s acceptability, appropriateness, and feasibility.
    RESULTS: Currently, the project is progressing through phase 1 and has completed recruitment. A total of 138 participants have been recruited to the study. To date, patient-reported outcome data from 123 participants at baseline and 87 participants at 6-month follow-up have been collected. Of these, qualitative data from semistructured interviews from 35 participants have also been obtained. Phase 2 and phase 3 of the project are yet to be completed.
    CONCLUSIONS: Limited research for patients with NETs suggests that QoL and patient experiences are significantly impaired compared with the general population. Furthermore, past research has failed to delineate how the clinical variability between those with functioning and nonfunctioning NETs impacts patient supportive care needs. This study will improve on the availability of disease-specific information as well as informing the design of a nurse-led online and phone-based supportive care intervention tailored for the unique needs of the NET patient population.
    UNASSIGNED: DERR1-10.2196/14361.
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  • 文章类型: Case Reports
    Acute lymphoblastic leukemia (ALL) is an uncommon disease. Approximately 14% of new ALL cases occur in adults aged 60 and over, and the three-year overall survival in this population is poor at 12.8%. Older adults with ALL are heterogeneous in terms of their underlying health status, which can make treatment selection challenging given the disease rarity and limited inclusion of older patients in clinical trials. A comprehensive geriatric assessment (CGA) is a compilation of tools to assess multiple domains such as physical function and cognition, and may assist in guiding treatment selection and supportive care interventions. However, studies on the use of CGA are limited in older adults with ALL. In this review, we discuss the utility of CGA in patients with various hematologic malignancies. Using two patient cases of ALL, we also describe how CGA may be use to guide treatment and supportive care interventions.
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  • 文章类型: Journal Article
    OBJECTIVE: With increasing expectations of a 5-year survival rate among cancer patients, there is growing interest in patient-reported outcome (PRO) measures, particularly measures of health-related quality of life (HRQOL) in cancer practice. The purpose of this review was to explore the existing interventions for patients coping with cancer in terms of intervention type, PRO measurements and outcomes; and to identify directions for future research.
    METHODS: Systematic review of randomised clinical trials. A systematic search of four databases was conducted to identify articles published in English or Chinese from January 2000 to July 2013. Studies were located using an electronic search, a manual search and an author search.
    RESULTS: A total of 34 articles corresponding to 33 original studies were identified and included in this review. These interventions were classified under four broad categories according to their approaches: psycho-education (15), case management (13), exercise (4) and feedback of PRO (1). The PRO measures covered different types of PRO measures, including HRQOL, functional status, symptom status, overall well-being and satisfaction with care. Positive outcomes of more than 70% (24) out of these interventions were reported.
    CONCLUSIONS: These findings highlight the significant outcomes of cancer patient interventions that applied PRO measures to evaluate their outcomes. A theory-driven and careful design of the programme should be considered in the whole process of developing, delivering and assessing the programmes. Collaboration among patients, clinicians, researchers and policy makers is crucial to ensure the development of effective and accessible interventions targeting improving cancer survivors\' HRQOL.
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