One of the challenges oncology nurses face when caring for patients in the outpatient setting is effectively monitoring and managing symptom burden from chemotherapy and other cancer treatments. Although staying at home and coming in for regular clinic visits is often easier on both patients and caregivers, they also experience their symptoms outside of a medical setting where oncology nurses would normally be able to respond quickly.
Nursing interventions such as coaching, telephone follow-up, and home care have been reported with inconsistent results. In their article in the January 2018 issue of the Oncology Nursing Forum, Coolbrandt et al. discussed the evaluation of a nursing intervention focused on patient education and self-management to reduce symptom distress in outpatients with cancer.
Managing Symptoms in the Outpatient Setting
Studies have shown that it’s important to engage a patient’s sense of control to change health behavior. Patients with cancer have reported a lack of knowledge and experience, feelings of uncertainty, and a sense of powerlessness with their diagnosis. According to studies, the negative association of symptom distress and efficacy of symptom management interventions suggests that improving symptom management can reduce the link between symptom distress and quality of life.
The current study’s authors designed an individually tailored nursing intervention called CHEMO-SUPPORT. It was directed toward four self-management objectives:
- Performing preventive self-care
- Monitoring symptoms
- Reporting and discussing symptoms with healthcare providers in a timely manner
- Performing self-care to relieve symptoms.
The Oncology Nurse’s Role
At Coolbrandt et al.’s institution, oncology nurses deliver the intervention in several steps throughout a patient’s treatment:
- In-person coaching at the start of treatment
- Telephone-based coaching during a patient’s first few days at home
- Providing a patient information brochure for ongoing reference
- Providing access to an online or on-call nursing service for as-needed help.
As treatment begins, nurses meet with patients to provide oral and written information about patients’ chemotherapy treatment and potential side effects. They use a didactic approach to achieve the goal of improving patients’ knowledge, which would in turn improve their ability to self-manage their symptoms. At the meeting, nurses also provide patients with a symptom diary to keep track of side effects at home.
During patient encounters at regular clinic appointments, nurses evaluate patients’ side effects using the symptom diary as a basis. This triggers supportive care interventions as dictated by institutional practice guidelines and clinical judgement.
The nurses also provide ongoing coaching, as outlined in Figure 1.
The Intervention’s Impact on Patients
Coolbrandt et al.’s study found that CHEMO-SUPPORT’s tailored intervention “significantly decreases overall symptom distress and symptom severity in adult patients starting their first treatment with chemotherapy.” It did so in part by boosting patients’ belief in their ability to manage treatment symptoms and the outcome expectations for that self-management.
“Symptom management programs should focus on enhancing patients’ perception of control, rather than simply providing coping information,” Coolbrandt et al. said.
Based on their findings, Coolbrandt et al. recommended that oncology nurses engage in direct coaching using clear self-management techniques to empower patients to address their symptoms and side effects. They also found that motivational interviewing is an effective strategy to strengthen patients’ motivation for addressing chemotherapy-related adverse effects.
For more information about CHEMO-SUPPORT and motivational interviewing, refer to the full article by Coolbrandt et al.
This monthly feature offers readers a concise recap of full-length articles published in the Clinical Journal of Oncology Nursing or Oncology Nursing Forum (ONF). This edition summarizes “A Nursing Intervention for Reducing Symptom Burden During Chemotherapy,” by Annemarie Coolbrandt, RN, PhD, Hans Wildiers, MD, PhD, Annouschka Laenen, PhD, Bert Aergeerts, MD, PhD, Bernadette Dierchx de Casterle, RN, PhD, Theo van Achterberg, RN, PhD, and Koen Milisen, RN, PhD, which was published in the January 2018 issue of ONF. Questions regarding the information presented in this article should be directed to the ONF editor at ONFEditor@ons.org. Photocopying of this article for educational purposes and group discussion is permitted.