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Integrating Palliative Care Into Self-management of Breast Cancer: A Pilot Randomized Controlled Trial
Dena Schulman-Green1, Sarah Linsky, Sangchoon Jeon
1Author Affiliations: New York University Rory Meyers College of Nursing (Dr Schulman-Green); Yale School of Nursing (Ms Linsky and Dr Jeon), Yale School of Medicine (Drs Holland and Chagpar), and Smilow Cancer Hospital (Drs Kapo and Chagpar and Ms Blatt), West Haven, Connecticut; and St Peters Hospital, Albany, New York (Dr Adams).
Background:
Breast cancer patients may not be well-informed about palliative care, hindering its integration into cancer self-management.
Objective:
The aim of this study was to test Managing Cancer Care: A Personal Guide (MCC-PT), an intervention to improve palliative care literacy and cancer self-management.
Methods:
This was a single-blind pilot randomized controlled trial to evaluate the feasibility/acceptability and intervention effects of MCC-PT on palliative care literacy, self-management behaviors/emotions, and moderation by demographic/clinical characteristics. We enrolled 71 stages I to IV breast cancer patients aged at least 21 years, with >6-month prognosis at an academic cancer center. Patients were randomized to MCC-PT (n = 32) versus symptom management education as attention-control (n = 39). At baseline, 1 month, and 3 months, participants completed the Knowledge of Care Options Test (primary outcome), Control Preferences Scale, Goals of Care Form, Medical Communication Competence Scale, Measurement of Transitions in Cancer Scale, Chronic Disease Self-efficacy Scale, Hospital Anxiety and Depression Scale, and the Mishel Uncertainty in Illness Scale.
Results:
Mean participant age was 51.5 years (range, 28-74 years); 53.5% were racial/ethnic minority patients, and 40.8% had stage III/IV cancer. After adjusting for race/ethnicity, MCC-PT users improved their palliative care literacy with a large effect size (partial η2 = 0.13). Patients at late stage of disease showed increased self-management (partial η2 = 0.05) and reduced anxiety (partial η2 = 0.05) and depression (partial η2 = 0.07) with medium effect sizes.
Conclusions:
Managing Cancer Care: A Personal Guide is feasible and appears most effective in late-stage cancer. Research is needed to elucidate relationships among cancer stage, race/ethnicity, and self-management outcomes.
Implications For Practice:
Integration of palliative care into cancer care can assist in creation of appropriate self-management plans and improve emotional outcomes.
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