Randomized pilot evaluation of the supportive care intervention 'CONNECT' for people following surgery for colorectal cancer.

摘要

BACKGROUND: Improvements can be made in the quality of cancer care if supportive care needs are addressed; however, there are few trials of supportive care interventions to guide policy and practice. OBJECTIVE: This study aimed to determine the effectiveness of a nurse-delivered telephone supportive intervention (the "CONNECT" intervention). DESIGN: This study was a pilot randomized controlled trial. Intervention group patients received 5 calls from a specialist colorectal nurse in the 6 months after hospital discharge. Each call was standardized, comprising the assessment of unmet need and the provision of information and emotional support. CONNECT was in addition to standard clinical follow-up. Patients allocated to the control group received standard follow-up only. SETTING: This study took place at the Royal Prince Alfred Hospital, Sydney, Australia. PARTICIPANTS: Patients (n = 75) were included who had been surgically treated for colorectal cancer (any stage). MAIN OUTCOME MEASURES: The main outcome measures were the unmet supportive care needs, health service utilization, and quality of life at 1, 3, and 6 months postdischarge. RESULTS: Of 87 eligible patients, 75 consented (86% consent rate). Thirty-nine patients were randomly assigned to CONNECT and 36 to usual care. At 6 months, there was a clinically relevant, but nonsignificant reduction in presentations to emergency departments (21% vs 33%; chi1 = 1.41, P = .23) and readmission to the hospital (37% vs 47%; chi1 = 0.82, P = .37) among intervention compared with control group participants. Nonsignificant differences between groups were found for all unmet supportive care need and quality-of-life scores, change scores, and trends. However, at 6 months, total quality-of-life scores were higher for intervention group patients than controls (106.0 vs 98.6). This difference (7.4) was clinically relevant. Improvements in total quality-of-life change scores demonstrated that at 6 months, improvements were more than twice as large and clinically significant in the intervention compared with the control group. CONCLUSIONS: CONNECT has shown promising indications on health system and patient outcomes that warrant a larger study to further investigate the potential of this intervention.