Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer.
OBJECTIVE
To evaluate quality of life (QOL) and cost outcomes of advanced practice nurses' (APNs') interventions with women diagnosed with breast cancer.


METHODS
Randomized clinical trial.


METHODS
Integrated healthcare system in a midwestern suburban community.


METHODS
210 women with newly diagnosed breast cancer with an age range of 30-85 years.


METHODS
The control group (n = 104) received standard medical care. The intervention group (n = 106) received standard care plus APN interventions based on Brooten's cost-quality model and the Oncology Nursing Society's standards of advanced practice in oncology nursing QOL was measured using the Functional Assessment of Cancer Therapy, Mishel Uncertainty in Illness Scale and Profile of Mood States at seven intervals over two years. Information about costs (charges and reimbursement) was collected through billing systems.


METHODS
Uncertainty, mood states, well-being, charges, and reimbursement.


RESULTS
Uncertainty decreased significantly more from baseline in the intervention versus control group at one, three, and six months after diagnosis (p = 0.001, 0.026, and 0.011, respectively), with the strongest effect on subscales of complexity, inconsistency, and unpredictability. Unmarried women and women with no family history of breast cancer benefited from nurse interventions in mood states and well-being. No significant cost differences were found.


CONCLUSIONS
APN interventions improved some QOL indicators but did not raise or lower costs.


CONCLUSIONS
The first six months after breast cancer diagnosis is a critical time during which APN interventions can improve QOL outcomes. More research is necessary to define cost-effective interventions.
Senior Services, Park Nicollet, HealthSystem Minnesota, Minneapolis, USA. ritzl@hsmnet.com
L J
LJ
Ritz
M J
MJ
Nissen
K K
KK
Swenson
J B
JB
Farrell
P W
PW
Sperduto
M L
ML
Sladek
R M
RM
Lally
L M
LM
Schroeder
D000223:Adaptation, Psychological; D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000191:economics / Q000451:nursing* / Q000523:psychology; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D015146:Midwestern United States; D009720:Nurse Clinicians / Q000191:economics; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012044:Regression Analysis