title: An interdisciplinary care approach for integration of palliative care in lung cancer.
abstract: OBJECTIVE
  Quality of Life (QOL) and symptom concerns are common in lung cancer. This article presents findings from 2 separate pilot studies that utilize an educational model to reduce barriers to pain and fatigue management ("barriers study") and an interdisciplinary palliative care approach to manage QOL concerns for patients with lung cancer ("QOL pilot").
  
  
  METHODS
  In the barriers study, a total of 46 patients with lung cancer with a self-reported pain and/or fatigue rating of >or=4 were accrued, with 18 patients in the usual care group and 28 in the experimental group, using a quasi-experimental design. This study involved a 4-part educational intervention delivered by a nurse to address pain and fatigue. In the QOL study, the pilot intervention included 10 patients with lung cancer. This pilot included use of QOL assessment completed by a nurse followed by an interdisciplinary case conference intended to initiate supportive care to address QOL and symptom concerns. Patient-reported outcomes such as barriers to pain and fatigue management, fatigue intensity, other symptoms, and overall QOL were analyzed through tabulation of standard summary statistics and multivariate analysis methods. All eligible patients were recruited from the ambulatory clinic of one National Cancer Institute-designated Comprehensive Cancer Center.
  
  
  RESULTS
  For the barriers study, patients with lung cancer in the experimental group had a statistically significant decrease in patient-related barriers for both pain and fatigue. Findings from the QOL pilot revealed that patients with lung cancer have multiple QOL concerns and that an interdisciplinary palliative care approach was feasible to address these complex, multidimensional patient needs.
  
  
  CONCLUSIONS
  Attention to barriers of symptom management, early referral to supportive care services, and coordination of interdisciplinary care are essential to supporting the QOL of patients with lung cancer. The next phase of this research will test QOL/symptom interventions for patients with lung cancer.
authors.affiliation: Department of Nursing Research & Education, Division of Population Sciences, City of Hope, Duarte, CA 91010, USA.
authors.forename: Tami
authors.initials: T
authors.lastname: Borneman
authors.forename: Marianna
authors.initials: M
authors.lastname: Koczywas
authors.forename: Mihaela
authors.initials: M
authors.lastname: Cristea
authors.forename: Karen
authors.initials: K
authors.lastname: Reckamp
authors.forename: Virginia
authors.initials: V
authors.lastname: Sun
authors.forename: Betty
authors.initials: B
authors.lastname: Ferrell
mesh_terms: D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D010146:Pain / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D010166:Palliative Care; D010348:Patient Care Team; D010865:Pilot Projects; D011379:Prognosis; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome