title: A nurse practitioner directed intervention improves the quality of life of patients with metastatic cancer: results of a randomized pilot study.
abstract: BACKGROUND
  There is a paucity of randomized studies evaluating the value of palliative interventions on a prospective basis in newly diagnosed oncology patients. We sought to prospectively evaluate quality of life (QoL) outcomes in advanced cancer patients who received discussion-based palliative care interventions from an advanced registered nurse practitioner (ARNP) integrated into the oncology team, and compare these outcomes with a control population.
  
  
  METHODS
  Patients with metastatic cancer were randomized to standard care or an ARNP-directed intervention that included discussions of the benefits of hospice, discussions on living wills and advanced directives (Five Wishes document) along with an assessment of QoL. Relevant endpoints included change from baseline QoL and improvement in hospice knowledge.
  
  
  RESULTS
  From November 13, 2008, through July 28, 2009, 26 patients were accrued at the Mayo Clinic in Jacksonville, Florida. The study closed early due to published data demonstrating the benefits of early palliative care interventions in the management of metastatic cancer patients. Statistically significant improvements from baseline were noted in emotional and mental QoL assessments in the intervention group that were not seen in the control group. Patients found it useful to have the living will and Five Wishes documents offered as part of the ARNP intervention.
  
  
  CONCLUSIONS
  An ARNP-directed intervention that explains the benefits of hospice and addresses advanced directives early in the course of metastatic cancer patients' treatment, is well received by the patients and their relatives and leads to measurable improvement in the patient's emotional and mental QoL.
authors.affiliation: College of Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Dyar
authors.forename: Mary
authors.initials: M
authors.lastname: Lesperance
authors.forename: Robert
authors.initials: R
authors.lastname: Shannon
authors.forename: Jeff
authors.initials: J
authors.lastname: Sloan
authors.forename: Gerardo
authors.initials: G
authors.lastname: Colon-Otero
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015400:Clinical Nursing Research; D005260:Female; D005431:Florida; D017051:Hospice Care / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000473:pathology / Q000523:psychology*; D009722:Nurse Practitioners; D010166:Palliative Care / Q000523:psychology*; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors