title: Care management by oncology nurses to address palliative care needs: a pilot trial to assess feasibility, acceptability, and perceived effectiveness of the CONNECT intervention.
abstract: BACKGROUND
  Specialty palliative care is not accessible for many patients with advanced cancer. There is a need to find alternative palliative care strategies in oncology clinics.
  
  
  OBJECTIVE
  The objective of the study was to assess the feasibility, acceptability, and perceived effectiveness of an oncology nurse-led care management approach to improve primary palliative care.
  
  
  METHODS
  The study design was a single-arm pilot trial of the Care Management by Oncology Nurses (CONNECT) intervention, in which registered oncology nurses receive specialized training and work closely with oncologists to (1) address symptom needs; (2) engage patients and caregivers in advance care planning; (3) provide emotional support; and (4) coordinate care. The subjects were 23 patients with advanced cancer, 19 caregivers, and 5 oncologists from a community oncology clinic in western Pennsylvania. Feasibility was assessed through enrollment rates, outcome assessment rates, and visit checklists. Patients, caregivers, and oncologists completed three-month assessments of acceptability and perceived effectiveness.
  
  
  RESULTS
  The consent-to-approach rate was 86% and enrolled-to-consent rate, 77%. CONNECT was implemented according to protocol for all participants. No participants withdrew after enrollment. Four patients died during the study; three-month outcome assessments were completed with all remaining participants (83%). Patients and caregivers reported high satisfaction with CONNECT and perceived the intervention as helpful in addressing symptoms (85%), coping (91%), and planning for the future (82%). Oncologists unanimously agreed that CONNECT improved the quality of care provided for patients with advanced cancer.
  
  
  CONCLUSIONS
  An oncology nurse-led care management intervention is feasible, acceptable, and was perceived to be effective for improving provision of primary palliative care. A randomized trial of CONNECT is warranted.
authors.affiliation: 1 Division of General Internal Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Yael
authors.initials: Y
authors.lastname: Schenker
authors.forename: Douglas
authors.initials: D
authors.lastname: White
authors.forename: Margaret
authors.initials: M
authors.lastname: Rosenzweig
authors.forename: Edward
authors.initials: E
authors.lastname: Chu
authors.forename: Charity
authors.initials: C
authors.lastname: Moore
authors.forename: Peter
authors.initials: P
authors.lastname: Ellis
authors.forename: Peggy
authors.initials: P
authors.lastname: Nikolajski
authors.forename: Colleen
authors.initials: C
authors.lastname: Ford
authors.forename: Greer
authors.initials: G
authors.lastname: Tiver
authors.forename: Lauren
authors.initials: L
authors.lastname: McCarthy
authors.forename: Robert
authors.initials: R
authors.lastname: Arnold
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D009369:Neoplasms / Q000451:nursing*; D009723:Nurse-Patient Relations; D009859:Oncology Nursing / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration*; D017060:Patient Satisfaction; D010414:Pennsylvania; D010865:Pilot Projects; D011368:Professional-Family Relations