title: An Advanced Practice Nurse Coordinated Multidisciplinary Intervention for Patients with Late-Stage Cancer: A Cluster Randomized Trial.
abstract: BACKGROUND
  Early palliative care provided through a palliative care consultative service is effective in enhancing patient outcomes. However, it is unknown whether the integration of palliative care as part of routine comprehensive cancer care improves patients' self-reported clinical outcomes.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the effects of a multidisciplinary coordinated intervention by advanced practice nurses at the clinic level on outcomes with patients newly diagnosed with late-stage cancer.
  
  
  METHODS
  A clustered, randomized, controlled trial design was used. Four disease-specific multidisciplinary clinics were randomized to the 10-week intervention (gynecologic and lung clinics) or to enhanced usual care (head and neck and gastrointestinal clinics). Patient primary outcomes (symptoms, health distress, depression, functional status, self-reported health) were collected at baseline and one and three months, and secondary outcomes were collected one and three months postbaseline. General linear mixed model analyses with a covariance structure of within-subject correlation was used to examine the intervention's effect.
  
  
  RESULTS
  The sample included 146 patients with newly diagnosed late-stage cancers. We found no differences between the two groups on the primary patient-reported outcomes at one and three months postbaseline; however, physical and emotional symptoms remained stable or significantly improved from baseline for both groups. Overall, secondary outcomes remained stable within the groups.
  
  
  CONCLUSIONS
  In this translational study, we demonstrated that if patients newly diagnosed with late-stage cancer were managed by disease-specific multidisciplinary teams who palliated their symptoms, providing whole-patient care, patient outcomes remained stable or improved.
authors: 1 School of Nursing, Yale University , New Haven, Connecticut.|2 School of Public Health, Yale University , New Haven, Connecticut.
authors: Ruth
authors: R
authors: McCorkle
authors: 1 School of Nursing, Yale University , New Haven, Connecticut.
authors: Sangchoon
authors: S
authors: Jeon
authors: 1 School of Nursing, Yale University , New Haven, Connecticut.
authors: Elizabeth
authors: E
authors: Ercolano
authors: 1 School of Nursing, Yale University , New Haven, Connecticut.|3 Divinity School, Yale University , New Haven, Connecticut.
authors: Mark
authors: M
authors: Lazenby
authors: 4 Smilow Cancer Hospital at Yale-New Haven , New Haven, Connecticut.
authors: Amanda
authors: A
authors: Reid
authors: 4 Smilow Cancer Hospital at Yale-New Haven , New Haven, Connecticut.
authors: Marianne
authors: M
authors: Davies
authors: 4 Smilow Cancer Hospital at Yale-New Haven , New Haven, Connecticut.
authors: Diane
authors: D
authors: Viveiros
authors: 5 School of Medicine, Yale University , New Haven, Connecticut.
authors: Scott
authors: S
authors: Gettinger
mesh_terms: D057179:Advanced Practice Nursing / Q000379:methods*; D000368:Aged; D002173:Cancer Care Facilities; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital; D010166:Palliative Care / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D011788:Quality of Life; D057170:Translational Research, Biomedical