CHAPEL HILL - A program of telephone counseling and education by nurses helps cancer patients cope with the effects of their disease, according to studies at the University of North Carolina at Chapel Hill.
"The advent of managed care has decreased the amount of time health care providers spend with patients. A premium is placed on seeing more patients in less time," says Dr. Merle Mishel, UNC-CH Kenan Distinguished Professor of Nursing and member of the UNC Lineberger Comprehensive Cancer Center. "Being unable to get questions answered is a common complaint of cancer patients who are discharged early with treatment side effects that compromise independent functioning."
With funding from the National Cancer Institute and the National Institute of Nursing Research, Mishel is conducting three psycho-educational intervention studies with cancer patients.
"In all three studies, nurses use telephone counseling and supplementary materials to teach patients and/or their family members how to manage uncertainty generated by their cancer diagnosis and treatment," Mishel says. "The intervention also teaches strategies to enhance self-care and self-help behaviors."
One study involves African-American and White men with localized prostate cancer and their family members. The second evaluates a related form of intervention in older White, Mexican-American and African-American Women with Breast cancer. The third tests the intervention in younger African-American women with breast cancer.
In the telephone-based nursing intervention, patients are called once a week over eight weeks. The nurses are matched to participants by race and gender. The same nurse delivers the calls to a patient throughout the intervention. Calls average about 15-20 minutes. Mishel points out that the program is individualized to the patient. "It's tailored to the person's concerns of that day, that week, that phone call. And much of what we do is to provide answers to questions, give people information, but we also give them resources. Patients receive a cancer dictionary that has words like 'metastases' spelled out and defined. So when they hear these words from a primary health care provider, they'll know what they mean." Patients are instructed to generate a list of questions, to monitor themselves for symptoms, "and they learn how to report side effects of their treatment," Mishel adds. "We teach patients the words to use to get the health care provider's attention. How to phrase the problem to avoid being triaged out by the office nurse."
In women with breast cancer, preliminary findings from the 8-week follow-up program of weekly telephone calls are positive.
"So far we've found that the program reduces the number of patient problems, helps patients manage the side effects of cancer treatment such as fatigue and helps them become more effective advocates for their own care. Patients show an improved ability to communicate their concerns to health providers, including doctors and nurses."
In the localized prostate cancer study, those receiving the intervention reported improved control over urine flow and increased satisfaction with sexual relationships. They also reported better family relationships, and greater work and recreational activities.
"For the family care givers of men with prostate cancer, the intervention resulted in less time spent in helping the patient manage side effects, improved problem solving, better communication with the physician, and improved quality of life," the UNC researcher says.
The intervention program also carries potential benefits for the health care system.
"It can reduce phone calls to the physician's office by 50%. It reaches and benefits minority populations and the under-served. And it can identify complications early, before complications become more costly," says Mishel.
She notes that serious complications were identified during phone calls and that patients were "pushed to see their physician before the next scheduled appointment."
In the follow-up phone calls, nurses ask questions about anything that had changed. "By doing that we identified symptoms of spinal cord compression in one man, pneumonitis in a woman, urinary stricture in another man."
Mishel also points out that adherence to management methods is improved. "For example, the doctor may teach prostate cancer patients Kegel Exercises, but if no one checks up on the patient they may do them incorrectly or sporadically, neither of which is effective. Men who had the intervention program improved in urine flow because the nurse repeatedly checked on the use of Kegels."
Similarly, the use of medication to manage side effects is also followed up, thus problems can be discovered early and changes made.
Mishel hopes her studies will lead to federal support for national adoption of her follow-up program.
"This research addresses a current gap in the health care system between receiving treatment and recovery," she says.
Note to media: Dr. Merle Mishel can be reached at 919-966-5294; E-mail: mishel@email.unc.edu