Abstract CN38
Background
Tailored self-management support (SMS) aims at improving patient self-management behaviours. The Symptom Navi Program (SNP) is a nurse-led intervention developed in Switzerland to support patients in the self-management of symptoms related to cancer treatments. We pilot-tested the SNP to evaluate the implementation process based on the RE-AIM (Reach Effectiveness – Adoption Implementation Maintenance) framework.
Methods
A cluster-randomized design complemented with qualitative methods was used to randomise nine Swiss cancer outpatient centres to prevent cross contamination between patients. Four clusters were randomized to the SNP group where nurses were trained to apply the SNP. Nurses conducted at least two semi-structured consultations per patient based on written information leaflets (Symptom Navi Flyers). We evaluated the proportion of patients receiving the intervention per protocol (reach) and nurses’ adherence to the training manual (adoption) with study specific online questionnaires completed by the nurses after every intervention. Additionally, we observed semi-structured consultations (implementation) and conducted focus-group interviews before and after the implementation. Data was analysed descriptively and by thematic analysis.
Results
Three of four trained centres implemented the SNP. Of the included patients, 88% (43 of 49) received the SNP interventions per protocol. The proportions of per protocol interventions varied from 75% to 100% depending on centre. Nurses’ self-reported adherence to the training manual was 92% (95% CI 87% to 95%). Six observations of SNP interventions and the focus group revealed that nurses emphasized informing on and monitoring of symptoms and established a collaborative partnership with patients. However, they scarcely coached patients in goal setting and patient self-management behaviour before and after the implementation.
Conclusions
A large majority of patients received the SNP interventions per protocol and nurses mostly reported to adhere to the training manual. Observations of consultations revealed that key elements of SMS were incompletely applied. Therefore, the nurse training for SMS should be improved and further evaluated.
Clinical trial identification
NCT03649984, release date: August 28, 2018; and SNCTP000002381.
Editorial acknowledgement
Legal entity responsible for the study
The Symptom Navi Pilot Study Group.
Funding
University of Applied Sciences and Arts Western Switzerland, School of Health Sciences Fribourg, Switzerland; Institute of Higher Education and Research in Health Care, Faculty of Biology and Medicine, University of Lausanne, Switzerland; Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Hospital Group Lindenhof, Bern, Switzerland; Swiss Cancer League, Bern, Switzerland; Dr. Hans Altschüler Stiftung, St. Gallen, Switzerland.
Disclosure
S. Peters: Honoraria (self), Advisory/Consultancy: Abbvie; Research grant/Funding (self), Non-remunerated activity/ies: Amgen; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (self), Non-remunerated activity/ies: Astra Zeneca; Honoraria (self), Advisory/Consultancy: Bayer; Honoraria (self), Advisory/Consultancy: Biocartis; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (self), Non-remunerated activity/ies: Boehringer-Ingelheim; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (self), Non-remunerated activity/ies: Bristol-Meyers; Honoraria (self), Research grant/Funding (self), Non-remunerated activity/ies: Clovis; Honoraria (self), Advisory/Consultancy: Daiichi Sankyo; Honoraria (self), Advisory/Consultancy: Debiopharm; Honoraria (self), Speaker Bureau/Expert testimony: Eli Lilly; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (self), Non-remunerated activity/ies: F. Hoffmann-La Roche; Honoraria (self), Advisory/Consultancy: Foundation Medicine; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self), Non-remunerated activity/ies: Illumina; Honoraria (self), Advisory/Consultancy: Janssen; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (self), Non-remunerated activity/ies: Merck-Sharp and Dohme; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self), Non-remunerated activity/ies: Merck Serono; Honoraria (self), Advisory/Consultancy: Merrimack; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (self), Non-remunerated activity/ies: Novartis; Honoraria (self), Advisory/Consultancy: Pharma Mar; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (self), Non-remunerated activity/ies: Pfizer; Honoraria (self), Advisory/Consultancy: Regeneron; Honoraria (self), Advisory/Consultancy: Sanofi; Honoraria (self), Advisory/Consultancy: Seattle Genetics; Honoraria (self), Speaker Bureau/Expert testimony: Takeda. M. Eicher: Research grant/Funding (self): Krebsliga Schweiz; Research grant/Funding (self): Dr. Hans Altschüler Stiftung St. Gallen; Honoraria (self): Vifor; Research grant/Funding (self): Roche; Research grant/Funding (self): Bristol Meyers Squibb. All other authors have declared no conflicts of interest.