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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
2004; Schwartz, 1999, 2000; Dimeo, 2001; Schwartz et al., 2001), pain (Miaskowski et al., 2004), and lymphedema (McKenzie and Kalda, 2003). These interventions (most often provided by nurses in the cancer care setting) have been variously termed psychoeducational, self-care, self-management support, and more recently, cognitive-behavioral interventions.7 They have been administered to patients before therapy or the onset of symptoms as prevention, to those experiencing symptoms or distress, or to those who have completed therapy. They have included interventions provided by a nurse alone or complemented by computer programs, video presentations, and other tools. While there may be differences in the underlying theory, the interventions included under the four rubrics of psychoeducation, self-care, self-management support, and cognitive-behavioral interventions are all designed to increase an individual’s skill in managing the illness and its effects. However, some approaches to illness self-management used with cancer patients have been delivered in combination with the provision of skilled physical nursing care, which has confounded interpretation of the effectiveness of the psychosocial component of care.
The PRO-SELF program, the most extensively tested strategy, targets various symptoms of cancer and its treatment and has been evaluated in multiple randomized trials (Larson et al., 1998; Dodd and Miaskowski, 2000; West et al., 2003; Kim et al., 2004; Miaskowski et al., 2004). The intervention involves nurses coaching patients and their families. The content includes information designed to assist patients “in managing the cancer treatment experience,” including basic information about the disease and its treatment, symptoms, and approaches to symptom management. In addition to this information, patients receive coaching in the skills necessary to manage their symptoms—for example, mouth care for mucositis (Larson et al., 1998) or opioid use for pain (Miaskowski et al., 2004)—and problem-solving assistance. Studies of this strategy found significantly reduced pain intensity and more appropriate use of opioids (Miaskowski et al., 2004). Given and colleagues (2006) tested a cognitive-behavioral intervention that included classes focused on self-management, problem-solving, and communication with providers. Those receiving the experimental intervention reported significantly fewer severe symptoms at 10 and 20 weeks’ follow-up. In randomized controlled trials, related interventions have been shown to improve mood and vigor among patients with malignant melanoma (Boesen et al., 2005), reduce psychological distress after radiotherapy (Stiegelis et al., 2004), reduce fatigue and improve functional status among cancer survivors (Gielissen et al., 2006), and improve sexual function and reduce worry among patients with prostate cancer (Giesler et al., 2005).
McCorkle and colleagues have developed and studied interventions in
This is another example of the terminology problem discussed earlier in this chapter.