ADVANCING GERIATRIC NURSING PRACTICE; A Specialized Home Care Intervention Improves Survival Among Older Post‐Surgical Cancer Patients

• DOI: 10.1111/j.1532-5415.2000.tb03886.x
• Publication Date: 2015-04-28T20:10:29Z
• Authors: Mathy Mezey; Terry Fulmer; Ruth McCorkle; Neville E. Strumpf; Isaac F. Nuamah; Diane C. Adler; Mary E. Cooley; Christopher Jepson; Edward J. Lusk; Michael Torosian
• Keywords: Male; Postoperative Care; Health Services for the Aged; Oncology Nursing; Aftercare; Home Care Services, Hospital-Based; Cancer Care Facilities; Middle Aged; Pennsylvania; Survival Analysis; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Nursing Evaluation Research; Neoplasms; Outcome Assessment, Health Care; Humans; Female; Nurse Clinicians; Aged; Follow-Up Studies; Program Evaluation; Proportional Hazards Models

CONTEXT: Changes in the healthcare system have resulted shortened hospital stays, moving focus of care from to home. Patients are discharged post‐operatively with ongoing needs, and whether they receive nursing post‐hospitalization can influence their recovery survival. Little information is available about factors that outcomes, including survival older cancer patients after surgery. OBJECTIVE: To compare length post‐surgical who received a specialized home intervention provided by advanced practice nurses (APNs) usual follow‐up an ambulatory setting. We also assessed potential predictors terms depressive symptoms, symptom distress, functional status, comorbidities, stay, age patient, stage disease. DESIGN: A randomized controlled study. SETTING: Discharged surgery at Comprehensive Cancer Center southeastern Pennsylvania. PATIENTS: Three hundred seventy‐five aged 60 92, newly diagnosed solid cancers, were treated surgically between February 1993 December 1995. One ninety groups 185 group. INTERVENTION: The was standardized protocol consisted standard assessment management guidelines, doses instructional content, schedules contacts. lasted 4 weeks three visits five telephone contacts APNs. Both family care‐givers comprehensive clinical assessments, monitoring, teaching, skills training. MAIN OUTCOME MEASURE: Time enrollment into study until death or last date known alive end November 1996. RESULTS: During 44‐month period, 93 (24.8%) 375 died. Forty‐one (22%) those died group, compared 52 (28%) Stage disease diagnosis differed two baseline (38% late group 26% control P = .01), so stratified analysis performed. Overall, found increased (P .002 using log‐rank test). Among early only, there no difference groups. patients, improved For example, 2‐year among cases 67% 40% cases. When Cox's proportional hazard model used adjust for significant covariates, relative 2.04 (CI: 1.33 3.12; .001) adjusting surgical hospitalization stay. CONCLUSIONS: This first empirical link Additional research needed test interventions aimed maintaining quality life outcomes effects on patients.