NEWS

By LESLIE H. LANG
UNC-CH School of Medicine

CHAPEL HILL – A program of telephone counseling and education by nurses helps cancer patients cope with 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," said Dr. Merle Mishel, UNC-CH Kenan Distinguished professor of nursing and a member of the UNC Lineberger Comprehensive Cancer Center. "A premium is placed on seeing more patients in less time. 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 said. "The intervention also teaches strategies to enhance self-care and self-help behaviors."

One study involves black 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 black 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. 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 said the program is individualized to the patient. "It’s tailored to the person’s concerns of that day, that week, that phone call," she said. "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 and monitor themselves for symptoms. "They learn how to report side effects of their treatment," Mishel said. "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 eight-week follow-up program 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," Mishel said. "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," Mishel said.

The intervention program also may benefit the health-care system.

"It can reduce phone calls to the physician’s office by 50 percent," she said. "It reaches and benefits minority populations and the under-served. And it can identify complications early, before complications become more costly."

Serious complications were identified during phone calls and patients were "pushed to see their physician before the next scheduled appointment," Mishel said.

In follow-up 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," she said.

In addition, Mishel said, 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 said she hoped the 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.

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Note: Contact Mishel at (919) 966-5294 or e-mail mishel@email.unc.edu

School of Medicine contact: Lynn Wooten, (919) 966-6046 or e-mail LWooten@unch.unc.edu.