Asking nurses to reach out to people who have advanced cancer -- even if only by phone -- can improve patients' mood and quality of life, a study in today's Journal of the American Medical Association reports.
Nurses in the study of 322 cancer patients were specially trained in palliative care, which focuses on relieving pain and coordinating the medical and social needs of people with long-term illness. Doctors randomly assigned half the patients to receive regular phone consultations and half to receive only their regular care. All of the patients had just started treatment and weren't expected to live more than a year.
Following a manual developed for the program, nurses discussed issues such as coping strategies, communicating with a doctor, finding support, managing symptoms and planning for the end of life, says study co-author Marie Bakitas of the Dartmouth-Hitchcock Norris Cotton Cancer Center. Nurses also referred patients to people who could help with other problems, such as depression or financial worries.
Though earlier studies have suggested patients benefit from face-to-face discussions, Bakitas says she was happy to see telephone talks helped patients, too. Many of Dartmouth's patients live an hour or more away and can't easily get to the hospital.
Providing palliative care didn't affect patients' symptoms, perhaps because people in both segments of the study experienced fewer symptoms than most patients, Bakitas says. Although patients who received such care lived slightly longer, that could have been the result of chance.
Still, the study's results were "quite striking," especially for a simple telephone program, says Diane Meier, director of the Center to Advance Palliative Care at Mount Sinai School of Medicine in New York.
"I can't think of anything more important than to be able to improve patients' self-assessed quality of life," Meier says. "This is the whole point of health care."
Unlike hospice care, which aims to improve quality of life for dying patients, palliative care can be offered to anyone with a serious, long-term illness -- such as cancer, kidney failure or stroke -- as soon as the patient is diagnosed, Meier says.
The number of hospitals that offer palliative care is growing. Among the largest hospitals -- those with 250 beds or more -- 80% now offer the service, Meier says.
Meier says the Dartmouth program could easily be copied at other hospitals. Bakitas notes that the main costs for the program were the full-time pay for two nurses with advanced degrees, whose salaries were about $50,000 each.
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