BACKGROUND: To address the support needs of newly diagnosed lung cancer patients with limited prognosis, the Milestone Communication Approach (MCA) was developed and implemented. Main elements of the MCA are situation-specific conversations along the disease trajectory conducted by an interprofessional tandem of physician and nurse. Aim of the study was to evaluate the effects of MCA on addressing support needs, quality of life and mood as compared to standard oncological care. PATIENTS AND METHODS: A randomized trial was conducted with baseline assessment and follow-up assessments at 3, 6 and 9 months in out-patients with newly diagnosed lung cancer stage IV at a German thoracic oncology hospital. Primary outcome was the subscale Health System and Information Needs of the Short Form Supportive Care Needs Survey (SCNS-SF34-G) at 3-month follow-up. Secondary outcomes included the other subscales of the SCNS-SF34-G, the Schedule for the Evaluation of Individual Quality of Life (SEIQoL), the Functional Assessment of Chronic Illness Therapy (FACT-L), the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) and the Distress Thermometer. RESULTS: At baseline, 174 patients were randomized of whom 102 patients (MCA: n=52; standard care: n=50) provided data at 3-month follow-up. Patients of the MCA group reported lower information needs at 3-month follow-up (M=33.4, SD=27.5; standard care: M=43.1, SD=29.9, p=.033). No effects were found for secondary outcomes. CONCLUSION: MCA lowered patient-reported information needs, but did not have other effects. MCA contributed to tailored communication, because an adequate level of information and orientation set the basis for patient-centered care. IMPLICATIONS FOR PRACTICE: By addressing relevant issues at predefined times, the MCA is a tool to provide individual patient-centered care facilitating the timely integration of palliative care for patients with a limited prognosis. Needs of lung cancer patients have to be assessed and addressed throughout the disease trajectory. While specific topics are relevant at particular times for all patients, i.e. information about the disease and directly associated healthcare, individual situations of patients and their families need to be considered. Additionally, using the SCNS-SF34 in clinical practice to identify problems for which patients need help might support individually targeted communication and preference-sensitive care.
- Krug, K.
- Bossert, J.
- Deis, N.
- Krisam, J.
- Villalobos, M.
- Siegle, A.
- Jung, C.
- Hagelskamp, L.
- Unsöld, L.
- Jünger, J.
- Thomas, M.
- Wensing, M.
Keywords
- communication
- lung cancer
- needs
- quality of life
- support
