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- Title
DECONSTUCTION OF A NURSING INTERVENTION TO EXAMINE THE MECHANISM OF ACTION.
- Authors
Given, Barbara; Given, Charles; Sikorskii, Alla
- Abstract
To translate behavioral interventions into clinical practice it is essential to a) demonstrate that exposure to the intervention results in significant improvement in the primary outcome and b) describe the mechanisms of the interventions that produce the patient outcome. A trial comparing a nurse directed with an automated voice response system for lowering severity of symptoms among patients undergoing chemotherapy is described. Then, the nurse- assisted arm of the trial is deconstructed to describe the mechanism. Cognitive Behavioral Theory guides this analysis. The framework is a Cognitive Behavioral Theoretical Framework. This trial accrued 343 patients receiving chemotherapy. Following a baseline interview patients were randomization to one of two arms. Computer assisted protocols recorded each symptom above a designated threshold at each of six contacts and documented intervention strategies delivered, whether patients tried them and, if tried, were strategies successful in lowering symptom severity. Strategies were organized around four domains: information, education, support, and communication. Each arm produced significant reduction over baseline. To describe the nurse directed mechanisms the frequency with which strategies from each domain was delivered. Second, the proportion of strategies delivered that "were tried" is described, Third, the proportion of strategies for each symptom tried that were successful and their relationship to the proportion of symptoms reduced below thresholds described. These data describe how after adjusting for patient age, baseline depression, site of cancer, and duration of symptoms: 1) are nurses more likely to deliver strategies from certain domains? 2) among strategies delivered are patients more likely to try those from certain domains? 3) are strategies from one domain more likely to lower symptom severity? These analyses identify strategies from domains that manage symptoms successfully and which patients are more likely to respond to and benefit from the strategies. These analyses begin to specify the mechanisms through which behavioral interventions modify self-care behaviors that lead to lowered symptom severity. Funding Sources: Automated Telephone Monitoring for Symptom Management. (CW Given PI) RO1 CA 30724 7/31/03-8/1/07
- Subjects
ONCOLOGY nursing; CANCER patient care; HEALTH outcome assessment; EVALUATION of medical care; NURSE-patient relationships
- Publication
Oncology Nursing Forum, 2007, Vol 34, Issue 1, p199
- ISSN
0190-535X
- Publication type
Article