- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04160650
Educational Nursing Intervention Among Patients With Colorectal Cancer During Chemotherapy
Educational Nursing Intervention on Nutrition Impact Side-effects' Self-care Among Patients With Colorectal Cancer During Chemotherapy: A Research Protocol for a Randomised Controlled Trial
The prevalence of malnutrition is common among patients with colorectal cancer. Chemotherapy induced side effects may impact negatively on nutrition intake thus increase the risk of malnutrition and serious complications for patients. Purpose is to test the effect of empowering education on activation and knowledge level among patients with colorectal cancer during the chemotherapy. Secondary outcomes are quality of life and malnutrition.
A two-arm, single center, patient blinded superiority trial with stratified randomization (1:1) and with repeated measures is used to measure the effectiveness of face-to-face education on nutrition intake related chemotherapy induced side-effects' self-care compared to standard care. Eligibility criteria are adult patients diagnosed with colorectal cancer and receiving intra venous chemotherapy treatment. Patients are recruited in one university hospital outpatient clinic in Finland. Experienced oncology nurse delivers the intervention two weeks after the first chemotherapy. Primary outcomes are activation in self-care and knowledge level. Secondary outcomes are quality of life and risk of malnutrition measured at baseline (M0) and after eight (M1) and 16 weeks (M2) after the intervention.
The study will provide knowledge of nurse-led educational intervention on self-care among patients with colorectal cancer. The findings will contribute to patient education and self-care, thus better quality of life.
Study Overview
Status
Detailed Description
The prevalence of malnutrition is common among patients with colorectal cancer. Chemotherapy induced side effects (nausea, vomiting, pain, mouth sores, fatigue, diarrhea, constipation, distress) may impact negatively on nutrition intake thus increase the risk of malnutrition thus serious complications for patients. Nurse-led empowering education may have positive effect on activation and knowledge level and enhance self-care of this patient group. Studies of nurse-led interventions that may enhance nutrition intake are scarce. Therefore, purpose of this study is to test the effect of educational nursing intervention on activation and knowledge level among patients with colorectal cancer during the chemotherapy. Secondary outcomes are quality of life and risk of malnutrition.
A two-arm, single center, patient blinded superiority trial with stratified randomization (1:1) and with repeated measures is used to measure the effectiveness of face-to-face education on nutrition intake related chemotherapy induced side-effects' self-care compared to standard care. Eligibility criteria are adult patients diagnosed with colorectal cancer and receiving intra venous chemotherapy treatment. Patients are recruited in one university hospital outpatient clinic in Finland. Experienced oncology nurse delivers the intervention two weeks after the first chemotherapy. Primary outcomes are activation in self-care and knowledge level. Secondary outcomes are quality of life and malnutrition risk measured at baseline (M0) and after eight (M1) and 16 weeks (M2) after the intervention.
The study will provide knowledge of the effectiveness of nurse-led empowering educational intervention on self-care related to chemotherapy-induced side effects that may deteriorate nutrition intake among patients with colorectal cancer. The findings will contribute to patient education and self-care, thus better quality of life.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Helsinki, Finland, 00029
- Helsinki University Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- able to speak and understand Finnish
- receiving chemotherapy every three weeks in outpatient clinic: oxaliplatin+capecitabine= Xelox; irinotecan + capecitabine = Xeliri; Xelox or Xeliri + Bevacizumab
Exclusion Criteria:
- weak physical, psychological or cognitive function that prevents participation
- not able to understand Finnish
Study Plan
How is the study designed?
Design Details
- Primary Purpose: SUPPORTIVE_CARE
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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EXPERIMENTAL: Educational nursing intervention
Patients in experimental group receive standard care and one-hour educational session. Patients are provided knowledge of
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This is an educational intervention which aims to answer the questions:
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NO_INTERVENTION: Standard care
Patients in control group receive standard care, information of
They receive a self-monitoring diary, which includes only side effects and their intensity (NRS 0-10). |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The rate of knowledge level (Knowledge test of malnutrition, nutrition impact side effects and their self-care, RasOma, Tuominen et al. 2019)
Time Frame: From the baseline to 8 and 16 weeks after the intervention
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Knowledge is seen as essential for empowerment (Rankinen et al. 2014; Castro et al. 2016).
It is assumed that knowledge level is better in the intervention group compared to control group.
Knowledge test was developed in the research group, which included an oncologist, a dietitian, oncology nurses and a researcher.
The instrument includes 15 items (yes/no, right answer=1 point, wrong answer=0 points).
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From the baseline to 8 and 16 weeks after the intervention
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The rate of self care activation (Patient Activation Measure PAM, Insignia Health; Hibbard et al. 2004)
Time Frame: From the baseline to 8 and 16 weeks after the intervention
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Activated individuals have the knowledge, skills and confidence to self-manage their health.
PAM shows how ready, willing and able an individual is to manage his or her health and healthcare.It is assumed that patients in the intervention group are more activated to self-care their side effects.
The activation score is based on a 0-100 point scale.
A change of 3-4 points is associated with the difference between engaging and not engaging in particular behaviors.
Activation self care is rated from 1 to 4 (1= low activation level; believing the patient role is important, 2=low activation level; having the confidence and knowledge necessary to take action, 3=moderate activation level; actually taking action to maintain and improve one's health, and 4=high activation level; staying the course even in stressful situations)(InsigniaHealth 2017).
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From the baseline to 8 and 16 weeks after the intervention
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The incidence of malnutrition risk (Nutritional Risk Screening NRS2002, Kondrup et al. 2003)
Time Frame: From the baseline to 8 and 16 weeks after hte intervention
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Nutrition consultations have affected positively on patients' food intake and nutritional status (Kiss & Krishnasamy 2014; Tu et al. 2013; Ravasco 2011, 2012).
Patients with a total score of ≥3 are classified as nutritionally at risk.
It is assumed that malnutrition risk is lesser in the intervention group compared to control group.
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From the baseline to 8 and 16 weeks after hte intervention
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The rate of quality of life (The Functional Assessment of Cancer Therapy Scale - Colorectal, FACT-C, Cella et al. 1993)
Time Frame: From the baseline to 8 and 16 weeks after the intervention
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The risk of malnutrition is strongly associated with QoL in cancer patients initiating chemotherapy (Calderon et al. 2018).The FACT-C questionnaire consists of 36 items on a 5-point Likert scale in four areas of well-being: physical (0-28 points), social (0-28 points), emotional (0-24 points), functional (0-28 points) and CRC subscale (0-28 points).
Higher score means better QoL (34 points=low level, 34-68 points= satisfactory, 68-102 points=average and 102-136 points=high)(Ganesh et al. 2016; Goździewicz et al. 2017).
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From the baseline to 8 and 16 weeks after the intervention
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of interruption, transfer and cancellation of the treatments
Time Frame: From the baseline to 8 and 16 weeks after the intervention
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Better nutritional status is related to better treatment effect and better well-being, which may lead to better adherence to treatment schedule (Ravasco et al. 2012).
Data is collected from patients' records.
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From the baseline to 8 and 16 weeks after the intervention
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Incidence of morbidity
Time Frame: From the baseline to 16 weeks after hte intervention
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Worse nutritional status is related to greater morbidity (Ravasco et al. 2012).
Data is collected from patients' records.
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From the baseline to 16 weeks after hte intervention
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Helena Leino-Kilpi, PhD, University of Turku
Publications and helpful links
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- NursEff
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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