Nurse-led Transitional Care to Improve Symptom Management in Childhood Cancer Survivors

A Nurse-facilitated Interdisciplinary Transitional Care Programme for Childhood Cancer Survivors and Their Parents to Improve Symptom Management: a Feasibility Randomised Waitlist-controlled Trial

This study aims to evaluate the feasibility and preliminary effectiveness of a nurse-facilitated interdisciplinary transitional care programme, based on the Omaha system, for Chinese childhood cancer survivors (CCSs) and their parents in Hong Kong. Investigators will conduct a two-arm, randomized waitlist-controlled trial at the Hong Kong Children's Hospital, the only local center for CCS follow-up. Sixty-eight dyads (CCS aged 13-18 and a parent) will be randomized to either the 12-week nurse-led intervention or usual care. The intervention includes an initial face-to-face assessment and regular follow-ups via Zoom, focusing on symptom management, health education, and self-care empowerment, with referrals to other professionals as needed. The control group receives standard discharge care and educational materials, and will be offered the intervention after data collection. Outcomes will be assessed at baseline, and 3 and 6 months post-intervention, including symptom management, quality of life, caregiver burden, self-efficacy, and emergency department visits. Feasibility will be evaluated by recruitment, retention, attendance, and data completeness rates. If effective, this programme could improve transitional care and symptom management for CCSs and their families, and inform clinical practice and policy in Hong Kong and beyond.

Study Overview

• Status: Not yet recruiting
• Conditions: Pediatric Cancer
• Intervention / Treatment: Other: Counseling based on Omaha system; Other: Usual Care

• Study Type: Interventional
• Enrollment (Estimated): 68
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ka Yan Ho; Phone Number: +8527666417; Email: kyeva.ho@polyu.edu.hk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria for CCSs:

• aged between 13 and 18 years
• diagnosed with any cancer
• completion of active cancer treatment within a month
• communicate in Chinese

Inclusion Criteria for parents:

• mother or father who has a significant caregiving role in the child's life
• could participate in the intervention at the same time as their child
• communicate in Chinese
• have an electronic device to access zoom

Exclusion Criteria for CCSs:

• cognitive impairment
• social and/or behavioural problem
• have terminal cancer
• participate in any similar intervention

Exclusion Criteria for parents:

• severe emotional problems
• participate in any similar intervention

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention group	Other: Counseling based on Omaha system; Investigators developed the intervention based on the Omaha system and investigators' previous studies. The intervention will last for 12 weeks. During week 1, dyads (a pairing of a child with their parent) will have a 1-hour face-to-face consultation with a RN. The RN will assess every dyad using the Omaha system to identify any problems. The Omaha system covers 42 problems grouped into 4 categories, including environmental, physiological, psychosocial and health-related behaviours. After identifying the problems, the RN will deliver corresponding interventions according to the intervention scheme in the Omaha system. Subsequent follow-up will be provided by the RN via zoom during weeks 2, 3, 4, 6, 8, 10 and 12 to evaluate their progress in terms of knowledge, behaviour and status using the rating scale in the Omaha system. The RN will assign further interventions, based on the Omaha system, to address their specific needs. Each follow-up should last around 30 minutes.
Other: Wait-list control group	Other: Counseling based on Omaha system; Investigators developed the intervention based on the Omaha system and investigators' previous studies. The intervention will last for 12 weeks. During week 1, dyads (a pairing of a child with their parent) will have a 1-hour face-to-face consultation with a RN. The RN will assess every dyad using the Omaha system to identify any problems. The Omaha system covers 42 problems grouped into 4 categories, including environmental, physiological, psychosocial and health-related behaviours. After identifying the problems, the RN will deliver corresponding interventions according to the intervention scheme in the Omaha system. Subsequent follow-up will be provided by the RN via zoom during weeks 2, 3, 4, 6, 8, 10 and 12 to evaluate their progress in terms of knowledge, behaviour and status using the rating scale in the Omaha system. The RN will assign further interventions, based on the Omaha system, to address their specific needs. Each follow-up should last around 30 minutes.; Other: Usual Care; Dyads in this group will receive usual care, defined as the existing care practices provided by the hospital, which include a discharge checklist and educational materials regarding the care. After the completion of data collection for all timepoints, they will be invited to join the counselling based on Omaha system intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Screening rate	Number of dyads screened divided by number of dyads available for screening.	Baseline
Eligibility rate	Number of dyads eligible divided by number of dyads screened.	Baseline
Recruitment rate	Number of eligible dyads agree to join divided by number of eligible dyads.	Baseline
Randomization rate	Number of dyads being randomized divided by number of participating dyads.	Baseline
Intervention attendance rate	Number of dyads who complete the intervention divided by number of dyads in the intervention group.	Immediately after the intervention completion
Retention rate	Number of dyads remaining in the study divided by number of dyads being randomized.	Baseline, immediately after the intervention completion, 3 months after intervention completion, 6 months after intervention completion
Completion rate	Number of dyads who complete the questionnaire divided by number of questionnaires distributed.	Baseline, immediately after the intervention completion, 3 months after the intervention completion, 6 months after the intervention completion
Missing data	Percentage of missing data	Baseline, immediately after the intervention completion, 3 months after the intervention completion, 6 months after the intervention completion
Adverse events	Number of unfavourable events and/or worsening reported.	During the study period including 12-week intervention and 6 months follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cancer-related symptoms in CCSs	It will be used to assess the cancer-related symptoms in CCSs. It has 30 items in seven domains: nutrition-related, psychosocial/central nervous system, oropharyngeal, bone marrow toxicity/neuropathy, skin/other toxicities, neurotoxicity and respiratory/other. Each item will be evaluated on a five-point scale, from 0 to 4. The psychometric properties have been well validated in CCSs.	Baseline, immediately after the intervention completion, 3 months after the intervention completion, 6 months after the intervention completion
CCSs' quality of life (QoL)	Paediatric Quality of Life Questionnaire (PedsQoL) will be used to assess the CCSs' QoL. It comprises 23 items. CCSs will rate their experience during the preceding month on a five-point scale. All items will be reverse-scored and linearly transformed onto a 0-100-point scale. This scale has well-established psychometric properties in CCSs.	Baseline, immediately after the intervention completion, 3 months after the intervention completion, 6 months after the intervention completion
Caregiver burden of parents	The caregiver burden in parents will be assessed using the Chinese version of the Caregiver burden inventory (CBI), which consists of 24 items in five dimensions: time-dependence, development, physical, social and emotional burdens. Each item will be evaluated from 0 (not at all relevant) to 4 (very relevant), with the total score between 0 and 96. The Chinese version is a valid and reliable instrument for use.	Baseline, immediately after the intervention completion, 3 months after the intervention completion, 6 months after the intervention completion
Caregiving competence of parents	Caregiving competence scale (CCS) will be used to record the competence of parents regarding their caregiving. This scale comprises four items, each of which is evaluated on a four-point rating scale, from 1 (not at all) to 4 (very much). The psychometric properties of the Chinese version have been well established.	Baseline, immediately after the intervention completion, 3 months after the intervention completion, 6 months after the intervention completion
Parental quality of life (QoL)	Parental QoL will be assessed using the Chinese version of the EQ-5D, with one question regarding each of five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The values will be weighted to convert into a value from 1 (full health) to 0 (equivalent to being dead). The psychometric properties of the EQ-5D have been well validated in the Chinese population.	Baseline, immediately after the intervention completion, 3 months after the intervention completion, 6 months after the intervention completion
Number of emergency department (ED) visits	It will be assessed by number of walk-in visits to the emergency department. These data will be collected in the central medical system with the assistance of PI in HKCH (Hong Kong Children's Hospital).	During the study period including 12-week intervention and 6 months follow up

Collaborators and Investigators

• Sponsor: The Hong Kong Polytechnic University

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): June 30, 2028
• Study Completion (Estimated): June 30, 2028

Study Registration Dates

• First Submitted: November 19, 2025
• First Submitted That Met QC Criteria: November 28, 2025
• First Posted (Estimated): December 9, 2025

Study Record Updates

• Last Update Posted (Estimated): December 9, 2025
• Last Update Submitted That Met QC Criteria: November 28, 2025
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: Omaha system; nurse-facilitated; interdisciplinary transitional care programme; Chinese childhood cancer survivors
• Additional Relevant MeSH Terms: Neoplasms
• Other Study ID Numbers: nurse-facilitated care

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No