Evaluating a shared care pathway intervention to reduce chemotherapy outpatients’ unplanned presentations to hospital: a randomised controlled trial

Abstract

Abstract Purpose The aim of this randomised controlled trial (RCT) was to explore whether a community nursing intervention for outpatients receiving systemic therapy reduced unplanned hospital presentations and improved physical and psychosocial health outcomes over the first three cycles of treatment compared to a control group receiving standard care. Methods The number of and reasons for unplanned presentations were obtained for 170 intervention and 176 control group patients. Patients self-completed the Hospital Anxiety and Depression Scale, the Cancer Behavior Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ-C30) at the start of the first four cycles. Poisson regression was used to compare the number of presentations between the intervention and control groups. Linear regression techniques were used to compare quality of life outcomes. Results The relative difference in unplanned presentations between the control and intervention groups was 12% (95% CI: −25%, 37%; P = 0.48) in favour of the intervention. At the start of cycle 4, there was no difference in anxiety (difference = 0.47 (95%CI: −0.28 to 1.22; P = 0.22)), depression (difference = 0.57 (95%CI:−0.18 to 1.31; P = 0.13)) or EORTC QLQ-C30 summary score (difference = 0.16 (95%CI:−2.67, 3.00; P = 0.90)). Scores for self-efficacy as measured by the Cancer Behavior Inventory were higher in the intervention group (difference = 4.3 (95%CI:0.7 to 7.9; P = 0.02). Conclusion This RCT did not demonstrate a benefit in reducing unplanned presentations to hospital. The trial identified improved cancer-based self-efficacy in patients receiving the intervention.