Feasibility and Effectiveness of Self-Management Education and Coaching on Patient Activation for Managing Cancer Treatment Toxicities

Doris Howell; Gregory R Pond; Denise Bryant-Lukosius; Melanie Powis; Patrick T McGowan; Tutsirai Makuwaza; Vishal Kukreti; Sara Rask; Saidah Hack; Monika K Krzyzanowska

doi:10.6004/jnccn.2022.7095

Feasibility and Effectiveness of Self-Management Education and Coaching on Patient Activation for Managing Cancer Treatment Toxicities

J Natl Compr Canc Netw. 2023 Mar;21(3):247-256.e8. doi: 10.6004/jnccn.2022.7095.

Authors

Doris Howell^{1

2}, Gregory R Pond^{3

4}, Denise Bryant-Lukosius^{3

4

5}, Melanie Powis⁶, Patrick T McGowan^{7

8}, Tutsirai Makuwaza⁹, Vishal Kukreti¹⁰, Sara Rask¹¹, Saidah Hack⁶, Monika K Krzyzanowska^{6

12}

Affiliations

¹ Princess Margaret Cancer Research Institute, University Health Network, Toronto, Ontario, Canada.
² Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
³ Escarpment Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada.
⁴ Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
⁵ School of Nursing, McMaster University, Hamilton, Ontario, Canada.
⁶ Department of Medical Oncology & Cancer Quality Laboratory (CQual), University Health Network (Princess Margaret Cancer Centre), Toronto, Ontario, Canada.
⁷ School of Public Health & Social Policy, University of Victoria, Victoria, British Columbia, Canada.
⁸ Institute of Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada.
⁹ Women's College Hospital, Toronto, Ontario, Canada.
¹⁰ Department of Medical Oncology and Hematology, University Health Network (Princess Margaret Cancer Centre), Toronto, Ontario, Canada.
¹¹ Department of Medical Oncology, Royal Victoria Hospital, Barrie, Ontario, Canada.
¹² Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

PMID: 36898363
DOI: 10.6004/jnccn.2022.7095

Abstract

Background: Poorly managed cancer treatment toxicities negatively impact quality of life, but little research has examined patient activation in self-management (SM) early in cancer treatment.

Methods: We undertook a pilot randomized trial to evaluate the feasibility, acceptability, and preliminary effectiveness of the SMARTCare (Self-Management and Activation to Reduce Treatment Toxicities) intervention. This intervention included an online SM education program (I-Can Manage) plus 5 sessions of telephone cancer coaching in patients initiating systemic therapy for lymphoma or colorectal or lung cancer at 3 centers in Ontario, Canada, relative to a usual care control group. Patient-reported outcomes included patient activation (Patient Activation Measure [PAM]), symptom or emotional distress, self-efficacy, and quality of life. Descriptive statistics and Wilcoxon rank-sum tests were used to examine changes over time (baseline and at 2, 4, and 6 months) within and between groups. We used general estimating equations to compare outcomes between groups over time. The intervention group completed an acceptability survey and qualitative interviews.

Results: Of 90 patients approached, 62 (68.9%) were enrolled. Mean age of the sample was 60.5 years. Most patients were married (77.1%), were university educated (71%), had colorectal cancer (41.9%) or lymphoma (42.0%), and had stage III or IV disease (75.8%). Attrition was higher in the intervention group than among control subjects (36.7% vs 25%, respectively). Adherence to I-Can Manage was low; 30% of intervention patients completed all 5 coaching calls, but 87% completed ≥1. Both the continuous PAM total score (P<.001) and categorical PAM levels (3/4 vs 1/2) (P=.002) were significantly improved in the intervention group.

Conclusions: SM education and coaching early during cancer treatment may improve patient activation, but a larger trial is needed.

Clinicaltrials: gov Identifier: NCT03849950.

Keywords: cancer; feasibility trial; patient activation; self-management support; treatment toxicities.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Feasibility Studies
Humans
Lung Neoplasms*
Mentoring*
Middle Aged
Ontario
Patient Participation
Quality of Life / psychology
Self-Management*

Associated data

ClinicalTrials.gov/NCT03849950

Grants and funding

154129/CIHR/Canada