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Cited by 47Cancer survivorship and careNursing care and researchMobile Health and mHealth Applications

A Multimedia Self-management Intervention to Prepare Cancer Patients and Family Caregivers for Lung Surgery and Postoperative Recovery

Open access
Sun, Virginia, Raz, Dan J., Ruel, Nora, Chang, Walter, Erhunmwunsee, Loretta, Reckamp, Karen, Tiep, Brian, Ferrell, Betty +2 more·2017·Clinical Lung Cancer
DOI 10.1016/j.cllc.2017.01.010PMC PMC5413411
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Abstract

Background The purpose of this study was to evaluate the feasibility and acceptability of a multimedia self-management (MSM) intervention to prepare patients and family caregivers for lung surgery.Patients and methods This is a quasi-experimental, 2-group, sequential enrollment pilot study of a 4-session multimedia intervention (audio/visual + print) to enhance self-management and quality of life (QOL) for patients and family caregivers. The intervention, Preparing for Lung Surgery, begins before surgery, and continues through hospitalization and discharge, with 2 telephone support sessions after discharge. Outcomes were assessed before surgery (preintervention), at discharge, and 2 to 4 weeks postdischarge (postintervention). Patient outcomes were assessed using the Functional Assessment of Cancer Therapy-General (QOL), MD Anderson Symptom Inventory and Functional Assessment of Cancer Therapy-Pulmonary Symptom Index (symptoms), self-efficacy, surgery-related knowledge, and patient activation. Family caregiver outcomes included City of Hope-QOL-Family (QOL), Caregiver Burden Scale, and knowledge. Paired t tests were used for exploratory evaluations of score changes from pre- to postintervention.Results Sixty participants (38 patients, 22 family caregivers) enrolled in the study (70% accrual). Postintervention scores were significantly improved for patients' emotional QOL (P = .001). Trends for improvements were observed for patient self-efficacy, surgery-related knowledge, and activation. Family caregivers' surgery-related knowledge was significantly improved (P = .02). Overall, participants were highly satisfied with the acceptability/usability of the intervention (3.6-3.7 of 4.0).Conclusion A standardized MSM intervention was feasible and acceptable in supporting readiness and preparedness for lung surgery and postoperative recovery. A larger randomized trial is needed to verify the impact of the MSM intervention on patient/family caregiver outcomes and health care resource use.

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Crossref · 10.1016/j.cllc.2017.01.010

Cites

36 of 36 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 26 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Intervention patients' emotional QOL improved significantly from pre- to post-intervention (19.9 vs 15.9, p=0.001).

    “Emotional QOL was significantly improved post-intervention for the intervention group (19.9 vs. 15.9, p=0.001).”
    • Also stated in: § Results · plain
      “Post-intervention scores were significantly improved for patients’ emotional QOL (p=0.001).”
    Quote in the paperSubstantial claim
  • Findingown data

    Most unscheduled encounters were for symptom management (36.8%).

    “The majority of unscheduled encounters were for symptom management (36.8%).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Overall, participants were highly satisfied with the acceptability/usability of the intervention (3.6 to 3.7 out of 4.0).

    “Overall, participants were highly satisfied with the acceptability/usability of the intervention (3.6 to 3.7/4.0).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Approximately 38% of enrolled participants were ethnic minorities.

    “Nevertheless, we were able to enroll approximately 38% ethnic minorities overall.”
    Quote in the paperNot a substantial claim
  • Findingown data

    All unscheduled encounters among intervention patients were triage phone calls.

    “For patients who received the MSM intervention, all unscheduled encounters were for triage phone calls.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 20
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingown data

    Unscheduled outpatient encounters after surgery occurred in 42.1% of intervention patients and 36.8% of usual care patients.

    “For healthcare resource use, 8 patients (42.1%) in the intervention group and 7 patients (36.8%) in the usual care group had an unscheduled outpatient encounter after surgery.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The most common reasons patients declined were feeling overwhelmed (72%) and severe illness (28%); caregivers declined most often because they were too busy (64%) or overwhelmed (36%).

    “The most common reasons for patients declining participation were being too overwhelmed (72%) and severe illness (28%). Being too busy (64%) and too overwhelmed (36%) were the most common reasons for family caregivers to decline participation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Eighty-seven percent of patients thought the amount of intervention content was just right, and all patients were comfortable with the timing.

    “Eighty-seven percent of patients felt that the amount of intervention content was just right, and all patients felt comfortable with the timing of the intervention.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For intervention patients, total QOL improved but the improvement was not statistically significant.

    “For patients who received the MSM intervention, scores for total QOL improved, although the improvement was not statistically significant (Table 4).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most family caregivers (81.8%) were female.

    “The majority of family caregivers (81.8%) were female (Table 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of eligible individuals over a 12-month period, about 70% agreed to take part in the study.

    “Of those eligible for the study in a 12-month period, an estimated 70% chose to participate in the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Twenty-six of 30 intervention participants (86.7%) completed the satisfaction tool.

    “A total of 16 patients and 10 family caregivers completed the satisfaction tool to assess acceptability and usability of the intervention (26/30 intervention group participants, 86.7%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Most surgical procedures were minimally invasive (73.7%), mean length of stay was similar between groups (3.8 vs 3.2 days), and most patients were treated for primary lung cancer (78.9%).

    “The majority of surgical procedures were minimally invasive (73.7%). Mean length of stay was similar between groups (3.8 days for usual care, 3.2 for intervention). The majority of patients were treated for primary lung cancer (78.9%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Patient mean age was 66.8 years in usual care and 64.5 years in the intervention group; caregiver mean age was 60.5 years in usual care and 59.5 years in the intervention group.

    “Mean age for patients was 66.8 for usual care and 64.5 for the intervention group. For family caregivers, mean age was 60.5 for usual care and 59.5 for intervention group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Seventy-three people (44 patients and 29 family caregivers) gave informed consent, and 13 (6 patients and 7 caregivers) withdrew, yielding 17.8% attrition.

    “A total of 44 patients and 29 family caregivers (N=73) provided informed consent for study participation. Of this total, 6 patients and 7 family caregivers (N=13) dropped-out of the study (17.8% attrition).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Although family caregivers were overall satisfied with the intervention, several felt there was too little content to support caregiving needs.

    “First, although family caregivers were overall satisfied with the intervention, several felt that overall there were too little content to support caregiving needs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Previous research by the authors suggests that lung cancer family caregivers experience significant psychological distress, higher caregiver burden, and decreased QOL related to caregiving.

    “Our previous research suggests that lung cancer family caregivers experience significant psychological distress, higher caregiver burden, and decreased QOL related to their caregiving role.8–11”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [8] Fujinami, 2012, Quality of life of family caregivers and challenges faced in caring for patients with lung cancer, Clin J Oncol Nurs source

      Not checked in the free run.

    • cites [9] Fujinami, 2015, Family caregivers' distress levels related to quality of life, burden, and preparedness, Psychooncology source

      Not checked in the free run.

    • cites [10] Grant, 2013, Family caregiver burden, skills preparedness, and quality of life in non-small cell lung cancer, Oncol Nurs Forum source

      Not checked in the free run.

    • cites [11] Kim, 2016, The impact of lung cancer surgery on quality of life trajectories in patients and family caregivers, Lung Cancer source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The observed improvements suggest that patients and family caregivers gained confidence, skills, and knowledge in managing their health.

    “The improvements in these outcomes suggest that patients and family caregivers gained confidence, skills, and knowledge in managing their health.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The PAM had excellent reliability in this study (Cronbach's alpha 0.92), and the Self-Efficacy Scale had alpha 0.89.

    “Overall reliability was excellent for the PAM, with Cronbach’s alpha measured at 0.92. Cronbach’s alpha for the Self-Efficacy Scale was 0.89.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The activation improvement was clinically meaningful because a 3-point difference is considered a minimally important difference for confidence in managing health behaviors.

    “this represents a clinically meaningful difference, as even a 3-point difference is considered a MID for confidence in managing health behaviors.34”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Benzo, 2016, Health coaching and COPD re-hospitalization: a randomized study, Am J Respir Crit Care Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent meta-analysis found that video interventions in cancer were as effective as, and in some RCTs superior to, print materials alone for knowledge transfer.

    “A recent meta-analysis found that video interventions in cancer were as effective, and in some RCTs, superior in knowledge transfer to print materials alone.18”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Gysels, 2007, Interactive technologies and videotapes for patient education in cancer care: systematic review and meta-analysis of randomised trials, Support Care Cancer

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Preoperative education can help patients and families cope with stress, alleviate anxiety, increase self-efficacy, and support postoperative recovery activities.

    “Studies have shown that preoperative education could help patients and families cope with the stressful events, alleviate anxiety, increase self-efficacy, and support postoperative recovery activities.6”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Ronco, 2012, Patient education outcomes in surgery: a systematic review from 2004 to 2010, Int J Evid Based Healthc source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    Because patient and family caregiver QOL likely improves with time after surgery, the current findings cannot definitively show that the observed improvements are due to the intervention alone.

    “as patient and family caregiver QOL likely improves with time after surgery2, it is not entirely possible with our current findings to claim definitively that the observed improvements are due to the intervention alone.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] Poghosyan, 2013, Health-related quality of life after surgical treatment in patients with non-small cell lung cancer: a systematic review, Lung Cancer source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The MSM intervention was feasible and acceptable for patients and family caregivers.

    “A standardized multimedia self-management intervention was feasible and acceptable in supporting readiness and preparedness for lung surgery and postoperative recovery.”
    • Also stated in: § Conclusion · plain
      “We now have evidence to report that the MSM intervention is feasible and acceptable for patients and family caregivers.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Pre- and post-intervention comparisons were exploratory.

    “our analysis was limited to feasibility and acceptability, and pre-and post-intervention comparisons were exploratory in nature.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Patient demographic variables differed between groups for education and marital status, with intervention patients more often having a college or graduate degree (100% vs 68.4%) and being married or partnered (84.2% vs 47.4%); other demographic variables were comparable.

    “Demographic variables among patients varied between the two groups with respect to education level and marital status, with all other demographic data being comparable. A larger percentage of the intervention patients indicated to have a college or graduate degree (100% vs. 68.4%) and identified themselves as married or partnered (84.2% vs. 47.4%) compared to the usual care patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Data were scanned into a relational database and audited for accuracy before analysis.

    “Data from Cardiff teleforms were scanned into a relational database and audited for accuracy prior to analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The majority of patients with early stage lung cancer (70%) undergo surgery.

    “The majority of patients with early stage lung cancer (70%) undergo surgery.1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Miller, 2016, Cancer treatment and survivorship statistics, 2016, CA Cancer J Clin

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Ill-preparedness for home recovery can potentially lead to significant morbidity, undesirable healthcare resource use, and immense social and economic costs.

    “This can potentially result in significant morbidity, undesirable healthcare resource use, and immense social and economic costs.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Most postoperative recovery takes place in the community, and family caregivers provide most care at home.

  • May combine two claims.

    Interpretationcitation

    The emotional QOL improvement was clinically meaningful because a 3-point difference is considered a minimally important difference.

    “This improvement is clinically meaningful, as a 3-point difference is considered a minimally important difference (MID).33”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Fowles, 2009, Measuring self-management of patients' and employees' health: further validation of the Patient Activation Measure (PAM) based on its relation to employee characteristics, Patient Educ Couns source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients often suffer an abrupt increase in unpleasant symptoms, impaired functional status, and poor QOL after surgery.

    “patients often suffer from an abrupt increase in unpleasant symptoms, impaired functional status, and poor quality of life (QOL) after surgery.2, 3”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [2] Poghosyan, 2013, Health-related quality of life after surgical treatment in patients with non-small cell lung cancer: a systematic review, Lung Cancer source

      Not checked in the free run.

    • cites [3] Rauma, 2015, Long-term lung cancer survivors have permanently decreased quality of life after surgery, Clin Lung Cancer source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Study procedures and protocol were approved by the Institutional Review Board.

    “Study procedures and protocol were approved by the Institutional Review Board.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All participants provided voluntary informed consent before enrollment.

    “All participants provided voluntary informed consent prior to enrollment.”
    Quote in the paperSubstantial claim
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  • The paper relies on this without support.

    Most postoperative recovery takes place in the community, and family caregivers provide most care at home.

    “Consequently, the majority of postoperative recovery occurs in the community, with family caregivers providing the majority of care at home.”

  • The paper relies on this without support.

    Few patient- and family-centered models of care for lung surgery exist in the literature.

    “The current literature offers few patient- and family-centered models of care in lung surgery.”

  • The paper relies on this without support.

    There are very few evidence-based, standardized preparatory interventions for cancer surgery in the literature.

    “While it may seem intuitive that there should be evidence-based, standardized preparatory interventions in cancer surgery, very few exist in the current literature.”

  • The paper relies on this without support.

    Patients are discharged from the hospital earlier after lung surgery because of advances in surgical care and changes in the healthcare environment.

    “Due to these advances in surgical care, as well as changes in the healthcare environment, patients are discharged from the hospital earlier after lung surgery.”

  • The paper relies on this without support.

    Family caregivers frequently report unmet needs in all QOL domains.

    “Family caregivers frequently report unmet needs in all QOL domains.”

  • The paper relies on this without support.

    Current perioperative and postoperative care leads to rapid transitions to recovery at home and lacks formal assessment mechanisms between hospital discharge and the first postoperative clinic visit.

    “Current perioperative and postoperative care results in rapid transitions to recovery at home and lack of formal assessment mechanisms between hospital discharge to first postoperative clinic visit.”

  • The paper relies on this without support.

    The MSM intervention is novel because it includes family caregivers.

    “Our intervention is novel because it includes family caregivers.”
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Authors
Sun, V., Raz, D. J., Ruel, N., Chang, W., Erhunmwunsee, L., Reckamp, K., Tiep, B., Ferrell, B., McCorkle, R., & Kim, J. Y.
Affiliations
  • City Of Hope National Medical Center (US)
  • Yale University (US)
Corresponding author
Sun, Virginia
ORCID
Venue
Clinical Lung Cancer
Publisher
Elsevier BV
Published
2017-05
Volume
18
Issue
3
Pages
e151-e159
ISSN
1525-7304 (ISSN-L)
DOI
10.1016/j.cllc.2017.01.010
PMC
PMC5413411
OpenAlex
W2585761380
Cited by
47
References
36
Citations by year
2026: 5 · 2025: 8 · 2024: 3 · 2023: 4 · 2022: 7 · 2021: 10 · 2020: 4 · 2019: 4 · 2017: 2
FWCI
1.20
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Lung Cancer (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Cancer Institute (P30CA33572)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Health Professions › Pharmacy › Nursing care and research
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
lung surgery, family caregivers, cancer patients, preoperative preparation, postoperative recovery, quality of life, self-efficacy, patient activation, caregiver burden, telephone support, feasibility and acceptability
MeSH terms
Self-Management, Aged, Family, Female, Humans, Lung Neoplasms, Male, Middle Aged, Patient Education as Topic, Pilot Projects, Postoperative Period, Quality of Life, Stress, Psychological, Pulmonary Surgical Procedures, Caregivers, Patient Satisfaction, Multimedia, Self Efficacy

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