Feasibility of an educational intervention program on managing the nutrition impact symptom cluster in patients with nasopharyngeal carcinoma during radiotherapy

"Background: Nasopharyngeal carcinoma (NPC) is endemic in southern China. Despite the improvement in radiotherapy (RT) technology, NPC patients still suffer from numerous and simultaneous distressing symptoms.Aims: The aim of the study was to explore the feasibility of an intervention program (an educational intervention program) in managing the most distressing symptom cluster (nutrition impact symptom cluster) in NPC patients during RT.Methods: The study was carried out in two parts. Part I consisted of groundwork research (n = 130) using a cross-sectional design to identify the most distressing symptom cluster. An instrument validation was also conducted at this point. Part II covered the development process and pilot testing of an educational intervention program, guided by the Medical Research Council (MRC) framework, to manage the nutrition impact symptom cluster identified in Part I. First, to inform development of the intervention, a systematic review was conducted to evaluate the effectiveness of psychoeducational intervention (PEI), which includes the educational intervention, in managing symptom clusters in patients with generic cancers. Second, a descriptive qualitative study was conducted through face-to-face semi-structured interviews with 25 NPC patients and 16 health professionals, separately, to provide further help in developing the intervention by investigating patients’ self-care experience and current clinical practice in managing the nutrition impact symptom cluster. Third, the feasibility and estimated effectiveness of the educational intervention program was explored in a pilot randomized controlled trial (RCT) (n = 40). Outcome measures, including severity of the nutrition impact symptom cluster, body weight, functional performance and quality of life (QOL), were assessed at baseline, week 3 of RT and at the end of RT. Inferential statistics, such as independent t-test, Chi-square test, Fisher’s exact test and the generalized estimating equation (GEE) model, were used to compare the baseline and various outcome variables between groups.Results: In Part I, the Chinese version of the MD Anderson Symptom Inventory - Head and Neck Module (MDASI-HN-C) was found to be a reliable and valid instrument. The same dataset then revealed four symptom clusters in NPC patients during RT; the nutrition impact cluster was identified as the most distressing, and was thus chosen as the target outcome of the intervention. In Part II, the systematic review found that PEI, in particular, patient education, was a promising intervention to manage cancer symptom clusters. Then, the findings of the qualitative study further informed and guided the development of an educational intervention program. The pilot RCT found that the conducting the program in a clinical setting was feasible and well received by patients. It also had some favorable effects on managing the nutrition impact symptom cluster, in terms of relieving the cluster itself (Cohen’s d = -0.37), and improving the physical well-being (Cohen’s d = -0.15) and head and neck cancer (HNC) specific QOL (Cohen’s d = -0.05).Conclusion: The implementation of the educational intervention program appears to be feasible with NPC patients during RT, showing some effect in improving the nutrition impact symptom cluster. A future full-scale study with an adequate sample is warranted."研究背景：鼻咽癌在中國南部高發。儘管放療技術在進步，鼻咽癌病人在接受放療期間仍然存在著各種同時出現的症狀困擾。研究目的：本研究旨在測試一個健康教育干預項目在管理鼻咽癌病人放療期間最嚴重的營養相關症狀群的可行性。研究方法：本研究分為兩個部分。第一部分採用橫斷面的研究方法（n = 130），目的是為了找出最嚴重的症狀群，包括檢驗一個量表的信效度。第二部分包括健康教育干預專案的設計和預實驗。首先，研究者做了一個系統評價來評估心理及健康教育干預對管理癌症病人症狀群的效果。然後，研究者又做了一個質性研究，通過與25名鼻咽癌放療病人和16名醫護人員面對面訪談來瞭解目前營養相關症狀群的管理現狀，以便為干預的設計提供進一步線索。最後，研究者做了一個隨機對照試驗的預實驗（n = 40），來評價本研究所設計的健康教育干預專案的可行性。研究指標包括營養相關症狀群的嚴重性、體重、功能水準以及生活品質，並於干預前、放療第3周以及放療結束進行測量。統計推斷方法包括獨立樣本t檢驗、卡方檢驗、Fisher確切概率法和廣義估計方程模型，用以比較組間差異。研究結果：第一部分的研究結果表明，中文版的M. D. Anderson症狀調查表（頭頸）的信效度良好。此外，四個症狀群被發現，其中以營養相關症狀群最為嚴重，因此被選為本研究的干預目標。第二部分，通過系統評價，研究者發現心理及健康教育干預，尤其是健康教育對管理癌症病人的症狀群有一定效果。接著，質性研究的結果進一步提示了健康教育干預項目的必要性，並為該專案的設計提供了具體方案。最後，預實驗表明本研究所設計的健康教育干預專案是可行的並受病人歡迎。該項目在減輕營養相關症狀群（Cohen’s d = -0.37）以及提高與身體（Cohen’s d = -0.15）和頭頸癌相關（Cohen’s d = -0.05）的生活品質上有一定效果。研究結論：本研究所設計的健康教育干預專案是可行的，並對管理鼻咽癌病人放療期間的營養相關症狀群有一定效果。將來需要做一個大規模的研究來驗證該項目的有效性。"Xiao, Wenli.Thesis Ph.D. Chinese University of Hong Kong 2016.Includes bibliographical references (leaves 226-250).Abstracts also in Chinese.Title from PDF title page (viewed on 01, February, 2018).Detailed summary in vernacular field only.Detailed summary in vernacular field only.Detailed summary in vernacular field only.Detailed summary in vernacular field only.Detailed summary in vernacular field only