Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer.

PURPOSE/

OBJECTIVES

To evaluate quality of life (QOL) and cost outcomes of advanced practice nurses' (APNs') interventions with women diagnosed with breast cancer.

DESIGN

Randomized clinical trial.

SETTING

Integrated healthcare system in a midwestern suburban community.

SAMPLE: 210 women with newly diagnosed breast cancer with an age range of 30-85 years.

METHODS

The control group (n = 104) received standard medical care. The intervention group (n = 106) received standard care plus APN interventions based on Brooten's cost-quality model and the Oncology Nursing Society's standards of advanced practice in oncology nursing QOL was measured using the Functional Assessment of Cancer Therapy, Mishel Uncertainty in Illness Scale and Profile of Mood States at seven intervals over two years. Information about costs (charges and reimbursement) was collected through billing systems.

MAIN RESEARCH VARIABLES: Uncertainty, mood states, well-being, charges, and reimbursement.

FINDINGS: Uncertainty decreased significantly more from baseline in the intervention versus control group at one, three, and six months after diagnosis (p = 0.001, 0.026, and 0.011, respectively), with the strongest effect on subscales of complexity, inconsistency, and unpredictability. Unmarried women and women with no family history of breast cancer benefited from nurse interventions in mood states and well-being. No significant cost differences were found.

CONCLUSIONS

APN interventions improved some QOL indicators but did not raise or lower costs.

IMPLICATIONS FOR NURSING PRACTICE: The first six months after breast cancer diagnosis is a critical time during which APN interventions can improve QOL outcomes. More research is necessary to define cost-effective interventions.