An Advanced Practice Nurse Coordinated Multidisciplinary Intervention for Patients with Late-Stage Cancer: A Cluster Randomized Trial

J Palliat Med. 2015 Nov;18(11):962-9. doi: 10.1089/jpm.2015.0113. Epub 2015 Aug 25.


Background: Early palliative care provided through a palliative care consultative service is effective in enhancing patient outcomes. However, it is unknown whether the integration of palliative care as part of routine comprehensive cancer care improves patients' self-reported clinical outcomes.

Objective: The objective of this study was to evaluate the effects of a multidisciplinary coordinated intervention by advanced practice nurses at the clinic level on outcomes with patients newly diagnosed with late-stage cancer.

Methods: A clustered, randomized, controlled trial design was used. Four disease-specific multidisciplinary clinics were randomized to the 10-week intervention (gynecologic and lung clinics) or to enhanced usual care (head and neck and gastrointestinal clinics). Patient primary outcomes (symptoms, health distress, depression, functional status, self-reported health) were collected at baseline and one and three months, and secondary outcomes were collected one and three months postbaseline. General linear mixed model analyses with a covariance structure of within-subject correlation was used to examine the intervention's effect.

Results: The sample included 146 patients with newly diagnosed late-stage cancers. We found no differences between the two groups on the primary patient-reported outcomes at one and three months postbaseline; however, physical and emotional symptoms remained stable or significantly improved from baseline for both groups. Overall, secondary outcomes remained stable within the groups.

Conclusion: In this translational study, we demonstrated that if patients newly diagnosed with late-stage cancer were managed by disease-specific multidisciplinary teams who palliated their symptoms, providing whole-patient care, patient outcomes remained stable or improved.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Advanced Practice Nursing / methods*
  • Aged
  • Cancer Care Facilities
  • Cluster Analysis
  • Female
  • Humans
  • Least-Squares Analysis
  • Male
  • Middle Aged
  • Neoplasms / nursing*
  • Outcome and Process Assessment, Health Care / statistics & numerical data
  • Outpatient Clinics, Hospital
  • Palliative Care / methods
  • Palliative Care / organization & administration*
  • Palliative Care / standards
  • Patient Care Team / organization & administration*
  • Patient Care Team / standards
  • Quality of Life
  • Translational Research, Biomedical