An APN Homecare Intervention:Implementing Evidence Based Coping Mechanisms for Breast Cancer

Purpose:
This intervention will demonstrate that an APN home assessment of coping strategies can improve breast cancer patient health by decreasing symptom clusters,reducing anxiety and distress,as well as assist in maintaining their ADLs. These outcomes will enhance the overall quality of survivorship.

Significance:
Providing home visits focused on improving coping ability, patients can have reduced distress and anxiety from the threat of chemotherapy. Facilitating navigation and providing access to health care resources 24/7 can allow optimal physical and psychosocial health, decreasing health system cost.

Strategy and Implementation:
The setting for the intervention will be delivered starting in the outpatient oncology clinic. During the initial consultation establishing report with the patient will be essential. The population identified for the intervention is women ages that have a newly diagnosed Stage 2/3 breast cancer. These patients will be receiving standard and proven adjuvant chemotherapy. The intervention will then be centered in the home of the patient. The intervention will involve the initial meeting at the conclusion of the patient-physician oncology consultation visit, a follow up phone call within 24-48 hours to set up the home visit as well as assess their current level of distress, a home visit one week prior to initial chemotherapy, and a follow up visit after the fourth completed cycle of chemotherapy.

Evaluation:
The empirical indicators used are the patient distress thermometer (PDT) at time of consultation and the Cancer Coping Questionnaire(CCQ) at the first and second visit. Ideally the outcome will show that those with a higher score on the PDT will show an improvement in comparative scores on the CCQ.

Implications for Practice:
The APN using a home based intervention specific to coping and adaptation can be a successful for patients with cancer. Delivering novel care through a tailored personal design and prioritization of symptom-management strategies, will improve patient health outcomes and reduce cost.