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Targeted Home Nursing Visits Post Breast Surgery Cost-Effective

Targeted Home Nursing Visits Post Breast Surgery Cost-Effective

ORLANDO—Breast cancer patients who received targeted home nursing visits
after a short-stay surgery used fewer postoperative health services and had
improved social and family well-being, compared with patients receiving no
visits or nontargeted visits. Gwen K. Wyatt, RN, PhD, associate professor of
nursing, Michigan State University, presented the study results at the Era of
Hope Department of Defense Breast Cancer Research Program meeting. The study
included 240 female breast cancer patients. Short hospital stay was defined as
48 hours or less. Patients were 21 years of age or older and fluent in English.
The majority were white, married, and employed prior to surgery.

Patients were randomized into three groups. The 121 women in the
intervention cohort received home nursing visits by a special team of
practitioners following a prescribed protocol (see Table). The first control
group, with 64 participants, received discharge care by a nurse from a
home-care agency after a referral from the surgeon. The 55 patients in the
third cohort received no postoperative home nursing care. Data collection
included paper and pencil self-reports before surgery but after diagnosis, and
a telephone interview 4 weeks after surgery. The quick turnaround on the
preoperative questionnaire presented one of the study’s prime challenges, Dr.
Wyatt said.

The intervention group received their first in-home nursing visit within 1
to 3 days after discharge. Nurses made at least two home visits and called by
telephone at least twice. The women also had 24-hour access to the study nurse.
Both the protocol nurses and the agency nurses determined how many visits were
ultimately made.

Study Results

"The women in the intervention group were significantly more likely than the
controls to receive instruction in postsurgical self-care, including range of
motion, lymphedema prevention, and breast self-exams," Dr. Wyatt said.

A significantly higher percentage in the controls exceeded the 48-hour
hospital stay, she said. Physicians did not know into which group the women had
been randomized. However, the patients knew and may have welcomed the
opportunity to leave the hospital confident that they would receive help at
home, Dr. Wyatt suggested.

Protocol nurses made significantly fewer home-care visits than their agency
counterparts: an average of 2.65 visits per patient vs 6.44 for patients
receiving care from the agency nurses. The intervention group also made fewer
emergency room visits and had fewer social work needs.

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