The diagnosis of cancer of the head and neck, and the multimodality medical treatment including surgery, radiation, and/or chemotherapy are a major health crisis for patients. While this is a curable disease for many patients, these complex treatment plans add greatly to the physical and psychological demands on the patients. The treatments can result in a number of undesirable outcomes which could be attenuated by an increase in patients' self-care. Little research has addressed patients' psychosocial and educational needs and the effects of cancer nursing intervention on promoting patients' self-care which should result in beneficial outcomes in this patient population. This proposal is the nursing component of a comprehensive Head and Neck Oncology Rehabilitation Program evolving from the work of a University study group. It describes a randomized controlled intervention trial of the effectiveness of educational and behavioral strategies on targeted patient outcomes. All newly diagnosed head and neck cancer patients will be asked to complete a screening battery. Eligible patients, upon initial assignment to radiation or chemotherapy, will be invited to participate in this 6-month clinical trial. They will be stratified by treatment modality and prior surgery status and then randomized to either (1) educational interventions alone; (2) educational interventions combined with a reinforcement contracting; or (3) a placebo control group. Patients will participate in a series of three individual intervention meetings with a research nurse during the course of treatment. Data collection will include 3-and 6-month followups. Dependent variables include behavioral, physiological, and self-report measures of self-care behaviors including appointment keeping and nutritional maintenance, and selected health, treatment, and well-being outcomes. The study will also test the ability of the screening battery to predict patients' need for, and responsiveness to, the nursing interventions. The choice of variables and their predicted relationships are guided by a nursing theory-derived model of self-care. The long range goal of this effort is the identification of a cancer nursing intervention protocol addressing the psychosocial needs of head and neck cancer patients which can be incorporated readily into the health care programs in many different treatment centers at reasonable cost in materials and personnel. The testing of a theory-based model increases the likelihood that results can be generalized to other patient populations.
