Educational program on cancer cachexia for nurses: a pilot randomized controlled trial

Nurses often face challenges in assessing and managing cancer cachexia owing to the lack of standardized assessment tools and education. We developed the Comprehensive Cancer Cachexia Assessment Tool and an e-learning program to enhance nurses’ knowledge and assessment skills and evaluated their feasibility and acceptability. We recruited nurses to care for patients with cancer and randomly assigned them to an intervention or control group. The intervention group completed an e-learning program and tests and questionnaires, including a basic knowledge test, case-based questions, the Capability, Opportunity, Motivation (COM) questionnaires, and daily practice. The control group completed the same test and questionnaires. Data were collected at baseline, immediately after the intervention, and one month later. Of the 65 facilities invited, 9 agreed to participate (9/65, 13.8%). Thirty-one participants consented to participate in the trial (31/122, 25.4%). Of these, 15 were randomly assigned to the intervention group and 16 to the control group. After randomization, two participants were found not to meet the eligibility criteria. The completion rate was 54.8% (17/31), with 66.7% (10/15) in the intervention group and 43.8% (7/16) in the control group. Participants who completed the program were younger than those who dropped out (completion: 34.0; dropout: 40.3 years) and had fewer years of clinical experience (11.4 vs. 16.6 years). Acceptability of the Comprehensive Cancer Cachexia Assessment Tool was higher in the intervention group for ease of use (intervention: 90.0%; control: 33.3%) and clinical applicability (100% vs. 50.0%). In the intervention group, 80.0% rated the e-learning program as appropriate in difficulty and usability, 80.0% reported that it met their learning needs, and 90.0% would recommend it. Test and questionnaire burden was often rated as excessive in both groups (60.0% vs. 100%). Several participants reported technical issues related to the program. No major issues related to staffing or study coordination were identified. The educational program was deliverable and acceptable for nurses. However, the trial process was problematic for a future randomized controlled trial. Challenges included revising eligibility screening procedures and criteria, improving recruitment strategies at the facility level, and reducing participant burden associated with data collection. UMIN Clinical Trials Registry (UMIN-CTR), UMIN000052812. Registered on 27 November 2023.