To the Editor:
Thank you for the comments on our recently published article on the effects of an intervention aimed at improving nurse-patient communication in oncology.1 The commentary questions the reporting of the study as a randomized controlled trial, as 5 nurses originally assigned to the intervention program were unable to participate at the scheduled dates. These nurses were instead enrolled in the control group, and 4 nurses from the original control group were included in the intervention group. Because of the relatively small number of participating nurses (n = 24) and subsequent loss of statistical power, we chose not to exclude the nurses who were unable to participate in the intervention program.
As the study was planned as a randomized control trial and the randomization process was conducted, we chose to report the study as such, despite the nurse cross-over. As we have described the process of group assignment in detail, we do not believe that this limits the ability of the reader to scrutinize the results. This being said, we do agree that it is necessary to consider whether the results could have been influenced by the changes in group allocation after the randomization process. Reanalyzing the data, we find that the nurses who withdrew from the intervention group reported a higher frequency of stress at baseline but were otherwise comparable to the remaining participants on measures of communication, self-efficacy, and burnout. As we have already discussed in the article, we cannot ignore the possibility that the 5 nurses who withdrew were less motivated in participating in the intervention program than the remaining participants in this group. Given the small effect sizes, we do not find it very likely that the conclusion of the study would have turned out any differently, given that the 5 nurses had participated in the intervention program or had been excluded from the study and still believe that the results represent a valid contribution to the field. With regard to methodological rigor, we can only agree with the commentator concerning the value and usefulness of explicit criteria and transparency when reporting different study designs and results.
Mette T. Rask, PhD fellow, MSc, RN
Psychooncology Research Unit
Aarhus University Hospital
& Research Unit for General Practice
Department of General Practice
Institute of Public Health
Aarhus University
Mette L. Jensen, MSc
Department of Oncology
Aarhus University Hospital
Jorn Andersen, MDSci
Department of Oncology
Aarhus University Hospital
Robert Zachariae, MDSci, MSc
Psychooncology Research Unit
Aarhus University Hospital
Aarhus, Denmark
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