# APBA Kısa Özet

A nurse-navigated game-based intervention (N2-GBI) significantly improved transition readiness, reduced cancer worry, and increased patient activation in adolescents with osteosarcoma compared to usual care, but did not significantly improve transition expectation. The study was a cluster-nonrandomized controlled trial with 59 participants.

# Çalışma neyi araştırdı?

This study examined the effects of a nurse-navigated game-based intervention (N2-GBI) on transition readiness and psychosocial outcomes in adolescents diagnosed with osteosarcoma. Adolescents with osteosarcoma face significant clinical and psychosocial challenges during the transition from adolescence to adulthood. The research aimed to determine whether a game-based intervention navigated by nurses could improve key outcomes such as transition readiness, cancer worry, patient activation, and transition expectation compared to standard usual care.

# Yöntem

The study employed a cluster-nonrandomized controlled trial design. A total of 59 adolescents with osteosarcoma were enrolled, with the intervention group comprising 32 participants and the control group 27 participants. The mean age of the intervention group was 15 years, while the control group had a mean age of 13 years. The N2-GBI programme was delivered alongside usual care to the intervention group, while the control group received usual care only. Outcomes were assessed at baseline (T0), immediately after the intervention (T1), and at 12-week follow-up (T2). Generalized estimating equations were used to estimate the intervention effects, accounting for the clustered nature of the data.

# Temel bulgular

The N2-GBI group showed significantly greater improvement in transition readiness at T1 compared to the control group (β = 8.83, p < 0.001). The N2-GBI programme also significantly reduced cancer worry (p = 0.009). Additionally, the N2-GBI programme significantly increased patient activation (p = 0.001). Regarding transition expectation, the N2-GBI programme had no significant effect (p = 0.056). These findings suggest that the game-based component, supported by nurse navigation, positively impacted key readiness and activation outcomes.

# Bulgular ne anlama geliyor?

The results indicate that a nurse-navigated game-based program can be an effective adjunct to usual care for improving transition readiness, reducing cancer-related worry, and enhancing patient activation in adolescents with osteosarcoma. The significant improvement in transition readiness (β = 8.83, p < 0.001) and patient activation (p = 0.001) suggests that the intervention may help adolescents better prepare for the transition to adult care. The reduction in cancer worry (p = 0.009) further supports the psychosocial benefits of the programme. However, the lack of significant effect on transition expectation (p = 0.056) suggests that the intervention may not directly alter expectations about the transition process itself.

# Klinik önem

The findings have important clinical implications for oncology nursing and adolescent cancer care. The nurse-navigated game-based approach offers a potentially engaging and effective strategy to support adolescents during a critical developmental transition. By improving transition readiness and patient activation, the programme may facilitate a smoother transition from pediatric to adult oncology services. The reduction in cancer worry may improve overall quality of life during treatment and survivorship. Clinicians may consider integrating similar game-based, nurse-navigated interventions into transitional care protocols for adolescents with osteosarcoma and other cancers. However, the imprecise nature of the findings and the study limitations should be considered when implementing these results in practice.

# Sınırlılıklar

Several limitations affect the generalizability and precision of these findings. The small sample size (N=59) limits the generalizability of the results to the broader adolescent osteosarcoma population. The cluster-nonrandomized design introduces selection bias, as participants were not randomly assigned to groups. The short follow-up duration of 12 weeks limits the assessment of sustained effects beyond the immediate post-intervention period. Additionally, the lack of blinding of participants and personnel may introduce performance and detection bias. Potential confounders not fully adjusted for in the analysis may also influence the observed outcomes. These limitations should be considered when interpreting the results and designing future research.