Automated home monitoring and management of patient-reported symptoms during chemotherapy: results of the symptom care at home RCT.
Automated home monitoring and management of patient-reported symptoms during chemotherapy: results of the symptom care at home RCT.
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DOI：
10.1002/cam4.1002
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发表时间：
2017-03
期刊：
影响因子：
4
通讯作者：
Donaldson G
中科院分区：
文献类型：
--
作者：
Mooney KH;Beck SL;Wong B;Dunson W;Wujcik D;Whisenant M;Donaldson G
针对控制不良症状的技术辅助远程干预可能会改善癌症症状结局。在一项随机对照试验中，测试了自动症状管理系统的有效性，以确定它是否减少了化疗相关症状。首先，358例开始化疗的患者被随机分配到家庭症状护理（SCH）干预组（n = 180）或加强常规护理（UC）组（n = 178）。参与者称自动监测系统每天报告11种症状的严重程度。SCH受试者接受了自动自我管理辅导和执业护士（NP）电话随访，以治疗控制不佳的症状。NP使用基于指南的决策支持系统。主要终点是所有症状的症状严重程度，以及重度、中度、轻度和无症状天数。次要终点是个体症状严重程度。采用混合效应线性模型和负二项回归比较SCH与UC。SCH参与者在所有症状中的症状严重程度显著降低（P < 0.001）。平均而言，SCH参与者的相对症状负担减轻为3.59个严重程度点（P < 0.001），约为UC的43%。与UC相比，SCH参与者的重度（减少67%）和中度（减少39%）症状天数显著减少（均P < 0.001），具有非常快速的治疗获益。除腹泻外，SCH参与者的所有个体症状均显著降低（P < 0.05）。家庭症状护理显著改善了症状结局。这些结果表明，症状可以通过自动化家庭监测和随访来改善，以加强对控制不良症状的护理。
Technology‐aided remote interventions for poorly controlled symptoms may improve cancer symptom outcomes. In a randomized controlled trial, the efficacy of an automated symptom management system was tested to determine if it reduced chemotherapy‐related symptoms. Prospectively, 358 patients beginning chemotherapy were randomized to the Symptom Care at Home (SCH) intervention (n = 180) or enhanced usual care (UC) (n = 178). Participants called the automated monitoring system daily reporting severity of 11 symptoms. SCH participants received automated self‐management coaching and nurse practitioner (NP) telephone follow‐up for poorly controlled symptoms. NPs used a guideline‐based decision support system. Primary endpoints were symptom severity across all symptoms, and the number of severe, moderate, mild, and no symptom days. A secondary endpoint was individual symptom severity. Mixed effects linear modeling and negative binominal regressions were used to compare SCH with UC. SCH participants had significantly less symptom severity across all symptoms (P < 0.001). On average, the relative symptom burden reduction for SCH participants was 3.59 severity points (P < 0.001), roughly 43% of UC. With a very rapid treatment benefit, SCH participants had significant reductions in severe (67% less) and moderate (39% less) symptom days compared with UC (both P < 0.001). All individual symptoms, except diarrhea, were significantly lower for SCH participants (P < 0.05). Symptom Care at Home dramatically improved symptom outcomes. These results demonstrate that symptoms can be improved through automated home monitoring and follow‐up to intensify care for poorly controlled symptoms.