Feasibility of Long-Term Patient Self-Reporting of Toxicities From Home via the Internet During Routine Chemotherapy
Feasibility of Long-Term Patient Self-Reporting of Toxicities From Home via the Internet During Routine Chemotherapy
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DOI：
10.1200/jco.2012.47.6804
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发表时间：
2013-07-10
影响因子：
45.3
通讯作者：
Basch, Ethan
中科院分区：
文献类型：
--
作者：
Judson, Timothy J.;Bennett, Antonia V.;Basch, Ethan
目的患者报告的结果越来越多地用于常规的门诊癌症护理，以指导临床决策和加强沟通。先前的证据表明，患者在预定的诊所就诊时遵守报告的情况良好，但关于两次就诊之间遵守长期纵向报告的证据有限。患者和方法在三级癌症中心接受肺癌、妇科、泌尿生殖系统或乳腺癌化疗的患者，如果可以使用家用计算机并有以前的电子邮件经验，则被要求在两次就诊之间通过Web自我报告七种症状毒性。每周向参与者发送电子邮件提醒；患者报告的高度毒性触发了对护士的电子邮件警报；在访问时向肿瘤学家提供打印的报告。根据每月(平均75%的参与者至少每月报告一次)和每周的遵从率(60%至少每周一次)来确定这种数据收集方法是否值得进一步发展的先验阈值标准。结果从2006年9月到2010年11月，286名患者入选(%为女性；88%为白人；中位年龄为58岁)。平均随访34周(2~214周)。平均而言，每月依从性为83%，每周依从性为62%，直到死亡前一个月没有人员流失。更高的遵从性与较大的年龄和较高的教育程度有关，但与绩效状况无关。在最初的12周内，依从性最好。有症状的疾病和技术问题很少成为遵从性的障碍。结论每月对家庭网络报告的遵从性很高，但每周的遵从性较低，需要在常规护理环境中采取策略来提高遵从性。(C)美国临床肿瘤学会2013年
PurposePatient-reported outcomes are increasingly used in routine outpatient cancer care to guide clinical decisions and enhance communication. Prior evidence suggests good patient compliance with reporting at scheduled clinic visits, but there is limited evidence about compliance with long-term longitudinal reporting between visits.Patients and MethodsPatients receiving chemotherapy for lung, gynecologic, genitourinary, or breast cancer at a tertiary cancer center, with access to a home computer and prior e-mail experience, were asked to self-report seven symptomatic toxicities via the Web between visits. E-mail reminders were sent to participants weekly; patient-reported high-grade toxicities triggered e-mail alerts to nurses; printed reports were provided to oncologists at visits. A priori threshold criteria were set to determine if this data collection approach merited further development based on monthly (>= 75% participants reporting at least once per month on average) and weekly compliance rates (60% at least once per week).ResultsBetween September 2006 and November 2010, 286 patients were enrolled (64% were women; 88% were white; median age, 58 years). Mean follow-up was 34 weeks (range, 2 to 214). On average, monthly compliance was 83%, and weekly compliance was 62%, without attrition until the month before death. Greater compliance was associated with older age and higher education but not with performance status. Compliance was greatest during the initial 12 weeks. Symptomatic illness and technical problems were rarely barriers to compliance.ConclusionMonthly compliance with home Web reporting was high, but weekly compliance was lower, warranting strategies to enhance compliance in routine care settings. (C) 2013 by American Society of Clinical Oncology