Effect of Telecare Management on Pain and Depression in Patients With Cancer A Randomized Trial
Effect of Telecare Management on Pain and Depression in Patients With Cancer A Randomized Trial
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DOI：
10.1001/jama.2010.944
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发表时间：
2010-07-14
影响因子：
120.7
通讯作者：
Tu, Wanzhu
中科院分区：
文献类型：
--
作者：
Kroenke, Kurt;Theobald, Dale;Tu, Wanzhu
背景疼痛和抑郁是两种最普遍和可治疗的癌症相关症状，但他们经常被忽视，治疗不足，或两者兼而有之。目的确定是否集中的基于电话的护理管理与自动症状监测相结合，可以改善癌症患者的抑郁和疼痛。随机对照试验，在16个社区为基础的城市和农村肿瘤学实践中进行，涉及印第安纳州癌症疼痛和抑郁症（INCPAD）试验。招募于2006年3月至2008年8月进行，随访于2009年8月结束。参与的患者患有抑郁症（患者健康问卷-9分>= 10）、癌症相关疼痛（简明疼痛量表[BPI]最严重疼痛评分>= 6）或两者兼有。干预随机分配的202名患者接受干预，203名接受常规护理，按症状类型分层。干预组的患者接受由护士-医生专家团队进行的集中式远程护理管理，并通过交互式语音记录或互联网进行自动化家庭症状监测。抑郁症12例（20项霍普金斯症状自评量表[HSCL-20]）和疼痛（BPI）严重程度。96人只有疼痛，178人既有抑郁又有疼痛。在274名疼痛患者中，在12个月的试验中，干预组中的137名患者在BPI疼痛严重程度方面有更大的改善，无论是作为连续的严重程度评分还是作为分类疼痛反应者来测量。（BPI下降>= 30%）比常规治疗组的137例患者（HSCL下降50%）比常规治疗组的155例患者（P
Context Pain and depression are 2 of the most prevalent and treatable cancer-related symptoms, yet they frequently go unrecognized, undertreated, or both.Objective To determine whether centralized telephone-based care management coupled with automated symptom monitoring can improve depression and pain in patients with cancer.Design, Setting, and Patients Randomized controlled trial conducted in 16 community-based urban and rural oncology practices involved in the Indiana Cancer Pain and Depression (INCPAD) trial. Recruitment occurred from March 2006 through August 2008 and follow-up concluded in August 2009. The participating patients had depression (Patient Health Questionnaire-9 score >= 10), cancer-related pain (Brief Pain Inventory [BPI] worst pain score >= 6), or both.Intervention The 202 patients randomly assigned to receive the intervention and 203 to receive usual care were stratified by symptom type. Patients in the intervention group received centralized telecare management by a nurse-physician specialist team coupled with automated home-based symptom monitoring by interactive voice recording or Internet.Main Outcome Measures Blinded assessment at baseline and at months 1, 3, 6, and 12 for depression (20-item Hopkins Symptom Checklist [HSCL-20]) and pain (BPI) severity.Results Of the 405 participants enrolled in the study, 131 had depression only, 96 had pain only, and 178 had both depression and pain. Of the 274 patients with pain, 137 patients in the intervention group had greater improvements in BPI pain severity over the 12 months of the trial whether measured as a continuous severity score or as a categorical pain responder (>= 30% decrease in BPI) than the 137 patients in the usual-care group (P= 50% decrease in HSCL) than the 155 patients in the usual care group (P