Automated Symptom Alerts Reduce Postoperative Symptom Severity After Cancer Surgery: A Randomized Controlled Clinical Trial
Automated Symptom Alerts Reduce Postoperative Symptom Severity After Cancer Surgery: A Randomized Controlled Clinical Trial
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DOI：
10.1200/jco.2010.29.8315
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发表时间：
2011-03-01
影响因子：
45.3
通讯作者：
Vaporciyan, Ara A.
中科院分区：
文献类型：
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作者：
Cleeland, Charles S.;Wang, Xin Shelley;Vaporciyan, Ara A.
目的：接受肿瘤相关开胸手术的患者在手术后的第一周内症状明显。本研究考察了家庭症状监测和向临床医生反馈严重症状是否有助于更有效的术后症状控制。患者和方法我们招募了100例因肺癌或肺转移而接受开胸手术的患者，进行了一项两组随机对照试验；79名患者完成了这项研究。出院后，患者每周两次通过自动电话评估症状，持续4周。对于干预组的患者，如果某一组症状（疼痛、睡眠紊乱、窘迫、呼吸短促或便秘）达到预定的严重阈值，就会向患者的临床团队发送电子邮件警报，要求他们做出反应。没有为控件生成警报。用广义估计方程模型检验症状阈值事件的组间差异。结果干预组症状阈值事件比对照组减少更多（分别为19%和8%），症状阈值事件下降更快。两组间症状干扰平均减少量的差异为-0.36 （SE, 0.078; P = 0.02）。临床医生对84%的电子邮件警报做出了回应。两组对自动化系统和术后症状控制的满意度同样高。结论在胸外科术后4周内，频繁进行症状监测并在症状变为中度或重度时提醒临床医生，可减轻症状的严重程度。自动症状监测和分诊方法可以改善癌症大手术后的症状控制。这些结果应该在更大规模的研究中得到证实。
PurposePatients receiving cancer-related thoracotomy are highly symptomatic in the first weeks after surgery. This study examined whether at-home symptom monitoring plus feedback to clinicians about severe symptoms contributes to more effective postoperative symptom control.Patients and MethodsWe enrolled 100 patients receiving thoracotomy for lung cancer or lung metastasis in a two-arm randomized controlled trial; 79 patients completed the study. After hospital discharge, patients rated symptoms twice weekly for 4 weeks via automated telephone calls. For intervention group patients, an e-mail alert was forwarded to the patient's clinical team for response if any of a subset of symptoms (pain, disturbed sleep, distress, shortness of breath, or constipation) reached a predetermined severity threshold. No alerts were generated for controls. Group differences in symptom threshold events were examined by generalized estimating equation modeling.ResultsThe intervention group experienced greater reduction in symptom threshold events than did controls (19% v 8%, respectively) and a more rapid decline in symptom threshold events. The difference in average reduction in symptom interference between groups was -0.36 (SE, 0.078; P = .02). Clinicians responded to 84% of e-mail alerts. Both groups reported equally high satisfaction with the automated system and with postoperative symptom control.ConclusionFrequent symptom monitoring with alerts to clinicians when symptoms became moderate or severe reduced symptom severity during the 4 weeks after thoracic surgery. Methods of automated symptom monitoring and triage may improve symptom control after major cancer surgery. These results should be confirmed in a larger study.