Harnessing the EHR for the Delivery of Supportive Care in an Oncology Setting

利用 EHR 在肿瘤学环境中提供支持性护理

• 批准号: 10366020
• 负责人: Eden R. Brauer
• 金额: $ 18.68万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-05 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10366020
• 关键词: Acute; Address; Adoption; Algorithms; Ambulatory Care Facilities; Assessment tool; Attention; Behavior; Cancer Patient; Cancer Survivor; Caring; Chronic; Clinic; Clinical; Clinical Informatics; Collection; Communication; Complex; Continuity of Patient Care; Data; Detection; Development; Diagnosis; Disease; Documentation; Early identification; Electronic Health Record; Elements; Face; Fatigue; Future; Goals; Gold; Guidelines; Head and Neck Cancer; Health; Healthcare Systems; Infrastructure; Institution; Intervention; K-Series Research Career Programs; Lead; Link; Malignant Neoplasms; Measurable; Mental Depression; Mentorship; Methods; Mission; Morbidity - disease rate; National Cancer Institute; Oncology; Outcome Measure; Pain; Pathway interactions; Patient Care; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Phase; Population; Process; Protocols documentation; Provider; Quality of life; Recommendation; Reporting; Research; Resources; Structure; Supportive care; Symptoms; System; Time; Training; United States; base; cancer care; cancer diagnosis; cancer therapy; care delivery; clinical implementation; clinical practice; clinically actionable; cost effectiveness; design; dissemination trial; effectiveness validation; evidence base; experience; head and neck cancer patient; implementation barriers; implementation science; implementation trial; mortality; multidisciplinary; novel; novel strategies; outpatient programs; patient-clinician communication; physical symptom; pilot test; point of care; prevent; programs; psychological symptom; randomized trial; reduce symptoms; response; symptom management; symptomatic improvement; time use; tool; user centered design

Project Summary Symptom management and supportive care are essential to high-quality cancer care and optimal patient outcomes, but many barriers exist to their integration in routine oncology settings. Despite the availability and cost-effectiveness of validated symptom assessment tools, evidence-based supportive care interventions and clinical guidelines, adoption of supportive care using patient-reported outcomes in clinical practice remains low, leaving many patients with poor symptom control, unmet needs, and preventable suffering. Patient-reported outcomes offer one approach to symptom assessment by capturing the unique needs and values of each patient. This strategy is effective in identifying patients' needs, but does not necessarily help oncology providers address and manage these needs in their clinical interactions. Novel approaches are needed to facilitate systematic symptom assessment and management, and guide the appropriate provision of supportive care in real-world oncology settings. To address this critical gap in cancer care, this project will involve the development and pilot testing of a supportive care tool, embedded in the existing electronic health record, that collects patient-reported assessments of symptoms and supportive care needs, using well-established tools, and links these data to a system of evidence-based algorithms for supportive care. Specific aims of this project are: 1) to develop the content, design and technical infrastructure of an EHR-integrated supportive care tool, based on a pre- intervention assessment of stakeholder input and the local context; 2) to implement the EHR-integrated supportive care tool over an [18-month] intervention period in 5 HNCP outpatient clinics, with potential exposure of the tool to more than [300] eligible HNC patients and clinicians; and 3) to evaluate the [feasibility, acceptability, and] initial implementation of the EHR-integrated supportive care tool using a mixed methods approach. Findings from this project will provide the preliminary data to inform the design of a larger pragmatic randomized trial across multiple cancer clinics. The proposed K08 Career Development Award is designed to support the candidate's advanced training in cancer care delivery research, with formal training in the fields of clinical informatics and implementation science, while developing and pilot testing an electronic supportive care tool for use in routine oncology care. These broad goals are consistent with the National Cancer Institute's mission and scientific priorities.

项目概要 症状管理和支持护理对于高质量的癌症护理和最佳患者至关重要 成果，但将其融入常规肿瘤学环境中存在许多障碍。尽管有可用性和 经验证的症状评估工具、循证支持性护理干预措施的成本效益和 临床指南中，在临床实践中利用患者报告的结果进行支持性护理的采用率仍然很低， 导致许多患者症状控制不佳、需求得不到满足以及本可预防的痛苦。患者报告 结果通过捕捉每位患者的独特需求和价值观提供了一种症状评估方法。 这种策略可以有效地确定患者的需求，但不一定能帮助肿瘤学提供者解决问题 并在临床互动中管理这些需求。需要新的方法来促进系统化 症状评估和管理，并指导在现实世界中适当提供支持性护理 肿瘤学设置。 为了解决癌症护理方面的这一关键差距，该项目将涉及开发和试点测试 支持性护理工具，嵌入现有的电子健康记录中，收集患者报告 使用完善的工具评估症状和支持性护理需求，并将这些数据链接到 支持性护理的基于证据的算法系统。该项目的具体目标是： 1) 开发 电子病历集成支持性护理工具的内容、设计和技术基础设施，基于预 对利益相关者的意见和当地情况进行干预评估； 2）实施EHR一体化 在 5 个 HNCP 门诊诊所进行 [18 个月] 干预期间的支持性护理工具，具有潜在的暴露 将该工具提供给超过 [300] 名符合条件的 HNC 患者和临床医生； 3) 评估[可行性、可接受性、 ] 使用混合方法初步实施电子病历综合支持性护理工具。发现 该项目将提供初步数据，为更大规模的实用随机试验的设计提供信息 跨越多个癌症诊所。 拟议的 K08 职业发展奖旨在支持候选人的高级培训 癌症护理提供研究，接受过临床信息学和实施科学领域的正式培训， 同时开发并试点测试用于常规肿瘤护理的电子支持护理工具。这些广泛的 目标与国家癌症研究所的使命和科学优先事项一致。