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.

项目摘要 症状管理和支持性护理对于高质量的癌症护理和最佳患者至关重要 结果，但是在常规肿瘤学环境中的整合中存在许多障碍。尽管有可用性和 经过验证的症状评估工具的成本效益，基于证据的支持护理干预措施和 临床指南，使用患者报告的临床实践中的结果采用支持性护理仍然很低， 留下许多控制症状，未满足的需求和可预防的痛苦的患者。患者报告 结局通过捕获每个患者的独特需求和价值来提供一种症状评估方法。 该策略可有效地确定患者的需求，但不一定有助于肿瘤学提供者解决 并在其临床相互作用中管理这些需求。需要新颖的方法来促进系统 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。 为了解决癌症护理中的这一关键差距，该项目将涉及 嵌入现有电子健康记录中的支持护理工具收集患者报告 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 支持护理的循证算法系统。该项目的具体目的是：1）开发 EHR集成的支持护理工具的内容，设计和技术基础架构，基于预先 干预评估利益相关者的投入和本地环境； 2）实施EHR集成 在5个HNCP门诊诊所的[18个月]干预期间的支持性护理工具，潜在的暴露 该工具超过[300]合格的HNC患者和临床医生； 3）评估[可行性，可接受性， ]使用混合方法方法的EHR集成支持护理工具的初步实现。发现 该项目将提供初步数据，以告知更大的务实随机试验的设计 在多个癌症诊所中。 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，并在临床信息学和实施科学领域进行正规培训， 在开发和试点测试电子支持护理工具的同时，用于常规肿瘤学护理。这些广泛 目标与国家癌症研究所的使命和科学重点一致。