Nurse AMIE: Addressing Metastatic Individuals Everyday in Rural PA and WV

项目摘要/摘要 与城市癌症患者相比，生活在农村的癌症患者的预后更差。 设置。农村地区的个人因旅行而难以获得支持性护理服务 挑战、服务成本和总体上缺乏可用的支持性护理资源。后一个问题很可能是 极大地促进了城乡生存差异，因为多项研究定期记录 在晚期癌症的背景下，解决患者症状对生存有好处。技术可以提供 克服农村问题的解决方案，然而，在具体利用技术方面所做的工作很少- 基于解决方案，在农村环境中提供高质量的支持性护理。我们的团队已经开发并试行了 测试了一种基于药片的症状评估和支持性护理干预措施，称为护士Amie(地址 转移性癌症患者很好地接受了，包括一个子集 居住在非大城市县的农村患者(4个或以上的农村城市连续代码(RUC)县 更高)。向患者提供了平板电脑和蜂窝数据计划，使他们能够回答症状问题 然后，嵌入式个性化决策树提供基于证据的自我护理干预 解决自我报告的症状，目标是改善整体健康和福祉。一个计步器和 还提供了阻力带，因为有证据表明，体力活动可以帮助所有四个 Amie护士处理的症状(疲劳、睡眠、痛苦和痛苦)。这四种症状构成了 已被注意到与生活质量和生存相关的精神神经症状群 在肿瘤科的病人身上。护士Amie可以进行症状评估、跟踪数据并提供干预 如果互联网访问不可用，则离线。我们的初步证据表明……的可接受性和可行性 我们的患者在57%的干预天数中登录了基于平板电脑的方法。此外，患者使用 护士Amie报告说，患者对自我护理系统的满意度很高。根据试点的结果，我们 建议增加一项每周调查，类似于Basch等人之前的研究。和Denis等人。要扩大规模 平台的症状评估方面。我们建议这种基于距离的支持性护理 干预(Amie护士)将对农村患者的总体生存(主要结果)产生重大影响， 癌症治疗相关的症状、功能和健康相关的生活质量。我们将把精力集中在 N=344名居住在非大城市县的服务不足或低收入的成年男女(RUCC代码4- 9)获得支持性医疗服务的机会很少。这项工作将在一个强大的社区的帮助下进行 咨询委员会，并由宾夕法尼亚州和西弗吉尼亚州农村卫生办公室指导。我们将注册并随机分配 患者接受艾米护士的支持性护理干预或常规护理。注册时间为 定期就诊和干预将延长随访时间(2年)。我们会 同时检查Amie护士的成本效益。

Project Summary/Abstract Individuals with cancer who live in rural settings experience worse outcomes as compared to those in urban settings. Individuals in rural regions have difficulty accessing supportive care services due to travel challenges, cost of services, and overall lack of available supportive care resources. The latter issue likely contributes greatly to the urban/rural survival differences, given that multiple studies document that regularly addressing patient symptoms has a survival benefit in the setting of advanced cancer. Technology may provide solutions to overcome issues of rurality, however, little work has been done to specifically leverage technology- based solutions to deliver high quality supportive care in rural settings. Our team has developed and pilot tested a tablet-based symptom assessment and supportive care intervention called Nurse AMIE (Addressing Metastatic Individuals Everyday) that was well received by patients with metastatic cancer, including a subset of rural patients living in non-metropolitan counties (Rural Urban Continuum Code (RUCC) counties of 4 or higher). Patients were provided a tablet and cellular data plan to allow them to answer symptom questions daily, and an embedded personalized decision tree then offered evidence based self-care interventions to address the self-reported symptom with a goal of improving overall health and well-being. A pedometer and resistance band were also provided, given evidence that physical activity can assist with all four of the symptoms addressed in Nurse AMIE (fatigue, sleep, distress, and pain). These four symptoms form the basis of the psychoneurological symptom cluster that has been noted to be associated with quality of life and survival in oncology patients. Nurse AMIE can conduct symptom assessment, track data, and provide interventions offline if internet access is unavailable. Our preliminary evidence demonstrates acceptability and feasibility of the tablet-based approach as our patients logged on 57% of intervention days. Furthermore, patients using Nurse AMIE reported high patient satisfaction with the self-care system. Based on findings from the pilot, we propose to add a weekly survey similar to that from prior research by Basch et al. and Denis et al. to expand the symptom assessment aspect of the platform. We propose that this distance based supportive care intervention (Nurse AMIE) will have significant effects on rural patients overall survival (primary outcome), cancer treatment-related symptoms, function, and health related quality of life. We will focus our efforts on N=344 underserved or low-income adult men and women living in non-metropolitan counties (RUCC codes 4- 9) that have low access to supportive care. This work will be carried out with the help of a strong community advisory board, and guided by the PA and WV State Offices of Rural Health. We will enroll and randomize patients to receive the Nurse AMIE supportive care intervention or usual care. Enrollment will occur at regularly scheduled medical visits and the intervention will extend for the length of follow-up (2 years). We will also examine the cost effectiveness of Nurse AMIE.