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

项目概要/摘要 生活在农村环境中的癌症患者的预后比城市患者差 设置.由于旅行，农村地区的个人难以获得支持性护理服务 挑战、服务成本和总体缺乏可用的支持性护理资源。后一个问题可能 这在很大程度上导致了城市/农村的生存差异，因为多项研究经常记录 解决患者症状在晚期癌症的情况下具有存活益处。技术可以提供 然而，解决农村问题的办法很少有具体利用技术的工作， 为农村地区提供高质量的支持性护理。我们的团队已经开发并试点了 测试了一种基于平板电脑的症状评估和支持性护理干预，称为护士AMIE（寻址 转移性癌症患者（包括一个亚组） 居住在非大都市县的农村患者（农村城市连续体代码（RUCC）县为4或 更高）。为患者提供平板电脑和蜂窝数据计划，以允许他们回答症状问题 然后，嵌入式个性化决策树提供基于证据的自我护理干预措施， 解决自我报告的症状，以改善整体健康和福祉为目标。计步器和 阻力带也提供了，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、痛苦和疼痛）。这四种症状构成了 已注意到与生活质量和存活率相关的精神神经症状群 在肿瘤患者中。护士AMIE可以进行症状评估，跟踪数据，并提供干预措施 如果无法访问Internet，则脱机。我们的初步证据表明， 基于平板电脑的方法，因为我们的患者记录了57%的干预日。此外，患者使用 护士AMIE报告患者对自我护理系统的满意度很高。根据飞行员的调查结果，我们 我建议增加一个类似于Basch等人和Denis等人先前研究的每周调查，以扩大 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（护士AMIE）将对农村患者的总生存率（主要结局）产生显著影响， 癌症治疗相关症状、功能和健康相关生活质量。我们将集中精力 N=344名居住在非大都市县的服务不足或低收入成年男性和女性（RUCC代码4- 9)他们很难获得支持性护理。这项工作将在强大的社区帮助下进行 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。我们会招募并随机 患者接受AMIE护士的支持性护理干预或常规护理。入组时间为 定期安排医疗访视，干预措施将延长至随访期（2年）。我们将 同时，我们也要研究一下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.