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

AMIE 护士：每天应对宾夕法尼亚州和西弗吉尼亚州农村地区的转移性个体

• 批准号: 10437588
• 负责人: Kathryn H. Schmitz
• 金额: $ 8.34万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-24 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10437588
• 关键词: Address; Adult; Advanced Malignant Neoplasm; Cancer Patient; Client satisfaction; Clinical; Code; Communities; Cost Effectiveness Analysis; County; Data; Decision Trees; Disseminated Malignant Neoplasm; Distress; Enrollment; Fatigue; Goals; Health; Hospitals; Individual; Institutes; Internet; Intervention; Length; Low income; Malignant Neoplasms; Medical; Medical center; Metastatic breast cancer; Metastatic to; Nurses; Oncology; Outcome; Pain; Patient Self-Report; Patients; Pennsylvania; Personal Satisfaction; Physical activity; Probability; Quality of life; Quality-Adjusted Life Years; Randomized; Randomized Controlled Trials; Reporting; Research; Resistance; Resources; Rural; Rural Health; Schedule; Self Care; Services; Severities; Site; Sleep; Supportive care; Surveys; Symptoms; Tablets; Technology; Telephone; Travel; Treatment-Related Cancer; Uncertainty; Universities; Visit; West Virginia; Woman; Work; acceptability and feasibility; base; care systems; common symptom; cost; cost effective; cost effectiveness; cost estimate; evidence base; experience; follow-up; health related quality of life; improved; men; opportunity cost; pedometer; personalized decision; pilot test; primary outcome; psychosocial; rural area; rural patients; rural setting; rural underserved; rurality; symptom cluster; symptomatic improvement; treatment as usual; tumor; urban setting; usual care arm

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.

项目总结/文摘