COMPUTERIZED SYMPTOM REPORT CONSULT FOR CANCER PATIENTS

未缓解的癌症疼痛和疲劳是主要的健康问题。我们建议在326名癌症患者中进行随机临床试验，以比较常规护理和计算机化工具在临床就诊期间症状缓解和以患者为中心的沟通方面的效果。计算机化的工具包括三个有效和可靠的疼痛和疲劳量表的电子版(症状报告)和为患者定制的认知行为教育干预(症状咨询)。具体目的是1)评估在门诊肿瘤学环境中使用症状报告-症状咨询工具的可行性，其中包括50名接受放射治疗的癌症患者的不同样本。我们假设患者平均将在20-30分钟内完成工具，回答超过80%的问题，并将该程序报告为报告症状信息和接收自我护理信息的可接受的方式；以及2)比较常规护理和计算机化工具在以下方面的影响：a)在276名接受放射治疗的不同样本中的患者结果(疼痛和疲劳强度、疼痛质量、对疼痛和疲劳的满意程度、对疼痛的误解、运动水平)；b)放射肿瘤学家样本中的提供者结果(建议治疗疼痛和疲劳的次数；临床就诊时间)；以及c)患者-提供者伙伴关系结果(在有录音的诊所就诊期间以提供者为中心的谈话与以患者为中心的谈话的比率)。我们假设两组的就诊时间相同，但实验组报告的当前和最严重疼痛和疲劳的强度、MPQ疼痛质量分量表、临床就诊期间以提供者为中心的谈话与以患者为中心的谈话的比率降低；对疼痛和疲劳程度、运动水平、疲劳或止痛处方的数量的满意度增加。患者要么完成通常的评估，要么使用新的计算机化工具。在试验组，将使用症状报告数据来提供症状摘要，并为患者提供症状咨询。在常规诊所就诊期间，患者和提供者之间的互动将被录音，并分析就诊期间的沟通类型。在预测试(癌症症状的高峰期)四周后，患者将完成计算机化评估工具以记录结果。研究结果将用于指导该工具的修订，并计划未来的研究，以实施这一新的癌症控制技术，以改善健康沟通和症状管理。

Unrelieved cancer pain and fatigue are major health problems. We propose a randomized clinical trial with pre-test/post-test measures in 326 patients with cancer to compare effects of usual- care and the computerized tool on symptom resolution and patient- centered communication during clinic visits. The computerized tool includes electronic versions of three valid and reliable scales for pain and fatigue (Symptom Report) and cognitive- behavioral education interventions customized for patients (Symptom Consult). The specific aims are to 1) evaluate the feasibility of using the Symptom Report-Symptom Consult tool in an outpatient oncology setting with a diverse sample of 50 cancer patients receiving radiation. We hypothesize that the average patient will complete the tool in 20-30 minutes, provide answers to more than 80 percent of the items, and report the program as an acceptable way to report symptom information and receive self- care information; and 2) compare usual-care and the computerized tool for effects on: a) patient outcomes (pain and fatigue intensity, pain quality, satisfaction with pain and fatigue levels, misconceptions about pain, exercise levels) in a diverse sample of 276 persons receiving radiation therapy; b) provider outcomes (number of treatments suggested for pain and fatigue; clinic visit length) in a sample of radiation oncologists; and c) patient-provider partnership outcomes (ratio of provider-centered to patient-centered talk during audiotaped clinic visits). We hypothesize that the length of the clinic visit will be the same for the two groups but that the experimental group will report decreased scores for the intensity of their current and worst pain and fatigue, the MPQ pain quality subscales, ratio of provider-centered to patient-centered talk during clinic visits; and increased levels of satisfaction with pain and fatigue levels, exercise levels, number of fatigue or pain prescriptions. Patients will either complete usual assessments or use a new computerized tool. In the experimental group, the Symptom Report data will be used to provide a summary of the symptoms and to provide a Symptom Consult to patients. The interaction between the patient and the provider during routine clinic visits will be audiotaped and analyzed for types of communication during the visit. Four weeks after the pre-test (peak of their cancer symptoms), patients will complete the computerized assessment tool to document outcomes. Study findings will be used to guide revisions of the tool and to plan future studies to implement this new cancer control technology for improved health communications and symptom management.