Telephone Linked Care: An IT Enabled Integrated System for Cancer Symptom Relief

电话关联护理：IT 支持的癌症症状缓解集成系统

• 批准号: 8136553
• 负责人: KATHLEEN H MOONEY
• 金额: $ 119.18万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-24 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8136553
• 关键词: Absenteeism; Accounting; Adherence; Adopted; Adult; Adverse effects; Belief; Caring; Chemotherapy-Oncologic Procedure; Clinic; Clinical Trials; Communication; Computerized Medical Record; Computers; Cost Effectiveness Analysis; Cost-Benefit Analysis; Coupled; Coupling; Cytotoxic agent; Development; Distress; Documentation; Effectiveness; Electronic Health Record; Electronic Mail; Elements; Fatigue; Guidelines; Health Personnel; Home environment; Hour; Individual; Information Technology; Instruction; Intervention; Knowledge; Lead; Left; Libraries; Life; Link; Malignant Neoplasms; Methods; Modeling; Monitor; Nausea; Nurse Practitioners; Oncologic Nursing; Oncology Nurse; Outpatients; Pamphlets; Participant; Patient Monitoring; Patients; Pattern; Performance; Productivity; Provider; Quality of life; Randomized; Reporting; Research; Research Personnel; Resolution; Sampling; Self Care; Severities; Suggestion; Symptoms; System; Systems Integration; Technology; Telecommunications; Telephone; Testing; Time; Visit; Work; base; cancer care; cancer cell; cancer therapy; chemotherapy; comparison group; cost; effective therapy; evidence base; evidence based guidelines; experience; functional status; group intervention; improved; improved functioning; meetings; oncology; oral mucositis; programs; prospective; satisfaction; standard care; symptom management; treatment as usual; treatment strategy

DESCRIPTION (provided by applicant): Cancer chemotherapy is associated with side effects that can produce symptoms that impact quality of life and impair functioning. Many individuals experience multiple symptoms during a course of chemotherapy. While there have been advances in treating symptoms and a growing body of evidence- based symptom guidelines, effective symptom relief is often elusive. A variety of reasons account for this including inadequate communication between patients and their health care providers, difficulty in following ambulatory patients who are at home, inadequate application of the evidence base to treat symptoms, and health care providers beliefs about subjective patient complaints and beliefs about the efficacy of current symptom treatment approaches. In addition, poor communication and documentation practices among health care providers about the patient's symptom experiences often interferes with continuity and tracking unrelieved symptoms to resolution. Coupling the use of technology with a responsive health care provider such as an oncology nurse practitioner who applies current best evidence to treat symptoms, provides an opportunity to overcome barriers, improve symptom relief and subsequently improve functioning in individuals receiving chemotherapy for cancer. This prospective, clinical trial proposes to test a daily automated system know as Telephone Linked Care (TLC-NP) for monitoring symptoms for patients living at home during chemotherapy treatment. The monitoring system is paired with automated delivery of self-care suggestions tailored to the patient's specific symptom profile. TLC also automatically emails 'alerts' to the study oncology nurse practitioner about unrelieved symptoms. The nurse practitioner, utilizing national evidence based symptom guidelines intervenes for unrelieved symptoms. Integration of the system is further enhanced through documentation of assessments and interventions incorporated seamlessly into the electronic medical record so that the entire oncology treatment team has access to the patient's progress. The specific aims of the study are to test whether the TLC-NP intervention reduces severity and distress of 12 symptoms, improves functional performance and decreases interference with activity when compared with a usual care group. Other aims will compare self care strategies utilized and their perceived effectiveness, document satisfaction with the TLC system, explore impact on work productivity and absenteeism and conduct a cost-benefit analysis. The sample will consist of 280 adult participants initiating a course of chemotherapy who will be randomly assigned to the experimental condition, TLC-NP, the integrated management system with nurse practitioner support or to usual care which includes daily symptom documentation utilizing the TLC system but without TLC self-care instructions or interface with the nurse practitioner. Participants in the usual care group are instructed to interact in their usual manner with their heath care team for symptom concerns. Participants will call TLC daily and report symptoms for the previous 24 hours for a course of chemotherapy.

描述（由申请人提供）：癌症化疗会产生副作用，这些副作用可能会产生影响生活质量和损害功能的症状。许多人在化疗过程中会出现多种症状。尽管在治疗症状方面取得了进展，并且基于证据的症状指南也越来越多，但有效的症状缓解往往难以实现。造成这种情况的原因有多种，包括患者与其医疗保健提供者之间沟通不足、难以跟踪在家中的门诊患者、治疗症状的证据基础应用不充分、以及医疗保健提供者对患者主观投诉的信念以及对当前症状治疗方法有效性的信念。此外，医疗保健提供者之间关于患者症状经历的沟通和记录不善常常会干扰连续性和跟踪未缓解症状直至解决。将技术的使用与响应迅速的医疗保健提供者（例如应用当前最佳证据来治疗症状的肿瘤科执业护士）结合起来，为接受癌症化疗的个体提供了克服障碍、改善症状缓解并随后改善功能的机会。这项前瞻性临床试验旨在测试一种称为电话联动护理 (TLC-NP) 的日常自动化系统，用于监测化疗期间居家患者的症状。监测系统可自动提供针对患者具体症状的自我护理建议。 TLC 还会自动通过电子邮件向研究肿瘤学执业护士发送有关未缓解症状的“警报”。执业护士利用国家基于证据的症状指南对未缓解的症状进行干预。通过将评估和干预措施无缝合并到电子病历中，系统的集成得到进一步增强，以便整个肿瘤治疗团队能够了解患者的进展情况。该研究的具体目的是测试与常规护理组相比，TLC-NP 干预是否可以减轻 12 种症状的严重程度和痛苦、改善功能表现并减少对活动的干扰。其他目标将比较所使用的自我护理策略及其感知有效性、记录对 TLC 系统的满意度、探索对工作生产力和缺勤的影响，并进行成本效益分析。该样本将由 280 名开始化疗的成年参与者组成，他们将被随机分配到实验条件、TLC-NP、具有执业护士支持的综合管理系统或常规护理，其中包括利用 TLC 系统记录日常症状，但没有 TLC 自我护理说明或与执业护士的互动。常规护理组的参与者被要求以常规方式与他们的健康护理团队互动，以解决症状问题。参与者将每天致电 TLC 并报告化疗疗程前 24 小时的症状。