SymptomCare@Home (SCH): Deconstructing an effective, technology-assisted, symptom management intervention

SymptomCare@Home (SCH)：解构有效的、技术辅助的症状管理干预措施

• 批准号: 9903257
• 负责人: KATHLEEN H MOONEY
• 金额: $ 85.88万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9903257
• 关键词: Absenteeism; Accelerometer; Accident and Emergency department; Address; Adherence; Adopted; Adoption; Affect; Cancer Etiology; Cancer Patient; Caring; Characteristics; Chemotherapy-Oncologic Procedure; Clinic Visits; Clinical; Control Groups; Decision Support Systems; Distress; Exercise; Fatigue; Health; Healthcare Systems; Home environment; Individual; Infusion procedures; Intervention; Monitor; Nurse Practitioners; Oncology; Outpatients; Participant; Patient Outcomes Assessments; Patients; Physical activity; Process; Productivity; Provider; Psyche structure; Public Health; Quality-Adjusted Life Years; Randomized; Randomized Controlled Trials; Reporting; Research; Self Management; Severities; Symptoms; System; Technology; Telephone; Testing; Time; Translating; Work; base; cancer care; cancer therapy; care systems; chemotherapy; clinical implementation; clinical practice; control trial; cost; cost effective; cost effectiveness; disabling symptom; eHealth; economic evaluation; evidence based guidelines; experience; follow-up; health care service utilization; hospital services; innovation; multi-component intervention; novel strategies; physical symptom; psychological symptom; public health relevance; reduce symptoms; response; satisfaction; side effect; social; symptom management; telehealth; telehealth systems; treatment arm; treatment as usual; trial design; urgent care; usability; willingness to pay

 DESCRIPTION (provided by applicant): Cancer patients receiving chemotherapy experience multiple poorly controlled symptoms at home in the interim weeks between clinic visits and the next infusion. Their care during this interim time period is suboptimal. Technology can be utilized to bridge the gap between patient symptom needs at home and oncology team response. Automated patient-reported symptom home monitoring and management systems offer a new approach to symptom care. Our research team has developed and tested SymptomCare@Home (SCH). This multi-component automated system monitors daily patient-reported symptoms at home, provides tailored automated self-management coaching based on the specific symptoms reported and transmits unrelieved symptom alert reports to an oncology provider who, using the SCH decision support system provides follow-up telephone-delivered symptom care. We have demonstrated that SCH dramatically reduces physical and psychological symptom severity. However there remain several gaps in translating a successful, multi-component symptom intervention into clinical practice. These include understanding 1) the contribution and value of each part of the intervention so that the active components are selected for clinical implementation and 2) the costs associated with the intervention and its components. Therefore the aims of this project are to deconstruct the SCH symptom monitoring and management system to determine the relative contribution and costs of its components to achieving symptom reduction, maintain general health functioning and reduce healthcare utilization. We will also examine who benefits most and least from the individual components and from the overall system. A 5 group randomized control trial design will be utilized with 750 participants (150/group) beginning a new course of chemotherapy who will call the SCH system daily and report the presence and severity of 11 symptoms throughout a course of chemotherapy or up to 6 months. This study is both significant and innovative because it shifts the current clinical practice paradigm for providing symptom care episodically during clinic visits to an innovative approach that is patient-centric, providing symptom care when and where the patient needs it. The study will address questions not generally asked in multi-component interventions, determining the active ingredients and their costs. Determining the value of new approaches to care such as automated telehealth interventions is essential to the decision process of healthcare systems and payers who decide what to adopt and reimburse. It is also vitally important to patients so that new symptom care innovations are adopted that better meet their needs and dramatically reduce their symptoms.