Improving Recovery after Major Cancer Surgery using Patient-Reported Outcomes

利用患者报告的结果改善重大癌症手术后的康复

• 批准号: 9310343
• 负责人: Xin Shelley Wang
• 金额: $ 64.8万
• 依托单位: UNIVERSITY OF TX MD ANDERSON CAN CTR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9310343
• 关键词: Absence of pain sensation; Address; Adjuvant; Adjuvant Therapy; Adopted; Adoption; Affect; Anesthesia procedures; Anesthesiology; Assessment tool; Cancer Center; Cancer Patient; Caring; Clinical; Clinical Oncology; Clinical Research; Clinical Trials; Cognitive; Complex; Computerized Medical Record; Consensus; Convalescence; Data; Diet; Diffusion of Innovation; Discipline of Nursing; Early Mobilizations; Economics; Equipment and supply inventories; Feedback; Focus Groups; Food; Future; Gastrointestinal Surgical Procedures; Goals; Home environment; Hospitalization; Hospitals; Individual; Knowledge; Lead; Length of Stay; Liquid substance; Longitudinal Studies; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Malignant neoplasm of gastrointestinal tract; Malignant neoplasm of urinary bladder; Measurement; Measures; Medical Oncology; Methods; Morbidity - disease rate; Nurses; Nursing Staff; Observational Study; Operating Rooms; Operative Surgical Procedures; Opioid; Outcome; Outcome Measure; Outcome Study; Pain Measurement; Pain management; Pathway interactions; Patient Care; Patient Outcomes Assessments; Patient Self-Report; Patients; Performance Status; Perioperative; Perioperative Care; Perioperative Nursing; Pharmaceutical Preparations; Phase; Population; Postoperative Care; Postoperative Period; Procedures; Process; Provider; Psychometrics; Radiation Oncology; Readiness; Recovery; Recovery of Function; Reporting; Research; Research Design; Resources; Risk; Series; Severities; Surgeon; Surgical Oncology; Surveys; Symptoms; System; Techniques; Testing; Thoracic Surgical Procedures; Time; Urogenital Cancer; base; cancer surgery; cancer therapy; clinical practice; cohort; cost; evidence base; functional status; high risk; hospital readmission; improved; innovation; instrument; knowledge base; minimally invasive; mortality; multidisciplinary; multimodality; novel; oncology; preference; programs; psychologic; response; routine practice; self-reported functional status; symptom management; theories; tool; user-friendly

PROJECT SUMMARY/ABSTRACT Increasing utilization of patient-reported outcomes (PROs) in clinical practice may lead to better postop- erative outcomes, with pain assessment and management as an excellent example. Although PROs are widely accepted in clinical research in medical and radiation oncology and are endorsed by the US Food & Drug Ad- ministration, the introduction of subjective outcomes is relatively novel in perioperative care practice― despite the fact that PROs are the best resource for defining and measuring the patient’s perspective of symp- tomatic and functional recovery after major cancer surgery and that the information they provide could poten- tially guide care during recovery. A major knowledge gap is that, although validated PRO tools exist, there are no established, user-friendly clinical methods for understanding and responding to symptom and function- al-status reports from patients after complex major surgery. The goal of our study is to establish a framework for clinical adoption of PROs, to define methods needed to interpret PRO data from the MD Anderson Symp- tom Inventory (MDASI), and to examine the MDASI’s clinical utility and patient and professional perspectives on using it in future practice. If we are successful, PROs could be added to well-defined, traditional metrics in perioperative care, such as decreased 30-day mortality, fewer complications, shortened hospital stays, and few- er hospital readmissions. The increasing inclusion of PRO portals in electronic medical record systems (such as EPIC) that can longitudinally track patient report away from the hospital make this approach feasible. Given EPIC’s decision to include the MDASI nationwide (also at MD Anderson Cancer Center), we believe we have a timely opportunity to provide the first evidence-based package to support implementation of the MDASI in perioperative care. At MD Anderson, perioperative recovery is being further improved by incorporation of an Enhanced Recovery Program (ERP) that challenges traditional surgical practices. The need to effectively com- pare ERP and traditional surgery outcomes exemplifies the urgency of this project. We propose a longitudinal clinical study, plus a survey of professionals to identify/address barriers to the use of PROs. We have assem- bled a strong multidisciplinary team from symptom research, surgical nursing, surgery, and anesthesiology to study patients undergoing surgery for gastrointestinal, gynecologic, or genitourinary cancer. Aim 1: Establish PRO-based methods to determine clinically meaningful postoperative symptom burden. Gap addressed: lack of quantitatively defined, procedure-specific symptom profiles and severity thresholds for managing moderate to severe symptoms, especially postdischarge. Aim 2: Establish PRO-based methods to evaluate postoperative functional recovery. Gap addressed: lack of empirical data on self-reported functional recovery to indicate readiness to resume planned oncology care or return to normal activities. Aim 3: Examine the utility of PROs as a postoperative outcome measure through a PRO study in patients and a “probe” observational study of cli- nicians. Gap addressed: lack of evidence about how the availability of PROs might alter clinical practice.

项目摘要/摘要 在临床实践中，增加患者报告结果（PRO）的利用率可能会导致更好的术后 疼痛评估和管理作为一个很好的例子。虽然专业人士广泛 在医学和放射肿瘤学的临床研究中接受，并得到美国食品和药物的认可 在周期性的护理实践中，主题结果的引入相对新颖 - 尽管事实是专业人士是定义和衡量患者对Symp-的观点的最佳资源 大规模癌症手术后的体育和功能恢复，他们提供的信息可能会大大 在康复过程中指导护理。一个主要的知识差距是，尽管存在经过验证的Pro工具，但 没有建立，用户友好的临床方法来理解和应对症状和功能 - 复杂的大型手术后，AlStatus报告了患者的报告。我们研究的目的是建立一个框架 为了临床采用专业人士，以定义从MD Anderson Symp-解释Pro数据所需的方法 汤姆（Tom）库存（MDASI），并检查MDASI的临床公用事业以及患者和专业观点 在将来的实践中使用它。如果我们成功，可以将优点添加到定义明确的传统指标中 围手术期护理，例如降低30天死亡率，较少的并发症，住院缩短，少数 ER医院再入院。在电子病历系统中增加了Pro门户网站的越来越多（例如 可以纵向跟踪患者报告的史诗般的）使这种方法可行。给出 Epic决定在全国范围内包括MDASI（也在MD Anderson Cancer Center），我们相信我们有一个 及时提供第一个基于证据的计划，以支持MDASI的实施 围手术期护理。在MD安德森（MD Anderson），通过合并一个定期恢复正在进一步改善 增强恢复计划（ERP），挑战传统的手术实践。需要有效的 PARE ERP和传统手术结果表明了该项目的迫切性。我们提出了一个纵向 临床研究，以及对专业人士的调查，以识别/解决专业人士使用的障碍。我们有会议 - 从症状研究，外科护士，手术和麻醉学到一个强大的多学科团队到 研究接受胃肠道，妇科或泌尿生殖器癌的手术的患者。目标1：建立 基于专业的方法来确定临床上有意义的术后症状负担。差距解决：缺乏 定义的，特定于程序的症状概况和严重程度阈值 严重的症状，尤其是入院后。目标2：建立基于专业的方法来评估术后 功能恢复。差距解决：缺乏有关自我报告的功能恢复的经验数据以表明 准备恢复计划的肿瘤学护理或恢复正常活动。目标3：检查专业人士的效用 作为术后通过对患者的专业研究的术后结局指标，以及对Cli-cli的“探针”观察研究 尼古斯。解决的差距：缺乏证据表明专业人士的可用性如何改变临床实践。