Implementation and Evaluation of an Expanded Bilingual Electronic Symptom Management Program across a Multi-site, Fully-integrated Comprehensive Cancer Center

在多站点、完全集成的综合癌症中心实施和评估扩展的双语电子症状管理计划

• 批准号: 10378999
• 负责人: DAVID CELLA
• 金额: $ 42.84万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10378999
• 关键词: Activities of Daily Living; Arthralgia; Articular Range of Motion; Cancer Model; Cancer Patient; Cancer Survivor; Chronic Care; Clinical; Communities; Comprehensive Cancer Center; Detection; Development; Diagnosis; Early Diagnosis; Electronic Health Record; Esthesia; Evaluation; Fatigue; Feedback; Future; Habilitation; Health system; Hybrids; Information Systems; Interruption; Intervention; Knowledge; Learning; Location; Lymphedema; Malignant Neoplasms; Maps; Measurement; Medicine; Modeling; Monitor; Muscle Weakness; Oncology; Ownership; Parents; Patient Outcomes Assessments; Patient Rights; Patients; Physical Function; Posture; Prevention; Provider; Randomized Controlled Trials; Rehabilitation therapy; Reporting; Research; Risk Factors; Self Management; Severities; Site; Skin; Support System; Surveys; Symptoms; System; Testing; Time; Work; bilingualism; cancer care; cancer diagnosis; cancer rehabilitation; disability; dissemination strategy; effectiveness trial; functional disability; implementation strategy; parent grant; patient population; prevent; programs; prospective; rehabilitation service; response; risk stratification; service utilization; side effect; skills; symptom management

Project Summary Physical and functional symptom burden is high among cancer survivors and is an ideal target for chronic care management. Cancer-related physical and functional side effects (PFs) include joint pain, fatigue, muscle weakness, loss of range of motion, altered skin sensation and integrity, postural abnormality, and lymphedema. Cancer survivors lack the knowledge and skills to prevent, detect, and manage PF side effects. Our research shows that a majority of cancer survivors report 3 or more long-lasting PFs and that rehabilitation services are under-utilized to treat them. Cancer rehabilitation interventions can reduce PFs and support functional ability. However, our work shows that cancer survivors lack receptivity to and misunderstand the benefits of cancer rehabilitation – even among those with cancer-related disability. Oncology providers also lack system support for timely identification of PFs and referral to rehabilitation. Usual cancer care lacks ownership for effective surveillance and management of PFs that can be done without interrupting clinical flow and overburdening providers and patients. Early rehabilitation (pre-hab) could facilitate ownership of PFs by educating patients on early detection and self-management of PFs, but this approach is completely absent from usual cancer care. The parent grant has developed the Northwestern Medicine Patient Reported Outcome (NMPRO) symptom monitoring system that prospectively monitors PFs severity with the Patient Reported Outcome Measurement Information System - Physical Function (PROMIS-PF) survey. With this Diversity Supplement, we will be able to: 1) leverage the parent grant to map the development of PFs across different cancer patient populations; 2) develop a learning health systems mechanism to support oncology providers to match the right patient, at the right time, with the right rehabilitation service, in the right location (4Rs Referral System); and 3) obtain stakeholder feedback about implementation and dissemination strategies for multi-level (patient, provider, community, system) prevention, detection, and management of cancer-related PFs and the development of risk stratification models for rehabilitation referral. The results from this supplement will inform the planned R01 resubmission to the NCI to test the combination of NMPRO + 4Rs + pre-hab in a large-scale randomized controlled trial. Our Specific Aims are: Aim 1: Map the trajectory and identify risk factors for development of physical and functional impairment and for cancer rehabilitation services utilization from the point of cancer diagnosis through at least the first year after diagnosis; Aim 2: Modify NMPRO to provide a decisional support mechanism for early and timely cancer rehabilitation referral in response to electronic health record alerts generated in the parent study; Aim 3: Identify realistic implementation, dissemination, and adaptation strategies for future hybrid effectiveness trials of pre-habilitation interventions for different cancer patient populations.

项目摘要 癌症幸存者的身体和功能症状负担很高，是长期护理的理想目标 管理癌症相关的身体和功能副作用（PF）包括关节疼痛，疲劳，肌肉疼痛， 虚弱、活动范围丧失、皮肤感觉和完整性改变、姿势异常和水肿。 癌症幸存者缺乏预防、检测和管理PF副作用的知识和技能。我们的研究 大多数癌症幸存者报告3个或更多的长期PF，康复服务是 未被充分利用来治疗它们。癌症康复干预可以减少PF并支持功能能力。 然而，我们的工作表明，癌症幸存者缺乏接受能力，误解了癌症的好处 康复-即使是那些与癌症有关的残疾人。肿瘤提供者也缺乏系统支持 及时识别PF并转诊至康复中心。乳腺癌护理缺乏有效的所有权 在不中断临床流程和不造成过度负担的情况下对PF进行监测和管理 供应商和患者。早期康复（pre-hab）可以通过教育患者 早期发现和自我管理的PF，但这种方法是完全没有从通常的癌症护理。 家长补助金已经开发了西北医学患者报告结果（NMPRO）症状 通过患者报告结局测量前瞻性监测PF严重程度的监测系统 信息系统-身体功能调查。有了这个多样性补充，我们将能够 1）利用父母资助绘制不同癌症患者人群的PF发展图; 2） 发展一个学习型卫生系统机制，以支持肿瘤学提供者匹配合适的患者， 正确的时间，正确的康复服务，在正确的位置（4 R转诊系统）;和3）获得 利益相关者对多层次（患者、提供者 社区，系统）预防，检测和管理癌症相关的PF和风险的发展 康复转诊的分层模式。该补充的结果将告知计划的R 01 再次提交给NCI，以在一项大规模随机化研究中测试NMPRO +4 R + pre-hab的组合。 对照试验我们的具体目标是：目标1：绘制发展轨迹并确定风险因素， 身体和功能障碍以及从癌症角度利用癌症康复服务 目标2：修改NMPRO以提供决策支持 回应电子健康记录警报的早期和及时癌症康复转介机制 目标3：确定现实的实施、传播和适应战略 用于未来不同癌症患者人群的预防干预的混合有效性试验。

项目成果

The influence of telehealth-based cancer rehabilitation interventions on disability: a systematic review.

• DOI: 10.1007/s11764-022-01181-4
• 发表时间: 2023-12
• 期刊: Journal of cancer survivorship : research and practice
• 作者: Brick R;Padgett L;Jones J;Wood KC;Pergolotti M;Marshall TF;Campbell G;Eilers R;Keshavarzi S;Flores AM;Silver JK;Virani A;Livinski AA;Ahmed MF;Kendig T;Khalid B;Barnett J;Borhani A;Bernard G;Lyons KD
• 通讯作者: Lyons KD

Receptivity to a Nurse-Led Symptom Management Intervention Among Highly Symptomatic Patients With Cancer.

• DOI: 10.1093/jnci/djab172
• 发表时间: 2022-03-08
• 期刊: Journal of the National Cancer Institute
• 作者: Wintheiser GA;Ruddy KJ;Herrin J;Rahman PA;Pachman DR;Leppin AL;Rutten LJF;Lee MK;Griffin JM;Tofthagen C;Chlan LL;Ridgeway JL;Mitchell SA;Cheville AL
• 通讯作者: Cheville AL

Symptom and needs assessment screening in oncology patients: Alternate outreach methods during COVID-19.

肿瘤患者的症状和需求评估筛查：COVID-19 期间的替代外展方法。

• DOI: 10.1080/07347332.2021.1890663
• 发表时间: 2021
• 期刊: Journal of psychosocial oncology
• 影响因子: 2.1
• 作者: Davis,MSN,MS,MPH,Kristina;Wilbur,MSW,Kayla;Metzger,BSN,Susan;Garcia,PhD,SofiaF;Cahue,MPH,September;Webster,MA,Kimberly;Lylerohr,MA,Madison;Himelhoch,PhD,MPH,HeatherL;Bilimoria,MD,Karl;Cella,PhD,David
• 通讯作者: Cella,PhD,David