Harnessing the EHR for the Delivery of Supportive Care in an Oncology Setting

项目摘要 症状管理和支持性护理对高质量的癌症护理和最佳患者至关重要 结果，但在常规肿瘤学环境中整合它们存在许多障碍。尽管有可用的和 经过验证的症状评估工具、循证支持性护理干预措施和 在临床指南中，在临床实践中采用患者报告的结果的支持性护理仍然很少， 使许多患者的症状控制不佳，需求得不到满足，并遭受可预防的痛苦。患者-报告 结果提供了一种通过捕捉每个患者的独特需求和价值来评估症状的方法。 这一策略在确定患者需求方面是有效的，但不一定有助于肿瘤提供者解决 并在他们的临床互动中管理这些需求。需要新的方法来促进系统化 症状评估和管理，并指导在现实世界中提供适当的支持性护理 肿瘤学设置。 为了解决癌症护理方面的这一关键差距，该项目将涉及开发和试点测试 嵌入现有电子健康记录中的支持性护理工具，可收集患者报告 使用成熟的工具评估症状和支持性护理需求，并将这些数据与 用于支持性护理的循证算法系统。该项目的具体目标是：1)开发 EHR集成支持性护理工具的内容、设计和技术基础设施，基于预 对利益攸关方的意见和当地情况进行干预评估；2)实施综合的电子健康记录 在5家HNCP门诊诊所的[18个月]干预期内使用支持性护理工具，可能会暴露于风险之中 将该工具提供给[300]多名符合条件的HNC患者和临床医生；以及3)评估[可行性，可接受性， 和]使用混合方法的EHR综合支持性护理工具的初步实施。发现 将从该项目中提供初步数据，为设计更大规模的务实随机试验提供参考 跨越多个癌症诊所。 拟议的K08职业发展奖旨在支持候选人在 癌症护理提供研究，在临床信息学和实施科学领域接受过正式培训， 同时开发和试点用于常规肿瘤学护理的电子支持性护理工具。这些宽阔的 目标与国家癌症研究所的使命和科学优先事项是一致的。

Project Summary Symptom management and supportive care are essential to high-quality cancer care and optimal patient outcomes, but many barriers exist to their integration in routine oncology settings. Despite the availability and cost-effectiveness of validated symptom assessment tools, evidence-based supportive care interventions and clinical guidelines, adoption of supportive care using patient-reported outcomes in clinical practice remains low, leaving many patients with poor symptom control, unmet needs, and preventable suffering. Patient-reported outcomes offer one approach to symptom assessment by capturing the unique needs and values of each patient. This strategy is effective in identifying patients' needs, but does not necessarily help oncology providers address and manage these needs in their clinical interactions. Novel approaches are needed to facilitate systematic symptom assessment and management, and guide the appropriate provision of supportive care in real-world oncology settings. To address this critical gap in cancer care, this project will involve the development and pilot testing of a supportive care tool, embedded in the existing electronic health record, that collects patient-reported assessments of symptoms and supportive care needs, using well-established tools, and links these data to a system of evidence-based algorithms for supportive care. Specific aims of this project are: 1) to develop the content, design and technical infrastructure of an EHR-integrated supportive care tool, based on a pre- intervention assessment of stakeholder input and the local context; 2) to implement the EHR-integrated supportive care tool over an [18-month] intervention period in 5 HNCP outpatient clinics, with potential exposure of the tool to more than [300] eligible HNC patients and clinicians; and 3) to evaluate the [feasibility, acceptability, and] initial implementation of the EHR-integrated supportive care tool using a mixed methods approach. Findings from this project will provide the preliminary data to inform the design of a larger pragmatic randomized trial across multiple cancer clinics. The proposed K08 Career Development Award is designed to support the candidate's advanced training in cancer care delivery research, with formal training in the fields of clinical informatics and implementation science, while developing and pilot testing an electronic supportive care tool for use in routine oncology care. These broad goals are consistent with the National Cancer Institute's mission and scientific priorities.