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

项目摘要 症状管理和支持性治疗对于高质量的癌症护理和最佳的患者治疗至关重要。 结果，但在常规肿瘤学环境中存在许多障碍。尽管可用性和 经验证的症状评估工具的成本效益，基于证据的支持性护理干预措施， 临床指南，在临床实践中采用患者报告结局的支持性治疗仍然很低， 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进行症状评估的方法。 这种策略在识别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的 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。 为了解决癌症护理中的这一关键差距，该项目将涉及开发和试点测试一种 支持性护理工具，嵌入现有的电子健康记录中，收集患者报告的 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 支持性护理的循证算法系统。该项目的具体目标是：1）开发 内容，设计和技术基础设施的EHR综合支持性护理工具，基于一个预先 （二）在香港推行综合环境卫生健康措施， 在5家HNCP门诊诊所进行[18个月]干预期间的支持性护理工具，有潜在暴露 超过[300]名合格的HNC患者和临床医生; 3）评估[可行性，可接受性， 和]使用混合方法初步实施EHR综合支持性护理工具。结果 将提供初步数据，为设计更大规模的实用随机试验提供信息 在多个癌症诊所里 拟议的K 08职业发展奖旨在支持候选人的高级培训， 癌症护理提供研究，在临床信息学和实施科学领域的正式培训， 同时开发和试点测试用于常规肿瘤护理的电子支持护理工具。这些广泛 这些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.