Computerized Assessment for Patients with Cancer: ESRA-C II

描述(申请人提供)：该研究项目的最终目标是通过在支持性环境中为个人创造机会，让个人充分表达自己对癌症症状和生活质量的担忧，从而最大限度地提高癌症患者的积极健康结果。癌症患者的诊断和分期范围很广，他们的症状发生率很高，可能会极大地影响生活质量。然而，临床医生经常面临资源缩水的问题，失去了与患者进行全面的人际互动的机会。患者报告的结果和状态，特别是症状和生活质量(QOL)问题，以可靠和系统的方式报告，是完整的临床评估、诊断和治疗计划所基于的信息的重要组成部分。在我们目前的临床试验中，通过向提供者提供筛查结果进行干预，我们在一个大型综合性癌症中心展示了患者症状和生活质量结果筛查的可行性和可接受性。我们准备分析当前的数据，这些数据将帮助我们回答对提供者沟通的影响问题，但某些关键问题仍然与患者和家属照顾者描述和毫不犹豫地提出令人担忧的症状和生活质量问题的能力有关。我们有证据表明，在面对面的诊所就诊中，某些症状(例如，认知障碍)被低估了。这些发现与其他研究一致，患者报告的卵巢癌症状、癌症相关疲劳和性行为变化的结果。能够将这些担忧传达给临床提供者，要求患者和/或护理人员了解这些担忧的重要性，有一个方便的时间、地点和方法进行沟通，并且临床提供者将认识到并解决这些担忧。这项研究的目的是进一步评估我们增强的基于网络的癌症电子自我报告评估程序Esra-C的临床应用，并重新评估其远程使用情况。癌症患者将使用该系统在治疗前、治疗中和治疗后自我评估自己的症状和生活质量。除了提供给临床医生的ESRA-C摘要以突出关注的领域外，我们的系统还将以患者可使用的格式提供定制摘要，并向每位患者提供三条信息：a)这种症状或生活质量问题(SQI)通常发生在像您这样的患者中的原因和频率，b)它可以得到处理，以及c)如何与您的临床提供商谈论SQI。这些信息将帮助患者与提供者进行面对面的临床会议，促进患者就患者所关注的问题、癌症相关症状和生活质量问题进行表达和沟通。这种加强沟通的双管齐下的方法，提供给提供者和患者，被认为是出色的临床监测和护理的有力补充。癌症患者的诊断和分期范围很广，他们的症状发生率很高，可能会极大地影响生活质量。患者报告的结果和状况，特别是症状和生活质量问题，以有效、可靠和系统的方式报告，是完整的临床评估、诊断和治疗计划所依据的信息的重要组成部分。

DESCRIPTION (provided by applicant): The ultimate goal of this program of research is to maximize positive health outcomes for those with cancer by creating opportunities in a supportive environment for individuals to fully express themselves regarding cancer symptoms and quality of life concerns. Patients with cancer, across a wide range of diagnoses and stages, have a high incidence of symptoms that may greatly impact quality of life. However, clinicians are faced too often with shrinking resources, removing opportunities for comprehensive, interpersonal interactions with patients. Patient-reported outcomes and status, particularly symptoms and quality of life (QOL) concerns, reported in a reliable and systematic way, are essential components of the information on which a complete clinical assessment, diagnosis and treatment plan is based. In our current clinical trial, having intervened by giving screening results to providers, we demonstrated the feasibility and acceptability of patient symptom and QOL outcome screening at a large comprehensive cancer center. We are poised to analyze current data that will help us answer the question of the impact on provider communication, yet certain key questions remain relevant to the ability of the patient and family caregivers to describe and present, without hesitation, the symptom and quality of life issues that are of concern. We have evidence that certain symptoms (e.g., cognitive dysfunction) are underreported in face-to-face clinic visits. These findings are consistent with other studies with patient-reported outcomes in ovarian cancer symptoms, cancer-related fatigue and changes in sexual activities. Being able to communicate such concerns to a clinical provider, requires that the patient and/or caregiver understand the concern is important, have a convenient time, place and method to communicate and that the clinical providers will acknowledge and address the concern. The purpose of this study is to further evaluate the clinical, and newly evaluate the remote, use of our enhanced web-based, electronic self-report assessment program for cancer, ESRA-C. Cancer patients will use the system to self-assess their symptoms and QOL before, during and after treatment. In addition to the ESRA-C summary given to clinicians, highlighting areas of concern, our system will provide a customized summary in a format that is useable by patients and coach each patient with three messages: a) why and how often this symptom or QOL issue (SQI) typically occurs in patients like you, b) it can be dealt with, and c) how to talk to your clinical providers about the SQI. These messages will assist patients in face-to-face clinic meetings with the providers, facilitating patient expression and communication regarding issues for which the patient is the expert, cancer related symptoms and QOL concerns. This two-pronged approach to enhancing communication, delivered to both providers and patients, is hypothesized to be a powerful adjunct to excellent clinical monitoring and care. Patients with cancer, across a wide range of diagnoses and stages, have a high incidence of symptoms that may greatly impact quality of life. Patient-reported outcomes and status, particularly symptoms and quality of life concerns, reported in an efficient, reliable and systematic way, are essential components of the information on which a complete clinical assessment, diagnosis and treatment plan is based.