Telephone Linked Care: An IT Enabled Integrated System for Cancer Symptom Relief

描述（由申请人提供）：癌症化疗与副作用相关，可产生影响生活质量和损害功能的症状。许多人在化疗过程中会出现多种症状。虽然在治疗症状方面取得了进展，越来越多的循证症状指南，但有效的症状缓解往往难以捉摸。原因有很多，包括患者和他们的医疗保健提供者之间的沟通不足，难以跟随在家的门诊患者，证据基础的应用不充分，以治疗症状，医疗保健提供者对患者主观投诉的信念和对当前症状治疗方法的疗效的信念。此外，卫生保健提供者之间关于患者症状经历的沟通和记录实践较差，经常干扰连续性和跟踪未缓解症状的解决。将技术的使用与响应性医疗保健提供者（例如应用当前最佳证据治疗症状的肿瘤科护士执业者）相结合，提供了克服障碍，改善症状缓解并随后改善接受癌症化疗的个体的功能的机会。这项前瞻性临床试验旨在测试一种称为电话联系护理（TLC-NP）的日常自动化系统，用于监测化疗期间住在家里的患者的症状。该监测系统与根据患者特定症状特征定制的自我护理建议的自动交付配对。TLC还自动通过电子邮件向研究肿瘤科执业护士发送有关未缓解症状的“警报”。执业护士，利用国家证据为基础的症状指南干预未缓解的症状。通过将评估和干预措施的文档无缝地纳入电子病历中，进一步增强了系统的集成，从而使整个肿瘤治疗团队都可以访问患者的进展情况。该研究的具体目的是测试与常规护理组相比，TLC-NP干预是否降低了12种症状的严重程度和痛苦，改善了功能表现并减少了对活动的干扰。其他目标将比较自我护理策略的使用和他们的感知效果，文件满意度与TLC系统，探索对工作效率和缺勤的影响，并进行成本效益分析。样本将由280名开始化疗疗程的成人参与者组成，他们将被随机分配至实验条件、TLC-NP、具有执业护士支持的综合管理系统或常规护理，常规护理包括使用TLC系统记录每日症状，但没有TLC自我护理说明或与执业护士的接口。常规护理组中的参与者被指示以他们通常的方式与他们的健康护理团队就症状问题进行互动。参与者将每天致电TLC，并报告化疗前24小时的症状。

DESCRIPTION (provided by applicant): Cancer chemotherapy is associated with side effects that can produce symptoms that impact quality of life and impair functioning. Many individuals experience multiple symptoms during a course of chemotherapy. While there have been advances in treating symptoms and a growing body of evidence- based symptom guidelines, effective symptom relief is often elusive. A variety of reasons account for this including inadequate communication between patients and their health care providers, difficulty in following ambulatory patients who are at home, inadequate application of the evidence base to treat symptoms, and health care providers beliefs about subjective patient complaints and beliefs about the efficacy of current symptom treatment approaches. In addition, poor communication and documentation practices among health care providers about the patient's symptom experiences often interferes with continuity and tracking unrelieved symptoms to resolution. Coupling the use of technology with a responsive health care provider such as an oncology nurse practitioner who applies current best evidence to treat symptoms, provides an opportunity to overcome barriers, improve symptom relief and subsequently improve functioning in individuals receiving chemotherapy for cancer. This prospective, clinical trial proposes to test a daily automated system know as Telephone Linked Care (TLC-NP) for monitoring symptoms for patients living at home during chemotherapy treatment. The monitoring system is paired with automated delivery of self-care suggestions tailored to the patient's specific symptom profile. TLC also automatically emails 'alerts' to the study oncology nurse practitioner about unrelieved symptoms. The nurse practitioner, utilizing national evidence based symptom guidelines intervenes for unrelieved symptoms. Integration of the system is further enhanced through documentation of assessments and interventions incorporated seamlessly into the electronic medical record so that the entire oncology treatment team has access to the patient's progress. The specific aims of the study are to test whether the TLC-NP intervention reduces severity and distress of 12 symptoms, improves functional performance and decreases interference with activity when compared with a usual care group. Other aims will compare self care strategies utilized and their perceived effectiveness, document satisfaction with the TLC system, explore impact on work productivity and absenteeism and conduct a cost-benefit analysis. The sample will consist of 280 adult participants initiating a course of chemotherapy who will be randomly assigned to the experimental condition, TLC-NP, the integrated management system with nurse practitioner support or to usual care which includes daily symptom documentation utilizing the TLC system but without TLC self-care instructions or interface with the nurse practitioner. Participants in the usual care group are instructed to interact in their usual manner with their heath care team for symptom concerns. Participants will call TLC daily and report symptoms for the previous 24 hours for a course of chemotherapy.