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

描述(申请人提供)：癌症化疗与副作用有关，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，而且越来越多的循证症状指南，但有效的症状缓解往往是难以捉摸的。造成这一现象的原因有很多，包括患者与其医疗保健提供者之间的沟通不充分、在家中跟踪门诊病人的困难、治疗症状的证据基础应用不足、保健提供者对患者主观投诉的信念以及对当前症状治疗方法的有效性的信念。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做法不佳，通常会干扰连续性和跟踪未缓解症状的解决。将技术的使用与反应灵敏的卫生保健提供者相结合，如肿瘤学护士从业者，他们应用当前最好的证据治疗症状，提供机会克服障碍，改善症状缓解，并随后改善接受癌症化疗的个人的功能。这项前瞻性的临床试验建议测试一种名为电话联系护理(TLC-NP)的日常自动化系统，用于监测化疗期间在家生活的患者的症状。该监测系统与根据患者特定症状特征量身定做的自我护理建议的自动交付相结合。TLC还会自动向研究肿瘤学执业护士发送电子邮件，通知他们未缓解的症状。护士从业者利用国家基于证据的症状指南对未缓解的症状进行干预。通过将评估和干预措施无缝地合并到电子病历中，以使整个肿瘤学治疗团队能够了解患者的进展，进一步加强了该系统的整合。这项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种症状的严重性和痛苦，改善了功能表现，并减少了对活动的干扰。其他目标将比较所使用的自我护理策略及其感知的有效性，记录对TLC系统的满意度，探索对工作生产率和缺勤的影响，并进行成本效益分析。样本将由280名开始化疗的成年参与者组成，他们将被随机分配到实验条件TLC-NP，这是一种具有护士从业者支持的综合管理系统，或接受常规护理，其中包括使用TLC系统的每日症状记录，但没有TLC自我护理说明或与护士从业者的接口。常规护理组的参与者被指示以他们通常的方式与他们的卫生保健团队进行互动，以解决症状问题。参与者将每天致电TLC，并报告一个疗程前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.