Telenursing Model for Management of Chemotherapy Side Effects

描述（由申请人提供）：本项目的目标是开发一种具有成本效益的主动远程护理系统，用于管理化疗副作用。患者将使用该系统在治疗期间每天报告健康状况，可以在网络上或通过电话上的交互式语音应答系统。根据报告的严重程度，该系统可以根据患者的疾病状况和治疗方案提供及时、循证、环境敏感的患者教育材料，并/或提醒肿瘤临床护理团队提供及时的远程监测和咨询。我们第一阶段的目标是：(1)设计一个远程护理模型，通过系统的文献回顾、网络资源回顾、焦点小组讨论和个人访谈，特别关注量身定制的患者指导；(2)建立基于远程护理模型的工作原型，并在现实环境中进行对照试点研究，以评估技术可行性，提供者和患者的接受程度，以及对临床结果和感知干预效果的影响。I期可行性研究的最初重点是针对淋巴瘤患者的中性粒细胞减少、疲劳和恶心这三种常见的化疗副作用，并将在II期扩展到其他副作用和癌症部位。该项目符合我们的长期战略方向，即改善获得护理的机会，促进患者自我管理，促进提供者与患者的沟通，并最终通过综合远程保健和电子保健技术、循证医学、患者报告结果方法和患者教育研究的多学科方法改善临床结果并降低医疗保健成本。拟议的工作旨在改善获得护理的机会，促进患者自我管理，促进提供者与患者的沟通，并最终改善临床结果并降低医疗保健成本。这一努力具有特别的公共卫生利益，因为随着人口老龄化，预计肿瘤患者的数量将增加。此外，远程护理解决了偏远农村地区的患者以及城市环境中的体弱或残疾患者获得护理的重大问题。

DESCRIPTION (provided by applicant): The goal of this specific project is to develop a cost-effective proactive telenursing system for the management of chemotherapy side effects. Patients will use this system to report health status on a daily basis during treatment, either on the Web or via interactive voice response system over the phone. Depending on the reported severity, the system may deliver just-in-time, evidence-based, context-sensitive patient education materials tailored to the patient's disease status and treatment regimen, and/or alert the oncology clinical care team to provide timely remote monitoring and consultation. Our Phase I aims are to (1) design a telenursing model with the special focus on tailored patient instructions via systematic literature review, web resource review, focus group discussions, and personal interviews; and (2) develop a working prototype based on the resultant telenursing model and conduct controlled pilot study in realistic settings to evaluate technical feasibility, the acceptance level by providers and patients, and the effects on clinical outcomes and perceived intervention effectiveness. The initial focus of the Phase I feasibility study is on neutropenia, fatigue and nausea, three of the common chemotherapy side effects, for lymphoma patients and will be extended to other side effects and cancer sites in Phase II. This project is consistent with our long-term strategic direction to improve access to care, promote patient self- management, facilitate provider-patient communication, and ultimately improve clinical outcomes and reduce healthcare costs with multidisciplinary approaches integrating telehealth and e-health technologies, evidence- based medicine, patient-reported outcomes methodologies, and patient education research. The proposed work is intended to improve access to care, promote patient self-management, facilitate provider-patient communication, and ultimately improve clinical outcomes and reduce healthcare costs. The effort is of particular public health interest since with the aging population the number of oncology patients is expected to increase. Also, telenursing addresses significant access to care issues for patients in remote rural locations as well as frail or disabled patients in urban settings.