Computerized Assessment for Patients with Cancer: ESRA-C II

描述(由申请人提供)：该研究项目的最终目标是为癌症患者创造机会，让他们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。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。在我们之前的临床试验中，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、可接受性和有效性。我们已经建立了癌症电子自我报告评估(ESRA-C)的能力，以改善患者与临床医生关于症状或生活质量问题(SQI)的对话，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。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。除了提供给临床医生的ESRA-C摘要，突出关注的领域外，我们的系统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)为什么这种SQI通常发生在像您这样的患者中，以及多久发生一次，b)可以处理它，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。这一竞争性补充的目的是描述治疗过程中症状学的自然历史，并确定重要临床过程和结果的关键SQI预测因素，特别是依从性和剂量修改，并评估在常规实施阶段将自我评估的SQI数据直接整合到电子病历(EMR)对临床过程的影响。 公共卫生相关性：癌症患者，在广泛的诊断和阶段，有可能极大地影响生活质量的症状的高发生率。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 for individuals to fully express themselves regarding cancer symptoms and quality of life concerns. 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 previous clinical trial, having intervened by giving screening results to providers, we demonstrated the feasibility, acceptability and efficacy of patient symptom and QOL outcome screening at a large comprehensive cancer center. We have established the ability of the electronic self-report assessment-cancer (ESRA-C) to improve the patient-clinician conversation regarding symptoms or QOL issues (SQI), 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. 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. 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 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. The purpose of this competitive supplement is to describe the natural history of symptomatology over the course of treatment and identify key SQI predictors of important clinical processes and outcomes, notably adherence and dose modifications, plus evaluate the impact on clinical processes of direct integration of self-assessed SQI data into the electronic medical record (EMR) in the routine implementation phase. PUBLIC HEALTH RELEVANCE: 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.