Automated Text-Based Symptom Monitoring With Rapid Clinician Triage for Patients With Cancer and Suspected or Confirmed COVID-19

2021 ◽  
pp. 1134-1140
Author(s):  
Cody E. Cotner ◽  
Mohan Balachandran ◽  
David Do ◽  
Will Ferrell ◽  
Neda Khan ◽  
...  
Keyword(s):  
Rapid Assessment ◽  
Monitoring Program ◽  
Outpatient Setting ◽  
Text Messages ◽  
Symptom Monitoring ◽  
Participant Satisfaction ◽  
Program Participant ◽  
Patients With Cancer ◽  
Oncology Nurse ◽  
Net Promoter

PURPOSE Patients with cancer are at greater risk of developing severe symptoms from COVID-19 than the general population. We developed and tested an automated text-based remote symptom-monitoring program to facilitate early detection of worsening symptoms and rapid assessment for patients with cancer and suspected or confirmed COVID-19. METHODS We conducted a feasibility study of Cancer COVID Watch, an automated COVID-19 symptom-monitoring program with oncology nurse practitioner (NP)-led triage among patients with cancer between April 23 and June 30, 2020. Twenty-six patients with cancer and suspected or confirmed COVID-19 were enrolled. Enrolled patients received twice daily automated text messages over 14 days that asked “How are you feeling compared to 12 hours ago? Better, worse, or the same?” and, if worse, “Is it harder than usual for you to breathe?” Patients who responded worse and yes were contacted within 1 hour by an oncology NP. RESULTS Mean age of patients was 62.5 years. Seventeen (65%) were female, 10 (38%) Black, and 15 (58%) White. Twenty-five (96%) patients responded to ≥ 1 symptom check-in, and overall response rate was 78%. Four (15%) patients were escalated to the triage line: one was advised to present to the emergency department (ED), and three were managed in the outpatient setting. Median time from escalation to triage call was 11.5 minutes. Four (15%) patients presented to the ED without first escalating their care via our program. Participant satisfaction was high (Net Promoter Score: 100, n = 4). CONCLUSION Implementation of an intensive remote symptom monitoring and rapid NP triage program for outpatients with cancer and suspected or confirmed COVID-19 infection is possible. Similar tools may facilitate more rapid triage for patients with cancer in future pandemics.

Cancer COVID Watch: A feasibility study of intensive remote symptom monitoring via automated text messages with integrated nurse practitioner triage for patients with cancer and suspected or confirmed COVID-19.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13580-e13580
Author(s):  
Cody Cotner ◽  
Christopher Manz ◽  
Mohan Balachandran ◽  
Will Ferrell ◽  
Neda Khan ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Nurse Practitioner ◽  
False Negative ◽  
Monitoring Program ◽  
Text Message ◽  
Outpatient Setting ◽  
Text Messages ◽  
Symptom Monitoring ◽  
Patients With Cancer ◽  
Oncology Nurse

e13580 Background: Patients with cancer are at greater risk of developing severe symptoms and dying from COVID-19 than the general population. Early detection of worsening symptoms and rapid nurse practitioner assessment may identify patients with cancer and suspected COVID-19 who require escalation of care while limiting strain on healthcare resources. Methods: We conducted a feasibility study of Cancer COVID Watch, an automated COVID-19 symptom monitoring program with oncology nurse practitioner-led triage among patients with cancer between April 23 and June 30, 2020. Oncology clinicians enrolled 34 patients who tested positive for COVID-19 or were experiencing symptoms concerning for COVID-19. Enrolled patients received twice daily automated text messages over 14 days that asked “How are you feeling compared to 12 hours ago? Better, worse, or the same?” and, if worse, “Is it harder than usual for you to breathe?” Patients who responded “worse” and “yes” were contacted within 1 hour by an oncology nurse practitioner to determine next steps in management. Chi-square and student t-tests are used to compare adherence, demographics, and outcomes between intervention responders and non-responders. Results: Mean age of patients was 62 years, 20 (59%) were female, 13 (38%) Black, 19 (56%) White, and mean ECOG was 1.2. 15 (44%) tested positive for COVID at the time of enrollment, 16 (47%) had a pending or scheduled test, and 2 (6%) tested negative but were enrolled due to concern of a false-negative test. 25 (74%) patients responded to ≥1 text message, and 24 (71%) responded to multiple messages. Patients were more likely to respond if they did not have an outpatient healthcare appointment within 14 days after enrollment (100% vs. 46%, p = 0.001) and if they had a pending or scheduled test versus a positive test at enrollment (88% vs. 53%, p = 0.04). 4 (12%) patients were escalated to the triage line: 1 was advised to present to the ED, and 3 were managed in the outpatient setting. 7 (21%) patients presented to the ED for infectious symptoms within 14 days of enrollment, and 2 (6%) were admitted for worsening COVID-19 symptoms. There was no difference in the ED presentation rate between patients who responded to ≥1 text message and those who did not (20% vs. 22%, p = 0.88). 3 (9%) patients died within 30 days of enrollment; no deaths were attributed to COVID. Participant satisfaction was high (Net Promoter Score 100, n = 4). Conclusions: Intensive remote symptom monitoring and rapid nurse practitioner triage for worsening symptoms is feasible for outpatients with cancer and suspected/confirmed COVID-19 infection. Patients with concerning symptoms were adherent with Cancer COVID Watch and mostly managed in the outpatient setting. Efforts to manage symptomatic patients with cancer during future pandemics could use a similar approach.

scholarly journals A Mobile Smoking Cessation Intervention for Mexico (Vive sin Tabaco... ¡Decídete!): Single-Arm Pilot Study (Preprint)

2018 ◽  
Author(s):  
Ana Paula Cupertino ◽  
Francisco Cartujano-Barrera ◽  
Mariana Ramírez ◽  
Rosibel Rodríguez-Bolaños ◽  
James F Thrasher ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Text Messaging ◽  
Text Messages ◽  
Smoking Cessation Program ◽  
Participant Satisfaction ◽  
Program Participant ◽  
High Satisfaction ◽  
Exhaled Carbon Monoxide ◽  
Mobile Intervention ◽  
Support Software

BACKGROUND Of the 14.3 million Mexicans who smoke, only a minority take advantage of evidence-based approaches to smoking cessation. Mobile health interventions have the potential to increase the reach of effective cessation interventions in Mexico. OBJECTIVE This study aimed to assess the feasibility and acceptability of an innovative, personalized, and interactive smoking cessation mobile intervention developed for Mexican smokers. METHODS We recruited 40 Mexican smokers to participate in Vive sin Tabaco... ¡Decídete!, a smoking cessation program that uses a tablet-based decision support software to drive a 12-week text messaging smoking cessation program and pharmacotherapy support. Outcome measures included participant text messaging interactivity with the program, participant satisfaction, and 12-week verified abstinence using urinary cotinine testing or exhaled carbon monoxide. RESULTS Average age of the participants was 36 years (SD 10.7), and they were primarily male (65%, 26/40) with at least an undergraduate degree (62%, 25/40). Most participants (95%, 38/40) smoked daily and were interested in quitting in the next 7 days. As an indicator of participant interactivity, participants sent an average of 21 text messages during the 12-week intervention (SD 17.62). Of the 843 messages that participants sent to the program, only 96 messages (11.3%, 96/843) used keywords. At 12 weeks, 40% (16/40) of participants were biochemically verified (87%, 35/40, follow-up rate). The majority of participants (85%, 30/35) reported being very satisfied or extremely satisfied with the program. CONCLUSIONS The Vive sin Tabaco... ¡Decídete! smoking cessation mobile intervention was accepted by participants, generated high satisfaction and high text messaging interactivity, and resulted in a noteworthy cessation rate at the end of treatment. This intervention is a promising strategy for smoking cessation in Mexico. Additional testing as a formal randomized clinical trial appears warranted.

scholarly journals Pilot randomized trial of an electronic symptom monitoring intervention for hospitalized patients with cancer

2019 ◽  
Vol 30 (2) ◽  
pp. 274-280 ◽  
Author(s):  
R.D. Nipp ◽  
A. El-Jawahri ◽  
M. Ruddy ◽  
C. Fuh ◽  
B. Temel ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Hospitalized Patients ◽  
Symptom Monitoring ◽  
Patients With Cancer

scholarly journals Innovative Partnerships to Address Food Insecurity during the COVID-19 Pandemic: The Brighter Bites Produce Voucher Program

2021 ◽  
Vol 18 (17) ◽  
pp. 9175
Author(s):  
Amier Haidar ◽  
Christine Markham ◽  
Allison Marshall ◽  
Ru-Jye Chuang ◽  
Meredith Spence ◽  
...  
Keyword(s):  
Low Income ◽  
Descriptive Statistics ◽  
Non Profit ◽  
Participant Satisfaction ◽  
Voucher Program ◽  
For Profit ◽  
Program Participant ◽  
Low Income Families ◽  
The One ◽  
The U.S

The purpose of this communication is to describe the Brighter Bites produce voucher program, and its implementation and utilization across Brighter Bites families in four cities in the U.S., during the COVID-19 pandemic. The voucher program was implemented over nine weeks starting April 2020, with up to four USD 25 store-specific produce coupons sent bi-weekly to the homes of each participating Brighter Bites family (USD 100 total/family). Measures included type of produce purchased, amount of voucher that was used, number of vouchers distributed and redeemed by families, and a post-program participant satisfaction survey. Descriptive statistics, including count, frequency, and percent, were computed, both overall and stratified by city. During this time, Brighter Bites distributed a total of over 43,982 vouchers to 12,482 low-income families, with a redemption rate of 60% (at least one voucher redeemed) across all cities. During times of crisis, non-profit–for-profit partnerships, such as the one between Brighter Bites and the grocery retail industry, are feasible, and successful in providing produce to families in need.

Navigation models in diverse outpatient settings: Shared themes, challenges, and opportunities.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 134-134
Author(s):  
Narcessa Gail-Rosales Greenwood ◽  
Cynthia B. Taniguchi ◽  
Amy Sheldrick ◽  
Leslie Hurley
Keyword(s):  
Best Practice ◽  
Performance Metrics ◽  
Community Setting ◽  
Outpatient Setting ◽  
Cost Of Care ◽  
Scope Of Practice ◽  
Evidence Based ◽  
Oncology Nurse ◽  
Geographical Regions ◽  
Nurse Navigator

134 Background: Navigation has been recognized by the Centers for Medicare and Medicaid Services (CMS) as a component of quality oncology care. This discussion highlights progress of Nurse Navigation implementation within 3 US Oncology Network practices. A team-based approach optimizing patient care coordination and providing enhanced services has been identified. Study practices demonstrate common navigation goals and desired outcomes, despite variations in practice size, dissimilar workflows, and unclear best-practice guidelines for navigation in the outpatient setting. Methods: The US Oncology Network formed a committee to study and develop evidence-based nurse navigation processes for recommendation to the greater Network. The committee includes 6 members, each a lead Oncology Nurse Navigator, practicing in different US geographical regions. Preliminary steps were to seek evidence-based support through: Existing models for Oncology Nurse Navigation that are adaptable for the community setting Best-practice in navigation recommendations from esteemed professional organizations Challenges and solutions identified and implemented Scope of practice for the Nurse Navigator in a community setting Performance metrics targeting effective, value-driven navigation Results: Focusing on scientific Nursing Process, study practices provided navigation services to 3762 patients. Gaps in navigation processes were identified, as well as barriers throughout the continuum of care. Scope of Practice for the community-based Nurse Navigator was defined. Navigation framework was established to include patient/family education, psychosocial interventions, referral outsourcing, and patient advocacy. A formal job description was created for the role of the Oncology Nurse Navigator. The Interdisciplinary Care Team Conference Standard was finalized to support coordination of care. Conclusions: Work remains to define, implement, and test effective navigational models to support challenges of patients receiving care in the outpatient setting. Benefits resulting from Nurse Navigation processes are emerging as healthcare trends advance quality of care while decreasing total cost of care.

Chemotherapy remote care monitoring program (CRCMP): Integration of an SMS text patient-reported outcome (PRO) in the electronic health record (EHR) to identify patients needing pharmacist intervention for chemotherapy-induced nausea and vomiting (CINV).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2001-2001 ◽  
Author(s):  
Shannon Hough ◽  
Rachel McDevitt ◽  
Victoria Nachar ◽  
Shawna Kraft ◽  
Anna Brown ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Rapid Assessment ◽  
Monitoring Program ◽  
Text Message ◽  
Pharmacist Intervention ◽  
Urgent Care ◽  
Cancer Center ◽  
Care Utilization ◽  
Patient Reported

2001 Background: CINV is a feared side effect of cancer therapy. Despite advances in management, CINV is a common cause for emergency department (ED) evaluation and other unplanned health care utilization. The University of Michigan Rogel Cancer Center initiated the CRCMP to proactively identify patients (pts) experiencing CINV and intervene prior to the need for urgent evaluation. Methods: Pts receiving highly emetogenic chemotherapy are identified by administration of a NK1 antagonist. Once enrolled in the CRCMP, pts receive a daily text message survey for 7 days after treatment. The survey is based on the validated MASCC anti-emesis tool (MAT). Responses are stored within a flowsheet in the EHR. Responses above a set threshold trigger a message to the team pharmacist for intervention. Data presented was reviewed from EHR and claims data. Results: In 8 mo, 652 pts received a NK-1 antagonist (2244 total cycles) and 387 pts enrolled in the CRCMP (59%). Each pt enrolled for an average of 1.8 cycles of chemo (range 1-8). Of patients enrolled, 61.4% were female and 86.2% were Caucasian. Chemotherapy intent was curative for 51.7% and palliative for 48.3% of pts. Pts enrolled most commonly received cisplatin-based (29.7%) followed by carboplatin-based (22.5%), and 5-fluoruracil-based (20.9%) therapy. Text message response rate was 94% (N=18,143 responses of 19,256 total messages sent). During 861 cycles of therapy, 7% of responses noted vomiting and 33% of responses noted nausea. Since implementation of CRCMP, total hospitalization, ED, and urgent care use has decreased (p=0.029) compared to historical data. When utilization for nausea-related diagnoses was considered, the reduction was more notable (Table). Conclusions: Pts engaged in the CRCMP for CINV, allowing for rapid assessment of PROs by a pharmacist. Health care utilization related to nausea was reduced following implementation of CRCMP. While these changes were numerically small, reduction in unnecessary care utilizing PROs can contribute to high value care for cancer patients. [Table: see text]

scholarly journals Breaking Cancer Bad News to Patients With Cancer: A Comprehensive Perspective of Patients, Their Relatives, and the Public—Example From a Middle Eastern Country

2016 ◽  
Vol 2 (5) ◽  
pp. 268-274 ◽  
Author(s):  
Jamal Zekri ◽  
Syed Mustafa Karim
Keyword(s):  
Middle Eastern ◽  
Multivariable Analysis ◽  
College Education ◽  
Outpatient Setting ◽  
Bad News ◽  
Middle Eastern Country ◽  
The Public ◽  
Patients With Cancer ◽  
Affirmative Response ◽  
Eastern Cultures

Purpose Empowering patients with cancer requires that they be continuously informed about their condition. In some Eastern cultures, this concept is often opposed by caregivers. We aim to compare the extent of disclosure desired by actual and presumed patients with cancer and their relatives in our practice. Methods Nine questions reflecting possible bad news communication to patients from diagnosis to the end of life were designed to investigate the extent of desired disclosure and were answered by 100 patients (cohort I) and 103 accompanying relatives (cohort II) in an outpatient setting. In addition, 103 public participants attending a family medicine clinic (cohort III) each answered the questions from the perspective of a presumed patient (cohort IIIA) and the perspective of a relative (cohort IIIB). The primary end point was affirmative response to six or more questions (AR ≥ 6), reflecting a preference to be informed of the majority (≥ 67%) of possible bad news. Results AR ≥ 6 was reported in 85% of cohort I and 52% of cohort II (χ2 P < .001). On multivariable analysis, AR ≥ 6 showed significant association with being a patient (in cohorts I and II) and having nonmetastatic disease (only in cohort I). In the public cohort, AR ≥ 6 was reported in 91% in cohort IIIA and 63% in cohort IIIB (χ2 P < .001). On multivariable analysis, AR ≥ 6 in cohort III was significantly associated with being a presumed patient and having at least a college education. Conclusion Patients desire disclosure of the majority of cancer-related bad news. This is in contrast to the views and requests of relatives. The public participants would also desire similar disclosure if they were to be diagnosed with cancer.

scholarly journals Infection rate and clinical management of cancer patients during the COVID-19 pandemic: experience from a tertiary care hospital in northern Italy

ESMO Open ◽  
2020 ◽  
Vol 5 (3) ◽  
pp. e000810 ◽  
Author(s):  
Dominic Fong ◽  
Simon Rauch ◽  
Christian Petter ◽  
Eva Haspinger ◽  
Monika Alber ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Tertiary Care ◽  
Outpatient Setting ◽  
Control Group ◽  
Care Hospital ◽  
Patients With Cancer ◽  
Reverse Transcription Pcr ◽  
Treatment Prevalence ◽  
Respective Control Group ◽  
Anticancer Treatment

BackgroundOptimal management of patients with cancer during COVID-19 pandemic is still pending.MethodsOur patients were advised to maintain their scheduled appointments, and planned cancer treatment was continued without unnecessary delays in an outpatient setting. Additional strict preventive infection measures were rapidly implemented at our outpatient department. When COVID-19 test became widely available, universal testing of healthcare workers and vigorous screening of all patients coming to our facility for COVID-19 infection were performed by SARS-CoV-2 real-time reverse transcription PCR on rhinopharyngeal swab.ResultsAs of the data cut-off on 9 April 2020, a total of 156 oncology patients with a median age of 67 (range 26–86) years and 63 haematology patients (median age 69 years, range 23–89) were screened for COVID-19 during active cancer treatment. Prevalence (1.8%; 4/219) of COVID-19 in patients with cancer was significantly higher compared with a respective control group of asymptomatic counterparts (p=0.018). Outcomes of COVID-19 positive patients were good, with only one observed death due to progression of advanced metastatic disease.ConclusionOur data indicate that continuation of anticancer treatment in epidemic areas during the COVID-19 pandemic seems to be safe and feasible, if adequate and strict preventive measures are vigorously and successfully carried out.

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