Self-reported patient barriers and the impact of digital health coaching on PRO in cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 189-189
Author(s):  
Matthew Allison ◽  
Stephen Burton ◽  
Dhiren Patel ◽  
Kelly Jean Brassil
Keyword(s):  
Medication Adherence ◽  
Access To Care ◽  
Healthy Eating ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Digital Health ◽  
Health Coaching ◽  
Financial Toxicity ◽  
Patient Reported ◽  
The Impact

189 Background: Barriers during cancer care include lack of social support, financial concerns, and communication with providers. While navigation has been identified as a way to address these concerns in the clinical context, opportunities exist to identify and address patient-reported barriers through digital health coaching to support patients beyond the clinical care setting. Methods: A retrospective analysis evaluated patient-reported barriers during cancer care for 708 individuals over the course of a digital health coaching program. Barriers were assessed in six domains, each represented by 5-10 questions in a company developed survey. The questions were administered prior to coaching on content aligned to the domains, specifically eating healthy, exercise, financial, access to care and medication adherence. Patients ranked both the presence and severity of the barrier. Patient reported outcomes such as exercise (Godin), health eating (Start the Conversation), financial toxicity (Comprehensive Score for Financial Toxicity (COST)) and physiologic and psychosocial outcomes (Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) 10) were measured and aligned to the barrier domains identified by the participants. Results: The eating healthy domain (2.43) received a significantly higher average score compared to other domains: financial (1.86), exercise (1.71), medication adherence (1.68) and access to care (1.65). Over the 12-week coaching program, physical activity increased by 56%, fatigue was reduced by 32%, financial toxicity was reduced by 8%, the healthy eating score improved by 17% and pain was reduced by 13%, as reflected in the PROMIS GH-10, Godin, STC and COST data. Conclusions: Outcomes suggest that healthy eating is a significant barrier identified by cancer patients during their treatment, followed by financial concerns and exercise, each of which demonstrated improvement over the course of digital health coaching. These results suggest digital health coaching provides a benefit to addressing barriers during cancer treatment and may improve patient reported outcomes, particularly as they relate to wellness behaviors such as healthy eating and exercise.

The impact of telemedicine on patient-reported outcomes in urologic oncology.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14154-e14154
Author(s):  
Adam John Gadzinski ◽  
Isabelle O. Abarro ◽  
Blair Stewart ◽  
John L. Gore
Keyword(s):  
Travel Time ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Care Delivery ◽  
Testis Cancer ◽  
Urologic Oncology ◽  
Time Costs ◽  
Patient Reported ◽  
The Impact ◽  
Travel Burden

e14154 Background: Nearly 20% of Americans live in rural communities. These individuals face barriers to accessing cancer care, including prevalent poverty and substantial travel burden to seeing cancer providers. We aimed to assess the impact of a rurally focused telemedicine program on patient outcomes in our urologic oncology outpatient clinic. Methods: We prospectively identified patients from rural Washington State, or who lived outside Washington, with a known or suspected urological malignancy being evaluated at the University of Washington Urology Clinic via an in person clinic or a telemedicine appointment. Patients were invited to complete a post-visit survey that assessed satisfaction, travel time, costs, and work absenteeism. We compared patient-reported outcomes between those seen as in-person versus telemedicine visits. Results: We invited 291 eligible patients from June 2019 – February 2020 to participate, 140 patients (48%) completed the survey. One-hundred and thirty-three patients had in person visits and 7 had telemedicine visits. Median age was 68, male 86%, and 69% Caucasian. Eighty-seven patients (62%) were from rural Washington; the remainder resided out-of-state. Patients were being evaluated for prostate cancer (57%), kidney cancer (18%), urothelial cancer (24%), and testis cancer (1%). Patient-reported outcomes are displayed in Table. Seventeen patients coming for in-person visits (13%) paid ≥ $1000 in total travel costs. No differences were noted in patient satisfaction. Conclusions: Patients traveling to our clinic from out-of-state and rural Washington incur significant travel time, costs, and time away from work to receive outpatient urologic cancer care. Telemedicine provides a medium for cancer care delivery that eliminates the significant travel burden associated with in person clinic appointments. [Table: see text]

Comorbidities and patient-reported outcomes among individuals with cancer enrolled in a digital health coaching program.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19278-e19278
Author(s):  
Kelly Jean Brassil ◽  
Jonathan Patterson ◽  
Matthew Allison ◽  
Stephen Burton ◽  
Thupten Norbu ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Digital Health ◽  
Patient Reported Outcome Measures ◽  
Health Coaching ◽  
Clinical Approach ◽  
Morbid Condition ◽  
Physical And Mental Health ◽  
Co Morbidity ◽  
Patient Reported ◽  
Morbid Conditions

e19278 Background: Many individuals with cancer, as high as 90% in some studies, experience co-morbidities, which are associated with survival, quality of life and health care costs. Patient reported outcomes (PRO) have demonstrated efficacy in tracking outcomes for individuals with cancer and other chronic conditions. We present real world evidence of co-morbidities and PRO data from a cohort of individuals with cancer engaged in a digital health coaching program. Methods: A retrospective analysis was conducted of self-reported co-morbidity data and PROs collected from individuals with cancer upon enrollment in a digital health coaching program. Descriptive statistics define frequency of co-morbidities and means of PRO, including the Patient Reported Outcome Measures Information System-Global Health (PROMIS-GH)10, for individuals with cancer only compared with those who also had a co-morbid condition. Results: Of 570 individuals, 127 reported a co-morbid condition on enrollment into the coaching program (22%). Of these, 49.6% (n = 63) reported 1, and 50.4% (n = 64) reported 2 or more conditions, of which the most commonly reported were cardiovascular (45.6%), metabolic (39.3%), and immune-related (22.8%). Mean PRO scores at baseline are presented for each measure for individuals who reported either no or 1 or more co-morbid conditions at baseline (Table). Interestingly individuals with at least 1 comorbidity reported higher PRO scores for physical and mental health at baseline than those with cancer alone. Conclusions: Co-morbid conditions, while known to influence clinical outcomes among individuals with cancer, may also influence trends in PRO. Higher scores in this cohort may suggest that experience with a pre-existing condition may support the individual’s ability to cope with a cancer diagnosis and its physical and emotional sequelae. Digital health coaching may offer a unique non-clinical approach to gather this data and to support individuals to optimize self-efficacy, improving health outcomes beyond the clinical setting. [Table: see text]

The impact of telemedicine on patient-reported outcomes in urologic oncology.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 200-200
Author(s):  
Adam John Gadzinski ◽  
Isabelle O. Abarro ◽  
Blair Stewart ◽  
John L. Gore
Keyword(s):  
Travel Time ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Care Delivery ◽  
Testis Cancer ◽  
Urologic Oncology ◽  
Time Costs ◽  
Patient Reported ◽  
The Impact ◽  
Travel Burden

200 Background: Nearly 20% of Americans live in rural communities. These individuals face barriers to accessing cancer care, including prevalent poverty and substantial travel burden to seeing cancer providers. We aimed to assess the impact of a rurally focused telemedicine program on patient outcomes in our urologic oncology outpatient clinic. Methods: We prospectively identified patients from rural Washington State, or who lived outside Washington, with a known or suspected urological malignancy being evaluated at the University of Washington Urology Clinic via an in person clinic or a telemedicine appointment. Patients were invited to complete a post-visit survey that assessed satisfaction, travel time, costs, and work absenteeism. We compared patient-reported outcomes between those seen as in-person versus telemedicine visits. Results: We invited 1453 eligible patients from August 2019–July 2020 to participate; 615 patients (42%) completed the survey. 198 patients had in person visits and 417 had telemedicine visits. Median age was 68, 89% were male, and 73% were white. 525 patients (85%) were from Washington; the remainder resided out-of-state. Patients were being evaluated for prostate cancer (62%), kidney cancer (14%), urothelial cancer (22%), and testis cancer (2%). Patient-reported outcomes are displayed in Table. Twenty-two patients coming for in-person visits (11%) paid ≥ $1000 in total travel costs. No differences were noted in patient satisfaction between in-person and telemedicine visit types. Conclusions: Patients traveling to our clinic from out-of-state and rural Washington incur significant travel time, costs, and time away from work to receive outpatient urologic cancer care. Telemedicine provides a medium for cancer care delivery that eliminates the significant travel burden associated with in-person clinic appointments. [Table: see text]

Impact of Pharmacist Intervention on Medication Adherence and Patient-Reported Outcomes among Depressed Patients in a Private Psychiatric Hospital of Nepal: a randomised controlled trial

2020 ◽  
pp. 001857872097046
Author(s):  
Nirmal Raj Marasine ◽  
Sabina Sankhi ◽  
Rajendra Lamichhane
Keyword(s):  
Medication Adherence ◽  
Psychiatric Hospital ◽  
Patient Reported Outcomes ◽  
Intervention Group ◽  
Control Group ◽  
Pharmaceutical Service ◽  
Patient Reported ◽  
Service Intervention ◽  
Severity Of Depression ◽  
The Impact

Aim: We aimed to evaluate the impact of pharmaceutical service intervention on medication adherence and patient-reported outcomes among patients diagnosed with depression in a private psychiatric hospital in Nepal. Methods: A single-center, open trial with a parallel design was conducted among 18 to 65 years aged patients, diagnosed with depression and under antidepressant medication(s) for ≥2 months. Patients were randomised into either the intervention or control group. The control group (n = 98) received the usual care, while the intervention group (n = 98) received a pharmaceutical service intervention. The two groups were compared using the Mann-Whitney U test, independent t-test, or chi-square test at 2 and 4 months for changes in medication adherence and patient-reported [severity of depression and health-related quality of life (HRQoL)] outcomes. Results: One hundred ninety adult patients were enrolled in the study. At baseline, there were no significant differences in any of the outcome measures between the intervention and control groups. At 2 and 4 months, the intervention group had a significant improvement only in medication adherence ( P < .001) compared with the control group [MGL score: 1 (2) vs 2 (2) and 1 (1) vs 2 (1), P < .001, respectively]. Conclusion: Our study suggests that a brief pharmaceutical service intervention in the hospital setting can have a significant impact on patients’ adherence to antidepressants but does not improve their severity of depression and HRQoL.

scholarly journals THU0498 PATIENT-REPORTED TREATMENT BURDEN AND ITS IMPACT ON QUALITY OF LIFE IN JUVENILE IDIOPATHIC ARTHRITIS: RESULTS FROM THE PHARMACHILD REGISTRY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 486-487
Author(s):  
A. Alongi ◽  
A. Consolaro ◽  
G. Vijatov-Djuric ◽  
G. Filocamo ◽  
O. Vougiouka ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Disease Activity ◽  
Patient Reported Outcomes ◽  
Sleep Problems ◽  
Psychosocial Health ◽  
Research Support ◽  
School Problems ◽  
Patient Reported ◽  
The Impact

Background:Juvenile Idiopathic Arthritis (JIA) patients experience impaired health and wellbeing due to multiple causes of physical and psychosocial distress, including treatment burden. Despite emerging evidence of its relevance [1], the contribution of treatment adverse events to patient-reported outcomes (PROs) in JIA has been poorly explored.Objectives:To evaluate and rank the impact of patient-reported adverse events (AEs) on overall wellbeing, health-related quality of life (HRQoL), school problems and self-reported medication adherence using data from Pharmachild, a large international JIA pharmacovigilance registry.Methods:Registry entries on 5340 prospective visits of 2251 patients enrolled till December 2018 were analyzed; all included patients were treated with at least one DMARDS or Biologic agent at the time of visit. In the Juvenile Arthritis Multidimensional Assessment Report (JAMAR), patients and parents compiled a checklist of treatments, side effects, self-reported adherence, administration difficulties and disease-related school problems occurred in the previous 4 weeks. Evaluated outcomes included patient acceptable symptom state (PASS), VAS-measured patient assessment of overall wellbeing (PGA) and HRQoL, assessed through the physical health (PhH) and psychosocial health (PsH) subscales. The relationships between AEs and PROs were tested through generalized linear models, accounting for disease activity and symptoms levels. Bayesian Networks were used to explore the causal effects of specific AEs on outcomes to disentangle the confounding role of disease status.Results:AEs were reported in 22.9% of visits. For similar levels of physician global assessment (MD global), patient-assessed disease activity, pain and function, patients reporting AEs had worse PGA, PsH, and lower probability of reaching PASS (fig. 1, all p-values <0.001). The impact of AEs on PGA was small but not trivial (effect size η20.031) and appears to be mediated by effects on PsH and school problems (p <0.001). Non-linear regression modelling revealed a significant moderating effect of MD global levels < 2.5 on the relationship between AEs and PGA (p 0.003), indicating that the impact of AEs is higher for lower disease activity states. AEs predicted self-reported medication adherence (p<0.001), even when adjusted for the number of administered treatments. In the Bayesian network model, mood swing and sleep problems emerged as the most influential items affecting PsH, (respectively, total effect 2.62 and 1.25, both p< 0.001). Fig. 2 shows the total standardized effect of specific AEs on mean PsH levels. Nausea had the highest impact on treatment adherence (total effect -0.0541, p <0.001), being the only AE directly linked to drug refusal.Conclusion:AEs have a measurable effect on the wellbeing and psychosocial health of JIA patients, particularly when disease activity is low, and significantly affect school activity and medication adherence. Mood swings and sleep problems show the strongest influence on HRQoL. Addressing AEs appears important to reduce disease impact, improve patients’ satisfaction and therapeutic compliance.References: :[1]Weitzman, Elissa R., et al. Journal of patient-reported outcomes 2.1 (2018): 1.Acknowledgments:for the Paediatric Rheumatology International Trials Organisation (PRINTO)Disclosure of Interests: :Alessandra Alongi: None declared, Alessandro Consolaro Grant/research support from: Pfizer Inc., AlfaSigma, Speakers bureau: AbbVie, Gordana Vijatov-Djuric: None declared, Giovanni Filocamo: None declared, Olga Vougiouka: None declared, Alma Nunzia Olivieri: None declared, Cristina Herrera Mora: None declared, Wolfgang Emminger: None declared, Angelo Ravelli: None declared, Nicolino Ruperto Grant/research support from: Bristol-Myers Squibb, Eli Lily, F Hoffmann-La Roche, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sobi (paid to institution), Consultant of: Ablynx, AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lily, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sanofi, Servier, Sinergie, Sobi, Takeda, Speakers bureau: Ablynx, AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lily, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sanofi, Servier, Sinergie, Sobi, Takeda

Patient Reported Outcomes and Financial Toxicity in Head and Neck Cancer (PaRTNer): Baseline financial toxicity and attitudes toward costs from a pilot study.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 56-56
Author(s):  
Fumiko Chino ◽  
David M. Brizel ◽  
Yvonne Marie Mowery
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Treatment Decisions ◽  
Financial Toxicity ◽  
Cost Information ◽  
Patient Reported ◽  
Part Time

56 Background: Cancer patients face considerable financial burden, but few studies have explored associations between radiation therapy (RT) and financial toxicity. This study assessed financial toxicity, patient-reported outcomes, and attitudes/perspectives on the role of cost in treatment decisions. Methods: In a prospective, survey-based, longitudinal study (NCT3506451), eligible patients were adults with newly diagnosed non-metastatic head and neck cancer (HNC) undergoing RT as part of their definitive cancer treatment. Surveys collected demographics, cancer details, the COmprehensive Score for financial Toxicity (COST) score to measure financial toxicity, and patient attitudes regarding cost conversations. Results: 60 patients were enrolled (2019-2021), and 58 completed the baseline survey prior to the start of RT. Most were white (75.9%) and non-Hispanic (98.1%). Median age was 61 (range 42-86). Most were married or in long term partnerships (67.0%), had completed at least some college (70.7%), and had employer sponsored private insurance (55.2%). Half were working at least part time, and most earned > $60,000/yr (55.4%). Oropharynx (48.3%) was the most common disease site; almost half (48.1%) received concurrent chemotherapy. Median baseline COST score was 25 (range 0-44), indicating borderline financial toxicity. 37.7% had reduced spending on leisure items, and 30.9% had reduced spending on basics like food or clothing to pay for cancer care. 10.5% had skipped doses of medications to make them last longer, and 21.1% had not filled a prescription because it was too expensive. 19.6% had borrowed money, and 36.4% had used either all or part of their savings (or had no savings at all) to pay for care. Of those employed at diagnosis, 38.9% took extended leave or reduced hours to part time. 25.9% felt their treatment costs/financial situation should be a factor in treatment decisions. 50.8% wanted the less costly treatment, assuming equal effectiveness. 46.6% felt they should receive cost information from their doctor, and 63.8% wanted a financial assistance counselor or social worker to provide cost information. 46.6% felt that discussing their costs would make them feel more involved in their care. While 43.1% felt that talking about cancer-related costs would reduce their anxiety, 36.2% felt it would increase their anxiety. The majority (63.8%) had little or no understanding about the costs of their cancer care, and 69.0% felt that educational materials about costs would be helpful. Conclusions: Despite borderline baseline financial toxicity scores, some HNC patients had already made significant sacrifices in order to afford care before RT had even started. There was little baseline knowledge of cancer costs and overall mixed attitudes toward cost conversation. Most patients felt that cost education would be helpful. Clinical trial information: NCT03506451.

Overview of the Patient Perspective at OMERACT 10 — Conceptualizing Methods for Developing Patient-Reported Outcomes

2011 ◽  
Vol 38 (8) ◽  
pp. 1699-1701 ◽  
Author(s):  
JOHN R. KIRWAN ◽  
PETER S. TUGWELL
Keyword(s):  
Clinical Trials ◽  
Experimental Work ◽  
Patient Reported Outcomes ◽  
Patient Perspective ◽  
Methodological Issues ◽  
Instrument Selection ◽  
Patient Reported ◽  
The Impact ◽  
Choice Of Instruments ◽  
The Way

This overview draws out the main conclusions from the 4 workshops focused on incorporating the patient perspective into outcome assessment at the 10th Outcome Measures in Rheumatology (OMERACT 10) conference. They raised methodological issues about the choice of outcome domains to include in clinical trials, the development or choice of instruments to measure these domains, and the way these instruments might capture the impact of a disease and its treatment. The need to develop a more rigorous conceptual model of quantifying the way conditions affect health, and the need to ensure patients are directly involved in the decisions about domains and instruments, emerged clearly. The OMERACT participants voted to develop guidelines for domain and instrument selection, and conceptual and experimental work will be brought forward to revise and upgrade the OMERACT Filter.

The impact of a recent relapse on patient-reported outcomes in subjects with multiple sclerosis

2012 ◽  
Vol 21 (10) ◽  
pp. 1677-1684 ◽  
Author(s):  
Brian C. Healy ◽  
Irene R. Degano ◽  
Ana Schreck ◽  
David Rintell ◽  
Howard Weiner ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Patient Reported Outcomes ◽  
Patient Reported ◽  
The Impact
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