An effectiveness-implementation hybrid trial for informatics-based cancer symptom management.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 236-236
Author(s):  
Justin D. Smith ◽  
Sofia F. Garcia ◽  
Frank J. Penedo ◽  
Denise M. Scholtens ◽  
Betina Yanez ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Cancer Patients ◽  
Symptom Management ◽  
Trial Design ◽  
Self Management ◽  
Management Intervention ◽  
Management Interventions ◽  
Implementation Trial ◽  
Hybrid Trial

236 Background: Oncology outpatients can facesignificant cancer- and treatment-related symptoms that compromise health related quality of life and quality health care. Although the burden of symptoms on patients’ lives are well-known, most health care systems are not ideally set up to relieve them. Patients are not typically drawn into meaningful engagement with the health care team in ways that enable symptom self-management. As a result, opportunities for early identification and treatment are lost, causing avoidable human suffering and cost. The Northwestern University IMPACT (NU IMPACT) project aims to evaluate the effectiveness and implementation of an informatics-driven symptom monitoring and web-based self-management intervention. The project uses PROMIS measures, integrated into the EHR, to trigger response and intervention. This presentation describes the effectiveness-implementation hybrid trial design and measurement of implementation. Methods: NU IMPACT will test the effectiveness and implementation of a system-wide symptom management intervention, across six adult hematology/oncology and gynecologic oncology outpatient clinics at Northwestern Memorial HealthCare, using a cluster randomized pragmatic roll-out implementation trial with an embedded individual-level randomized clinical trial. This unique design allows for a fully-powered randomized trial to establish the efficacy of the intervention, as well as a randomized test of implementation. We are enrolling approximately 6,000 patients in pre-implementation and 6,000 in post-implementation, with half of the latter group randomly assigned to enhanced symptom management, and the other half to usual care. Results: Implementation process is guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) model with evaluation following the RE-AIM framework. Particular focus is paid to adoption at the clinic and provider levels, the extent to which the intervention achieves meaningful reach to cancer patients, and the potential for sustainment. Additionally, we are testing and validating a newly developed method for tracking and reporting dynamic changes to implementation strategies. Conclusions: Achieving the aims of the NU IMPACT project is a critical step in the advancement of informatics-driven symptom management interventions for cancer patients. The innovative implementation trial design and measurement approach will aid in the rapid translation of findings to other healthcare systems. Clinical trial information: NCT03988543 .

scholarly journals Individually tailored self-management app-based intervention (selfBACK) versus a self-management web-based intervention (e-Help) or usual care in people with low back and neck pain referred to secondary care: protocol for a multiarm randomised clinical trial

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e047921
Author(s):  
Anna Marcuzzi ◽  
Kerstin Bach ◽  
Anne Lovise Nordstoga ◽  
Gro Falkener Bertheussen ◽  
Ilya Ashikhmin ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Neck Pain ◽  
Usual Care ◽  
Secondary Care ◽  
Self Management ◽  
Low Back ◽  
Musculoskeletal Health ◽  
Web Based ◽  
Management Intervention ◽  
Management Interventions

IntroductionLow back pain (LBP) and neck pain (NP) are common and costly conditions. Self-management is a key element in the care of persistent LBP and NP. Artificial intelligence can be used to support and tailor self-management interventions, but their effectiveness needs to be ascertained. The aims of this trial are (1) to evaluate the effectiveness of an individually tailored app-based self-management intervention (selfBACK) adjunct to usual care in people with LBP and/or NP in secondary care compared with usual care only, and (2) to compare the effectiveness of selfBACK with a web-based self-management intervention without individual tailoring (e-Help).Methods and analysisThis is a randomised, assessor-blind clinical trial with three parallel arms: (1) selfBACK app adjunct to usual care; (2) e-Help website adjunct to usual care and (3) usual care only. Patients referred to St Olavs Hospital, Trondheim (Norway) with LBP and/or NP and accepted for assessment/treatment at the multidisciplinary outpatient clinic for back or neck rehabilitation are invited to the study. Eligible and consenting participants are randomised to one of the three arms with equal allocation ratio. We aim to include 279 participants (93 in each arm). Outcome variables are assessed at baseline (before randomisation) and at 6-week, 3-month and 6-month follow-up. The primary outcome is musculoskeletal health measured by the Musculoskeletal Health Questionnaire at 3 months. A mixed-methods process evaluation will document patients’ and clinicians’ experiences with the interventions. A health economic evaluation will estimate the cost-effectiveness of both interventions’ adjunct to usual care.Ethics and disseminationThe trial is approved by the Regional Committee for Medical and Health Research Ethics in Central Norway (Ref. 2019/64084). The results of the trial will be published in peer-review journals and presentations at national and international conferences relevant to this topic.Trial registration numberNCT04463043.

Does a symptom management intervention affect depression among cancer patients: Results from a clinical trial

2004 ◽  
Vol 13 (11) ◽  
pp. 818-830 ◽  
Author(s):  
Charles Given ◽  
Barbara Given ◽  
Mohammad Rahbar ◽  
Sangchoon Jeon ◽  
Ruth McCorkle ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cancer Patients ◽  
Symptom Management ◽  
Management Intervention

scholarly journals Health care providers’ experiences of pain management and attitudes towards digitally supported self-management interventions for chronic pain: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cecilie Varsi ◽  
Ingrid Konstanse Ledel Solem ◽  
Hilde Eide ◽  
Elin Børøsund ◽  
Olöf B. Kristjansdottir ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Health Care Providers ◽  
Health Care Services ◽  
Self Management ◽  
Care Providers ◽  
Design Elements ◽  
Management Intervention ◽  
Management Interventions

Abstract Background Chronic pain constitutes a significant burden for the individuals affected, and is a frequent reason why patients seek health care services. While in-person psychosocial interventions can be of support to people living with chronic pain, such interventions are not always accessible. eHealth interventions may provide greater accessibility, but the evidence and use of digital self-management solutions for chronic pain are still limited and the lack of health care provider input in the development process of such solutions a concern. Therefore, the aim of the current study was to investigate health care providers’ experiences of treating patients with chronic pain, their attitudes towards, and use of, digital solutions in pain management, and their suggestions for content and design elements for a potential digital pain self-management intervention. Methods Twelve health care providers representing a variety of health care disciplines participated in semi-structured interviews. The interviews were analyzed using thematic analysis. Results The material was analyzed into three main themes: [1] Patients with chronic pain and their current use of the health care services, [2] Health care providers’ own motivation and impression of patient prerequisites for use of digital self-management interventions, and [3] Suggestions for content and design elements in a digital self-management intervention for people living with chronic pain. The challenges faced by patients living with chronic pain were described as numerous. Despite interest and positive attitudes, few of the health care providers had used or recommended eHealth solutions to their patients. A range of potential content and functionality elements were identified, including aspects of motivation and engagement and providers also emphasized the importance of easy access and positive, personal content to support existing treatment. Conclusions This study offers insights into health care providers’ considerations for the potential of digital self-management interventions supporting patients living with chronic pain. Findings indicate the need for change and a more comprehensive treatment approach to pain management. eHealth solutions may contribute to such change, and providers pointed to a need for health care provider involvement, timely support and follow-up as important factors for integrating digital pain self-management interventions into clinical care. Trial registration ClinicalTrials.gov: NCT03705104

scholarly journals Developing an Indigenous goal-setting tool: Counting Coup

2020 ◽  
Vol 1 (1) ◽  
pp. 49-57
Author(s):  
Iitáa Dáakuash ◽  
Alma McCormick ◽  
Shannen Keene ◽  
John Hallett ◽  
Suzanne Held
Keyword(s):  
Chronic Illness ◽  
Goal Setting ◽  
Indigenous Communities ◽  
Self Management ◽  
Future Research ◽  
Goal Theory ◽  
Management Intervention ◽  
Management Interventions ◽  
Indigenous Paradigm ◽  
Relational Accountability

Chronic illness self-management best practices include goal-setting as an important tool for developing better self-management habits and are often included as elements of chronic disease self-management interventions. However, the goal theory that many of these tools employ relies on individualistic principles of self-efficacy that are not culturally consonant within many Indigenous communities. During the creation of the [blinded] program, a chronic illness management intervention, we developed a goal-setting tool specific to the [blinded] Nation. Emerging from an Indigenous paradigm and methodology, Counting Coup serves as a goal-setting tool that promotes the [blinded] culture, connects individuals with their ancestors, and focuses on achievement of goals within relationships. Future research and practice should be grounded in the historical and cultural contexts of their communities when designing and implementing goal-setting tools. Limitations to Counting Coup as a goal-setting tool include the need for program facilitators to have a relationship with participants due to Counting Coup’s foundation in relational accountability and that the environmental context may pose difficulties for participants in moving towards behavior change.

scholarly journals Patients’ Communication Preferences Around Cancer Symptom Reporting During Cancer Treatment: A Phenomenological Study

2021 ◽  
Vol 12 (4) ◽  
Author(s):  
Sharyn Carrasco, PhD, RN
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Symptom Management ◽  
Phenomenological Study ◽  
Symptom Reporting ◽  
Communication Preferences ◽  
Health Care Practitioners

Background: The purpose of this descriptive phenomenological study was to gain an in-depth understanding of cancer patients’ experiences and perspectives on self-reporting their symptoms. Patients with cancer experience a wide variety of symptoms from both their disease and treatment, yet clinicians are often unaware of their patients’ symptoms due to poor reporting methods. Poorly documented symptoms are more likely to go untreated, causing increased symptom distress and decreased quality of life for patients. Effective, real-time communication between patients and health-care practitioners is key to symptom assessment and management. Moreover, it is important for patients’ communication preferences to be taken into account when developing symptom management plans. Methods: This qualitative study focused on the symptom reporting experiences of 13 adults in the United States with advanced or metastatic cancer who were undergoing systemic cancer treatment. Data were collected via interviews. Results: The findings revealed that a personalized symptom management plan, prompt reporting, and timely communication with health-care practitioners improved patients’ physical and emotional wellbeing. Conclusions: A better understanding of cancer patients’ experiences self-reporting their symptoms may lead to improved communication methods and more effective reporting systems, which ultimately reduce patient burden and enhance patients’ self-advocacy. Ensuring that patients’ preferences for reporting their symptoms are met may positively influence the likelihood and timeliness of symptom self-reporting. Developing new and improved ways for health-care teams to manage symptoms is vital to improving patients’ quality of life.

scholarly journals Design of a Web-based Symptom Management Intervention for Cancer Patients

2009 ◽  
pp. 775-784
Author(s):  
Christine M. Newlon ◽  
Chin-Chun A. Hu ◽  
Renee M. Stratton ◽  
Anna M. McDaniel
Keyword(s):  
Cancer Patients ◽  
Symptom Management ◽  
Web Based ◽  
Management Intervention

Changes in Patient Activation in a Self-Management Intervention

2019 ◽  
Vol 42 (3) ◽  
pp. 194-200
Author(s):  
Leeza A. Struwe ◽  
Myra S. Schmaderer ◽  
Lani Zimmerman
Keyword(s):  
Health Care ◽  
Patient Activation ◽  
Self Management ◽  
Outcome Analysis ◽  
Care Utilization ◽  
Individual Change ◽  
Point Change ◽  
Change Scores ◽  
Management Intervention ◽  
The Impact

The purpose of this study was to compare results using individual change in level of patient activation measure (PAM) scores, individual point change scores, and group means in an outcome analysis. We evaluated changes in PAM scores (increase in level or increase of ≥5 points) to mean group PAM scores on patients who completed a self-management intervention compared with usual care on health care utilization and health-related quality of life. The sample was a subset of 91 multimorbid patients with complete data at completion of a self-management intervention. Results indicated that using a change in points allowed for more refined analysis of change compared with level changes; however, both individual measures were more reflective of actual change than group means. When tailoring interventions, we should consider using individual change scores. Further research is needed to evaluate how best to use PAM scores to measure the impact on clinical and health care outcomes.

scholarly journals Randomized Pilot Trial of a Telephone Symptom Management Intervention for Symptomatic Lung Cancer Patients and Their Family Caregivers

2016 ◽  
Vol 52 (4) ◽  
pp. 469-482 ◽  
Author(s):  
Catherine E. Mosher ◽  
Joseph G. Winger ◽  
Nasser Hanna ◽  
Shadia I. Jalal ◽  
Lawrence H. Einhorn ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Family Caregivers ◽  
Symptom Management ◽  
Pilot Trial ◽  
Lung Cancer Patients ◽  
Management Intervention
Sign in / Sign up

Export Citation Format

Share Document