SymptomCare@Home: Deconstructing an Effective Symptom Management Intervention
| Status: | Enrolling by invitation |
|---|---|
| Conditions: | Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 5/5/2018 |
| Start Date: | August 7, 2017 |
| End Date: | March 2021 |
SymptomCare@Home (SCH): Deconstructing an Effective, Technology-assisted, Symptom Management Intervention
This project will determine the most important and cost effective components of
SymptomCare@Home, a new approach to cancer chemotherapy symptom care that has been shown to
reduce problematic symptoms through automated daily monitoring, self-management coaching, and
oncology team follow-up care using decisional support for patients at home when their
symptoms are most likely at their worse. Once the key parts of the intervention and its cost
effectiveness are known, it can be moved into everyday cancer care.
SymptomCare@Home, a new approach to cancer chemotherapy symptom care that has been shown to
reduce problematic symptoms through automated daily monitoring, self-management coaching, and
oncology team follow-up care using decisional support for patients at home when their
symptoms are most likely at their worse. Once the key parts of the intervention and its cost
effectiveness are known, it can be moved into everyday cancer care.
Cancer patients receiving chemotherapy experience multiple poorly controlled symptoms at home
in the interim weeks between clinic visits and the next infusion. Their care during this
interim time period is suboptimal. Technology can be utilized to bridge the gap between
patient symptom needs at home and oncology team response. Automated patient-reported symptom
home monitoring and management systems offer a new approach to symptom care. Our research
team has developed and tested SymptomCare@Home (SCH). This multi-component automated system
monitors daily patient-reported symptoms at home, provides tailored automated self-management
coaching based on the specific symptoms reported and transmits unrelieved symptom alert
reports to an oncology provider who, using the SCH decision support system provides follow-up
telephone-delivered symptom care. We have demonstrated that SCH dramatically reduces physical
and psychological symptom severity. However there remain several gaps in translating a
successful, multi-component symptom intervention into clinical practice. These include
understanding 1) the contribution and value of each part of the intervention so that the
active components are selected for clinical implementation and 2) the costs associated with
the intervention and its components. Therefore the aims of this project are to deconstruct
the SCH symptom monitoring and management system to determine the relative contribution and
costs of its components to achieving symptom reduction, maintain general health functioning
and reduce healthcare utilization. We will also examine who benefits most and least from the
individual components and from the overall system. A 5 group randomized control trial design
will be utilized with 750 participants (150/group) beginning a new course of chemotherapy who
will call the SCH system daily and report the presence and severity of 11 symptoms throughout
a course of chemotherapy or up to 6 months. This study is both significant and innovative
because it shifts the current clinical practice paradigm for providing symptom care
episodically during clinic visits to an innovative approach that is patient-centric,
providing symptom care when and where the patient needs it. The study will address questions
not generally asked in multi-component interventions, determining the active ingredients and
their costs. Determining the value of new approaches to care such as automated telehealth
interventions is essential to the decision process of healthcare systems and payers who
decide what to adopt and reimburse. It is also vitally important to patients so that new
symptom care innovations are adopted that better meet their needs and dramatically reduce
their symptoms.
in the interim weeks between clinic visits and the next infusion. Their care during this
interim time period is suboptimal. Technology can be utilized to bridge the gap between
patient symptom needs at home and oncology team response. Automated patient-reported symptom
home monitoring and management systems offer a new approach to symptom care. Our research
team has developed and tested SymptomCare@Home (SCH). This multi-component automated system
monitors daily patient-reported symptoms at home, provides tailored automated self-management
coaching based on the specific symptoms reported and transmits unrelieved symptom alert
reports to an oncology provider who, using the SCH decision support system provides follow-up
telephone-delivered symptom care. We have demonstrated that SCH dramatically reduces physical
and psychological symptom severity. However there remain several gaps in translating a
successful, multi-component symptom intervention into clinical practice. These include
understanding 1) the contribution and value of each part of the intervention so that the
active components are selected for clinical implementation and 2) the costs associated with
the intervention and its components. Therefore the aims of this project are to deconstruct
the SCH symptom monitoring and management system to determine the relative contribution and
costs of its components to achieving symptom reduction, maintain general health functioning
and reduce healthcare utilization. We will also examine who benefits most and least from the
individual components and from the overall system. A 5 group randomized control trial design
will be utilized with 750 participants (150/group) beginning a new course of chemotherapy who
will call the SCH system daily and report the presence and severity of 11 symptoms throughout
a course of chemotherapy or up to 6 months. This study is both significant and innovative
because it shifts the current clinical practice paradigm for providing symptom care
episodically during clinic visits to an innovative approach that is patient-centric,
providing symptom care when and where the patient needs it. The study will address questions
not generally asked in multi-component interventions, determining the active ingredients and
their costs. Determining the value of new approaches to care such as automated telehealth
interventions is essential to the decision process of healthcare systems and payers who
decide what to adopt and reimburse. It is also vitally important to patients so that new
symptom care innovations are adopted that better meet their needs and dramatically reduce
their symptoms.
Inclusion Criteria:
- Histological diagnosis of cancer
- Life expectance of at least three months
- Beginning a new course of chemotherapy that is planned for a minimum of three cycles
- English speaking
- Daily access to a telephone
- Cognitively capable to use the phone unassisted as verified by study staff at
recruitment
- Receiving care under the direction of one of the designated provider teams at Huntsman
Cancer Institute (SLC, UT) or Grady Cancer Institute (Atlanta, GA).
Exclusion Criteria:
- Receiving concurrent radiation therapy
- Exclusively receiving biotherapy
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