Centre for Health Research and Psycho-oncology, Cancer Council New South Wales, University of Newcastle and Hunter Medical Research Institute, Level 2, David Maddison Building, University of Newcastle, Callaghan, New South Wales 2308, Australia.
J Clin Oncol. 2009 Dec 20;27(36):6180-90. doi: 10.1200/JCO.2009.22.8718. Epub 2009 Nov 16.
Patients with cancer experience considerable symptom burden, psychological morbidity, and unmet psychosocial needs. Research suggests that feedback of patient-reported outcomes to clinicians or caseworkers, alongside management strategies, may result in improved patient functioning. Two intervention models were developed to test this effect in a randomized, controlled trial against usual care (UC): a telephone caseworker (TCW) model and an oncologist/general practitioner (O/GP) model. Primary end points included anxiety, depression, physical/emotional functioning, and unmet supportive care needs.
Participants with nonlocalized breast or colorectal cancers were surveyed by computer-assisted telephone interview (CATI) at three time points: baseline, 3 months, and 6 months. Data collected from participant CATIs in the supportive care models were used to generate feedback to either each participant's designated TCW, or their nominated O/GPs. Data obtained from participants in the UC model were used only to assess the impact of supportive care models. In total, 356 participants consented to study participation, completed the baseline CATI, and were randomly assigned to the UC, TCW, or O/GP groups.
No overall intervention effect was observed. Physical functioning was significantly improved at the third CATI for participants in the TCW model (P = .01), and there was a trend toward fewer participants with unmet needs (P = .07). TCW group participants also were more likely to have the following: identified issues of need discussed (P < .0001); referrals made (P < .0001); and strong agreement that the intervention improved communication with their health care team (P = .0005).
The TCW model holds some promise; however, additional work in at-risk populations is required before we recommend implementation.
癌症患者经历着相当大的症状负担、心理困扰和未满足的心理社会需求。研究表明，将患者报告的结果反馈给临床医生或个案工作者，并结合管理策略，可能会改善患者的功能。两种干预模式被开发出来，以在一项针对常规护理（UC）的随机对照试验中测试这一效果：电话个案工作者（TCW）模式和肿瘤医生/全科医生（O/GP）模式。主要终点包括焦虑、抑郁、身体/情绪功能和未满足的支持性护理需求。
非局部性乳腺癌或结直肠癌患者通过计算机辅助电话访谈（CATI）在三个时间点进行调查：基线、3 个月和 6 个月。从支持性护理模型中参与者的 CATI 收集的数据用于生成反馈，反馈给每个参与者指定的 TCW 或他们提名的 O/GP。从 UC 模型中参与者获得的数据仅用于评估支持性护理模型的影响。共有 356 名参与者同意参与研究，完成了基线 CATI，并被随机分配到 UC、TCW 或 O/GP 组。
未观察到总体干预效果。在 TCW 模型的第三次 CATI 中，参与者的身体功能显著改善（P =.01），且未满足需求的参与者数量呈下降趋势（P =.07）。TCW 组的参与者更有可能出现以下情况：确定讨论的需求问题（P <.0001）；提出转诊（P <.0001）；并强烈认为干预措施改善了与他们的医疗团队的沟通（P =.0005）。
TCW 模式有一定的前景；然而，在我们推荐实施之前，还需要在高危人群中开展更多的工作。
