Center for Shared Decision Making and Nursing Research, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
J Am Med Inform Assoc. 2010 Jul-Aug;17(4):403-10. doi: 10.1136/jamia.2010.005660.
To examine the effects of a computer-assisted, interactive tailored patient assessment (ITPA) tool in oncology practice on: documented patient care, symptom distress, and patients' need for symptom management support during treatment and rehabilitation.
For this repeated measures clinical trial at a university hospital in Norway, 145 patients starting treatment for leukemia or lymphoma were randomly assigned to either an intervention (n=75) or control group (n=70). Both groups used the ITPA for symptom assessments prior to inpatient and outpatient visits for up to one year. The assessment summary, which displayed patients' self-reported symptoms, problems, and distress in rank-order of the patient's need for support, was provided to physicians and nurses in the intervention group only but not in the control group.
Significantly more symptoms were addressed in the intervention group patient charts versus those of the control group. Symptom distress in the intervention group decreased significantly over time in 11 (58%) of 19 symptom/problem categories versus 2 (10%) for the control group. Need for symptom management support over time also decreased significantly more for the intervention group than the control group in 13 (68%) symptom categories.
This is the first study to show that an ITPA used in an interdisciplinary oncology practice can significantly improve patient-centered care and patient outcomes, including reduced symptom distress and reduced need for symptom management support.
研究在肿瘤学实践中使用计算机辅助、互动式个体化患者评估(ITPA)工具对以下方面的影响:记录的患者护理、症状困扰以及患者在治疗和康复期间对症状管理支持的需求。
在挪威一所大学医院进行的这项重复测量临床试验中,145 名开始接受白血病或淋巴瘤治疗的患者被随机分配到干预组(n=75)或对照组(n=70)。两组患者在接受门诊和住院治疗期间,均使用 ITPA 进行症状评估,为期一年。评估摘要以患者需求支持的等级顺序显示患者自我报告的症状、问题和困扰,仅向干预组的医生和护士提供,但对照组没有提供。
干预组患者病历中记录的症状明显多于对照组。与对照组相比,干预组 19 个症状/问题类别中的 11 个(58%)症状困扰随时间显著下降,而对照组仅 2 个(10%)下降。随着时间的推移,干预组患者对症状管理支持的需求也明显比对照组减少,13 个(68%)症状类别均如此。
这是第一项表明在跨学科肿瘤学实践中使用 ITPA 可显著改善以患者为中心的护理和患者结局的研究,包括减轻症状困扰和减少对症状管理支持的需求。