Harvard Medical School, Boston, MA, USA.
J Clin Oncol. 2011 Mar 10;29(8):1029-35. doi: 10.1200/JCO.2010.30.3909. Epub 2011 Jan 31.
Although patient-reported cancer symptoms and quality-of-life issues (SQLIs) have been promoted as essential to a comprehensive assessment, efficient and efficacious methods have not been widely tested in clinical settings. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment-Cancer (ESRA-C) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits. Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians.
This randomized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center. Patient-reported SQLIs were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit (n = 327); in the control group, no summary was provided (n = 333). SQLIs were scored for level of severity or distress. One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI. We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians.
The likelihood of SQLIs being discussed differed by randomized group and depended on whether an SQLI was first reported as problematic (P = .032). Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful.
The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US randomized clinical trial.
尽管患者报告的癌症症状和生活质量问题(SQLI)已被认为是全面评估的重要组成部分,但在临床环境中尚未广泛测试有效且高效的方法。本试验的目的是确定电子自我报告评估-癌症(ESRA-C)对在门诊就诊期间临床医生与癌症患者之间讨论 SQLI 的可能性的影响。次要目标包括比较两组之间的就诊时间以及临床医生报告的 ESRA-C 的有用性。
这项随机对照试验在综合癌症中心的两个机构的 660 名患有各种癌症诊断和分期的患者中进行。在治疗前就诊时(n = 327),患者报告的 SQLI 会自动显示在图形摘要上,并提供给临床团队;在对照组中(n = 333),则不提供摘要。SQLI 根据严重程度或困扰程度进行评分。每位参与者的一次治疗就诊都进行了录音,然后对每个 SQLI 的讨论进行评分。我们假设当干预措施提供给临床医生时,更有可能讨论有问题的 SQLI。
随机分组的 SQLI 讨论的可能性不同,并且取决于 SQLI 是否首先被报告为有问题(P =.032)。两组之间的就诊时间相似,并且临床医生报告摘要有用。
ESRA-C 是第一个在美国随机临床试验中增加 SQLI 讨论的电子自我报告应用程序。