Yount Susan E, Rothrock Nan, Bass Michael, Beaumont Jennifer L, Pach Deborah, Lad Thomas, Patel Jyoti, Corona Maria, Weiland Rebecca, Del Ciello Katherine, Cella David
Northwestern University, Chicago, Illinois, USA.
Northwestern University, Chicago, Illinois, USA.
J Pain Symptom Manage. 2014 Jun;47(6):973-89. doi: 10.1016/j.jpainsymman.2013.07.013. Epub 2013 Nov 7.
Lung cancer patients experience multiple, simultaneous symptoms related to their disease and treatment that impair functioning and health-related quality of life (HRQL). Computer technology can reduce barriers to nonsystematic, infrequent symptom assessment and potentially contribute to improved patient care.
To evaluate the efficacy of technology-based symptom monitoring and reporting in reducing symptom burden in patients with advanced lung cancer.
This was a prospective, multisite, randomized controlled trial. Two hundred fifty-three patients were enrolled at three sites and randomized to monitoring and reporting (MR) or monitoring alone (MA). Patients completed questionnaires at baseline, 3, 6, 9, and 12 weeks and symptom surveys via interactive voice response weekly for 12 weeks. MR patients' clinically significant symptom scores generated an e-mail alert to the site nurse for management. The primary endpoint was overall symptom burden; secondary endpoints included HRQL, treatment satisfaction, symptom management barriers, and self-efficacy.
This randomized controlled trial failed to demonstrate efficacy of symptom monitoring and reporting in reducing symptom burden compared with monitoring alone in lung cancer. HRQL declined over 12 weeks in both groups (P < 0.006 to P < 0.025); at week 12, treatment satisfaction was higher in MA than MR patients (P < 0.012, P < 0.027). Adherence to weekly calls was good (82%) and patient satisfaction was high.
Feasibility of using a technology-based system for systematic symptom monitoring in advanced lung cancer patients was demonstrated. Future research should focus on identifying patients most likely to benefit and other patient, provider, and health system factors likely to contribute to the system's success.
肺癌患者会同时经历多种与疾病和治疗相关的症状，这些症状会损害其功能及与健康相关的生活质量（HRQL）。计算机技术可以减少非系统性、不频繁的症状评估障碍，并可能有助于改善患者护理。
评估基于技术的症状监测和报告在减轻晚期肺癌患者症状负担方面的疗效。
这是一项前瞻性、多中心、随机对照试验。253名患者在三个地点入组，并随机分为监测与报告组（MR）或仅监测组（MA）。患者在基线、第3、6、9和12周完成问卷调查，并在12周内每周通过交互式语音应答进行症状调查。MR组患者具有临床意义的症状评分会生成电子邮件提醒给站点护士以便进行管理。主要终点是总体症状负担；次要终点包括HRQL、治疗满意度、症状管理障碍和自我效能感。
这项随机对照试验未能证明与仅进行监测相比，症状监测和报告在减轻肺癌患者症状负担方面的疗效。两组患者的HRQL在12周内均下降（P<0.006至P<0.025）；在第12周时，MA组患者的治疗满意度高于MR组（P<0.012，P<0.027）。每周通话的依从性良好（82%），患者满意度较高。
证明了使用基于技术的系统对晚期肺癌患者进行系统性症状监测的可行性。未来的研究应专注于确定最可能受益的患者以及其他可能有助于该系统成功的患者、提供者和卫生系统因素。
