希望试点研究:利用患者报告的结果和生物识别数据改善癌症护理。
The HOPE Pilot Study: Harnessing Patient-Reported Outcomes and Biometric Data to Enhance Cancer Care.
作者信息
Wright Alexi A, Raman Nikita, Staples Patrick, Schonholz Stephanie, Cronin Angel, Carlson Kenzie, Keating Nancy L, Onnela Jukka-Pekka
机构信息
Alexi A. Wright, Nikita Raman, Stephanie Schonholz, and Angel Cronin, Dana-Farber Cancer Institute; Alexi A. Wright and Nancy L. Keating, Harvard Medical School; Patrick Staples, Kenzie Carlson, and Jukka-Pekka Onnela, Harvard TH Chan School of Public Health; and Nancy L. Keating, Brigham and Women's Hospital, Boston, MA.
出版信息
JCO Clin Cancer Inform. 2018 Dec;2:1-12. doi: 10.1200/CCI.17.00149.
PURPOSE
Integrating patient-reported outcomes (PROs) into clinical practice is an increasingly promising strategy for improving patients' symptoms, communication, and clinical outcomes. The objective of the current study was to assess the feasibility, acceptability, and perceived effectiveness of a mobile health intervention that was designed to collect PROs and activity data as a measure of health status.
PATIENTS AND METHODS
This work was a pilot intervention with 10 patients with gynecologic cancers who received palliative chemotherapy. The HOPE (Helping Our Patients Excel) study used wearable accelerometers to assess physical activity and the Beiwe research platform to collect PROs, stratify patient responses by risk, provide tailored symptom management, and notify patients and clinicians of high-risk symptoms. Feasibility and acceptability were assessed through enrollment and adherence rates, and perceived effectiveness was evaluated by patients and oncologists at study completion.
RESULTS
The approach-to-consent rate was 100%, and participants were 90% and 70% adherent to the wearable accelerometers and smartphone surveys, respectively. Participants' mean daily step count was 3,973 (standard deviation [SD], 2,305 steps) and increased from week 1 (mean, 3,520 steps; SD, 1,937 steps) to week 3 (mean, 4,136 steps; SD, 1,578 steps). Active monitoring of participants' heart rates, daily steps, and PROs throughout the study identified anomalies in participants' behavior patterns that suggested poor health for two patients (20%). Patients and clinicians indicated that the intervention improved physical activity, communication, and symptom management.
CONCLUSION
A mobile health intervention that collects PROs and activity data as a measure of health status is feasible, acceptable, and was perceived to be effective in improving symptom management in patients with advanced gynecologic cancers. A larger, multisite, randomized clinical trial to assess the efficacy of the HOPE intervention on patients' symptoms, health-related quality of life, clinical outcomes, and health care use is warranted.
目的
将患者报告的结局(PROs)纳入临床实践是改善患者症状、沟通及临床结局的一项前景日益广阔的策略。本研究的目的是评估一项移动健康干预措施的可行性、可接受性及感知有效性,该干预措施旨在收集PROs和活动数据以衡量健康状况。
患者与方法
本研究为一项试点干预,纳入10例接受姑息化疗的妇科癌症患者。HOPE(帮助我们的患者取得卓越成效)研究使用可穿戴式加速度计评估身体活动,并利用“倍未”研究平台收集PROs,按风险对患者的回答进行分层,提供个性化的症状管理,并将高风险症状通知患者和临床医生。通过入组率和依从率评估可行性和可接受性,并在研究结束时由患者和肿瘤学家评估感知有效性。
结果
同意参与率为100%,参与者对可穿戴式加速度计和智能手机调查的依从率分别为90%和70%。参与者的平均每日步数为3973步(标准差[SD],2305步),并从第1周(平均3520步;SD,1937步)增加到第3周(平均4136步;SD,1578步)。在整个研究过程中对参与者的心率、每日步数和PROs进行主动监测,发现两名患者(20%)的行为模式存在异常,提示健康状况不佳。患者和临床医生表示,该干预改善了身体活动、沟通和症状管理。
结论
一项收集PROs和活动数据以衡量健康状况的移动健康干预措施是可行的、可接受的,且被认为在改善晚期妇科癌症患者的症状管理方面有效。有必要开展一项更大规模的、多中心的随机临床试验,以评估HOPE干预措施对患者症状、健康相关生活质量、临床结局及医疗保健利用的疗效。