a Survivorship Unit , Danish Cancer Society Research Center , Copenhagen , Denmark.
b Department of Oncology , Zealand University Hospital , Naestved , Denmark.
Acta Oncol. 2019 May;58(5):619-626. doi: 10.1080/0284186X.2018.1563717. Epub 2019 Jan 30.
Traditionally, women treated for breast cancer (BC) have been followed up through regular oncologist-led visits in outpatient clinics, focusing on detection of recurrences, new primary BC, symptom management, and psychological support. However, this follow-up routine is expensive and its effectiveness has been questioned. Consequently, alternative follow-up programs have been tested. The Guided Self-Determination method (GSD), which facilitates partnership between health-care provider and patient, has been shown to improve self-management in patients with chronic conditions, including cancer. Patient-reported outcomes (PRO) is another increasingly used tool to improve patient-provider communication, symptom monitoring and control. In combination, GSD and PRO may have the potential to meet the objectives of BC follow-up. To test this, we developed the MyHealth study, a randomized controlled trial comparing a nurse-led follow-up program based on GSD, collection of PRO, and patient navigation with routine oncologist-led follow-up. Here we describe how we developed the intervention and are currently testing the feasibility of the MyHealth protocol in terms of recruitment, adherence to the intervention, collection of PRO, and patient navigation. We have invited the first 25 consecutively enrolled patients to test the MyHealth intervention. This consists of (1) 3-5 initial GSD appointments with a nurse, (2) collection of PRO, and (3) symptom management and patient navigation. The randomized trial was launched in January 2017 and is still recruiting. Of 32 patients invited, 25 accepted participation. At 18-month follow-up, two patients have withdrawn, 143 PRO questionnaires have been completed (mean 5.7/patient) resulting in 59 nurse contacts (mean 2.4 per patient) and 14 project physician contacts (mean 0.6 per patient). A high recruitment rate and response rate to PRO indicate that follow-up led by specialist nurses, based on collection of PRO is feasible and acceptable for patients treated for early stage BC.
传统上，接受乳腺癌（BC）治疗的女性通过定期在门诊就诊的肿瘤专家来进行随访，重点是检测复发、新原发性 BC、症状管理和心理支持。然而，这种随访常规既昂贵又有质疑其有效性。因此，已经测试了替代随访方案。指导自主决策方法（GSD）促进了医患之间的合作，已被证明可以改善慢性疾病（包括癌症）患者的自我管理。患者报告的结果（PRO）是另一种越来越常用的工具，可改善医患沟通、症状监测和控制。GSD 和 PRO 结合使用可能有潜力满足 BC 随访的目标。为了验证这一点，我们开展了 MyHealth 研究，这是一项随机对照试验，比较了基于 GSD、PRO 收集和患者导航的护士主导的随访计划与常规肿瘤专家主导的随访。在这里，我们描述了如何开发干预措施，并正在根据招募情况、对干预措施的依从性、PRO 收集和患者导航来测试 MyHealth 方案的可行性。我们邀请了前 25 名连续入组的患者来测试 MyHealth 干预措施。该措施包括（1）与护士进行 3-5 次初始 GSD 预约，（2）PRO 收集，以及（3）症状管理和患者导航。随机试验于 2017 年 1 月启动，仍在招募中。在受邀的 32 名患者中，有 25 名接受了参与。在 18 个月的随访中，有 2 名患者退出，完成了 143 份 PRO 问卷（平均每位患者 5.7 份），产生了 59 次护士接触（平均每位患者 2.4 次）和 14 次项目医生接触（平均每位患者 0.6 次）。高招募率和 PRO 高响应率表明，基于 PRO 收集的专科护士主导的随访对早期 BC 治疗患者是可行且可接受的。
