University of Warwick, Coventry, UK.
Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK.
Support Care Cancer. 2020 Apr;28(4):1817-1827. doi: 10.1007/s00520-019-04967-y. Epub 2019 Jul 23.
This study assessed the feasibility of implementing a novel model of integrated prostate cancer care involving an online prostate cancer-specific holistic needs assessment (sHNA) and shared digital communication between patients and their healthcare professionals (HCPs). The sHNA produces a semi-automated care plan that is finalised in consultation between the patient and their practice nurse.
Men living with and beyond prostate cancer were invited to participate in a 9-month non-randomised cluster controlled feasibility study. The intervention group was asked to complete the sHNA on three occasions. Data were collected using Patient Reported Outcome Measures (PROMs) at baseline, 10 and 24 weeks, and 9 months. Outcomes included recruitment, retention, acceptability, and engagement with the sHNA and PROMs.
Fourteen general practices (8 intervention and 6 control), and 41 men (29 intervention and 12 control) participated. Initial patient engagement with the sHNA was high, with all but one receiving practice nurse-led follow-up and an individualised care plan. The sHNA proved useful in identifying 'red flag' symptoms, and helping practice nurses decide when to seek further medical care for the patients. There was a high level of acceptability for patients and HCPs. However, integration of care did not occur as intended because of problems linking hospital and general practice IT systems.
While the study demonstrated the feasibility of implementing the sHNA, it did not meet the a priori progression criteria; as such, undertaking a definitive randomised controlled trial is not appropriate until the identified methodological and technical issues have been addressed.
本研究评估了实施一种新型综合前列腺癌护理模式的可行性，该模式涉及在线前列腺癌特定整体需求评估（sHNA）以及患者及其医疗保健专业人员（HCP）之间的共享数字通信。sHNA 生成半自动化的护理计划，该计划在患者及其执业护士之间的协商中最终确定。
患有前列腺癌和已康复前列腺癌的男性被邀请参加一项为期 9 个月的非随机对照聚类可行性研究。干预组被要求在三次就诊时完成 sHNA。数据通过基线、10 周和 24 周以及 9 个月时的患者报告结局测量（PROMs）进行收集。结果包括招募、保留、可接受性以及对 sHNA 和 PROMs 的参与度。
有 14 家全科诊所（8 家干预组和 6 家对照组）和 41 名男性（29 名干预组和 12 名对照组）参与了研究。患者最初对 sHNA 的参与度很高，除了一名患者外，所有患者都接受了执业护士主导的随访和个性化护理计划。sHNA 在识别“红旗”症状方面非常有用，并帮助执业护士决定何时为患者寻求进一步的医疗护理。患者和 HCP 对其接受度都很高。然而，由于医院和全科诊所的 IT 系统之间存在连接问题，护理的整合并没有按预期进行。
虽然该研究证明了实施 sHNA 的可行性，但它没有达到预先设定的进展标准；因此，在解决已确定的方法学和技术问题之前，进行确定性随机对照试验是不合适的。
