Wolff Jennifer L, Aufill Jennifer, Echavarria Diane, Blackford Amanda L, Connolly Roisin M, Fetting John H, Jelovac Danijela, Papathakis Katie, Riley Carol, Stearns Vered, Zafman Nelli, Thorner Elissa, Levy Howard P, Guo Amy, Dy Sydney M, Wolff Antonio C
Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
NPJ Breast Cancer. 2021 Feb 12;7(1):14. doi: 10.1038/s41523-021-00217-9.
We examined the effects of a communication intervention to engage family care partners on patient portal (MyChart) use, illness understanding, satisfaction with cancer care, and symptoms of anxiety in a single-blind randomized trial of patients in treatment for breast cancer. Patient-family dyads were recruited and randomly assigned a self-administered checklist to clarify the care partner role, establish a shared visit agenda, and facilitate MyChart access (n = 63) or usual care (n = 55). Interviews administered at baseline, 3, 9 (primary endpoint), and 12 months assessed anxiety (GAD-2), mean FAMCARE satisfaction, and complete illness understanding (4 of 4 items correct). Time-stamped electronic interactions measured MyChart use. By 9 months, more intervention than control care partners registered for MyChart (77.8 % vs 1.8%; p < 0.001) and logged into the patient's account (61.2% vs 0% of those registered; p < 0.001), but few sent messages to clinicians (6.1% vs 0%; p = 0.247). More intervention than control patients viewed clinical notes (60.3% vs 32.7%; p = 0.003). No pre-post group differences in patient or care partner symptoms of anxiety, satisfaction, or complete illness understanding were found. Intervention patients whose care partners logged into MyChart were more likely to have complete illness understanding at 9 months (changed 70.0% to 80.0% vs 69.7% to 54.6%; p = 0.03); symptoms of anxiety were numerically lower (16.7% to 6.7% vs 15.2% to 15.2%; p = 0.24) and satisfaction numerically higher (15.8-16.2 vs 18.0-17.4; p = 0.25). A brief, scalable communication intervention led to greater care partner MyChart use and increased illness understanding among patients with more engaged care partners (NCT03283553).
在一项针对乳腺癌治疗患者的单盲随机试验中，我们研究了一种沟通干预措施对让家庭护理伙伴参与患者门户网站（MyChart）使用、疾病认知、癌症护理满意度以及焦虑症状的影响。招募患者-家庭二元组并随机分配一份自我管理清单，以明确护理伙伴的角色、制定共同的就诊议程并促进MyChart访问（n = 63）或常规护理（n = 55）。在基线、3个月、9个月（主要终点）和12个月时进行的访谈评估了焦虑（GAD-2）、FAMCARE平均满意度以及完整的疾病认知（4项中有4项正确）。带时间戳的电子互动测量了MyChart的使用情况。到9个月时，注册MyChart的干预组护理伙伴比对照组多（77.8%对1.8%；p < 0.001），登录患者账户的也更多（已注册者中分别为61.2%和0%；p < 0.001），但很少有人给临床医生发送消息（6.1%对0%；p = 0.247）。查看临床记录的干预组患者比对照组多（60.3%对32.7%；p = 0.003）。在患者或护理伙伴的焦虑症状、满意度或完整疾病认知方面，未发现组内前后差异。护理伙伴登录MyChart的干预组患者在9个月时更有可能有完整的疾病认知（从70.0%变为80.0%，而对照组从69.7%变为54.6%；p = 0.03）；焦虑症状在数值上更低（从16.7%降至6.7%，而对照组从15.2%降至15.2%；p = 0.24），满意度在数值上更高（15.8 - 16.2，而对照组为18. — 17.4；p = 0.25）。一项简短、可扩展的沟通干预措施导致护理伙伴对MyChart的使用增加，并且在护理伙伴参与度更高的患者中疾病认知有所提高（NCT03283553）。
