Department of Medicine, Division of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
J Natl Cancer Inst. 2022 Mar 8;114(3):458-466. doi: 10.1093/jnci/djab172.
The symptom burden associated with cancer and its treatment can negatively affect patients' quality of life and survival. Symptom-focused collaborative care model (CCM) interventions can improve outcomes, but only if patients engage with them. We assessed the receptivity of severely symptomatic oncology patients to a remote nurse-led CCM intervention.
In a pragmatic, cluster-randomized, stepped-wedge trial conducted as part of the National Cancer Institute IMPACT Consortium (E2C2, NCT03892967), patients receiving cancer care were asked to rate their sleep disturbance, pain, anxiety, emotional distress, fatigue, and limitations in physical function. Patients reporting at least 1 severe symptom (≥7/10) were offered phone consultation with a nurse symptom care manager (RN SCM). Initially, patients had to "opt-in" to receive a call, but the protocol was later modified so they had to "opt-out" if they did not want a call. We assessed the impact of opt-in vs opt-out framing and patient characteristics on receptiveness to RN SCM calls. All statistical tests were 2-sided.
Of the 1204 symptom assessments (from 864 patients) on which at least 1 severe symptom was documented, 469 (39.0%) indicated receptivity to an RN SCM phone call. The opt-out period (odds ratio [OR] = 1.61, 95% confidence interval [CI] = 1.12 to 2.32, P = .01), receiving care at a tertiary care center (OR = 3.59, 95% CI = 2.18 to 5.91, P < .001), and having severe pain (OR = 1.80, 95% CI = 1.24 to 2.62, P = .002) were associated with statistically significantly greater willingness to receive a call.
Many severely symptomatic patients were not receptive to an RN SCM phone call. Better understanding of reasons for refusal and strategies for improving patient receptivity are needed.
癌症及其治疗相关的症状负担会对患者的生活质量和生存产生负面影响。以症状为重点的协作式护理模式（CCM）干预可以改善结果，但前提是患者参与其中。我们评估了严重症状的肿瘤患者对远程护士主导的 CCM 干预的接受程度。
在作为美国国家癌症研究所 IMPACT 联盟（E2C2，NCT03892967）的一部分进行的一项实用、集群随机、阶梯式试验中，接受癌症治疗的患者被要求评估他们的睡眠障碍、疼痛、焦虑、情绪困扰、疲劳和身体功能受限程度。报告至少 1 种严重症状（≥7/10）的患者被提供与护士症状护理经理（RN SCM）进行电话咨询的机会。最初，患者必须“选择加入”才能收到电话，但后来修改了方案，以便他们如果不想接电话则必须“选择退出”。我们评估了“选择加入”与“选择退出”框架以及患者特征对 RN SCM 电话咨询的接受程度的影响。所有统计检验均为双侧检验。
在至少有 1 种严重症状记录的 1204 项症状评估（来自 864 名患者）中，有 469 项（39.0%）表示愿意接受 RN SCM 的电话咨询。“选择退出”期间（比值比[OR] = 1.61，95%置信区间[CI] = 1.12 至 2.32，P =.01）、在三级护理中心接受治疗（OR = 3.59，95% CI = 2.18 至 5.91，P <.001）和严重疼痛（OR = 1.80，95% CI = 1.24 至 2.62，P =.002）与更愿意接电话具有统计学显著相关性。
许多严重症状的患者对 RN SCM 电话咨询不感兴趣。需要更好地了解拒绝的原因和提高患者接受度的策略。
