肺癌患者症状管理的临床决策支持：一项群组 RCT。
Clinical Decision Support for Symptom Management in Lung Cancer Patients: A Group RCT.
机构信息
Research in Nursing and Patient Care (M.E.C, B.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Data Sciences (E.M., N.X., F.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
出版信息
J Pain Symptom Manage. 2022 Apr;63(4):572-580. doi: 10.1016/j.jpainsymman.2021.12.006. Epub 2021 Dec 16.
CONTEXT
Clinical guidelines are available to enhance symptom management during cancer treatment but often are not used in the practice setting. Clinical decision support can facilitate the implementation and adherence to clinical guidelines. and improve the quality of cancer care.
OBJECTIVES
Clinical decision support offers an innovative approach to integrate guideline-based symptom management into oncology care. This study evaluated the effect of clinical decision support-based recommendations on clinical management of symptoms and health-related quality of life (HR-QOL) among outpatients with lung cancer.
METHODS
Twenty providers and 179 patients were allotted in group randomization to attention control (AC) or Symptom Assessment and Management Intervention (SAMI) arms. SAMI entailed patient-report of symptoms and delivery of recommendations to manage pain, fatigue, dyspnea, depression, and anxiety; AC entailed symptom reporting prior to the visit. Outcomes were collected at baseline, two, four and six-months. Adherence to recommendations was assessed through masked chart review. HR-QOL was measured by the Functional Assessment of Cancer Therapy-Lung questionnaire. Descriptive statistics with linear and logistic regression accounting for the clustering structure of the design and a modified chi-square test were used for analyses.
RESULTS
Median age of patients was 63 years, 58% female, 88% white, and 32% ≤high school education. Significant differences in clinical management were evident in SAMI vs. AC for all target symptoms that passed threshold. Patients in SAMI were more likely to receive sustained-release opioids for constant pain, adjuvant medications for neuropathic pain, opioids for dyspnea, stimulants for fatigue and mental health referrals for anxiety. However, there were no statistically significant differences in HR-QOL at any time point.
CONCLUSION
SAMI improved clinical management for all target symptoms but did not improve patient outcomes. A larger study is warranted to evaluate effectiveness.
背景
临床指南可用于增强癌症治疗期间的症状管理，但在实践环境中经常未被使用。临床决策支持可促进临床指南的实施和遵循，并提高癌症护理质量。
目的
临床决策支持为将基于指南的症状管理整合到肿瘤学护理中提供了一种创新方法。本研究评估了基于临床决策支持的建议对肺癌门诊患者症状的临床管理和健康相关生活质量（HR-QOL）的影响。
方法
20 名提供者和 179 名患者被随机分配到对照组（AC）或症状评估和管理干预组（SAMI）。SAMI 包括患者报告症状和提供管理疼痛、疲劳、呼吸困难、抑郁和焦虑的建议；AC 包括就诊前的症状报告。在基线、两个月、四个月和六个月时收集结局。通过盲法图表审查评估建议的依从性。HR-QOL 通过癌症治疗功能评估-肺问卷进行测量。使用描述性统计、线性和逻辑回归，考虑到设计的聚类结构，以及修改后的卡方检验进行分析。
结果
患者的中位年龄为 63 岁，58%为女性，88%为白人，32%≤高中教育程度。在 SAMI 与 AC 相比，所有达到阈值的目标症状的临床管理均存在显著差异。SAMI 组患者更有可能接受持续释放的阿片类药物治疗持续性疼痛、辅助药物治疗神经性疼痛、阿片类药物治疗呼吸困难、兴奋剂治疗疲劳以及精神健康转介治疗焦虑。然而，在任何时间点，HR-QOL 均无统计学差异。
结论
SAMI 改善了所有目标症状的临床管理，但未改善患者结局。需要更大规模的研究来评估有效性。
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