General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
J Cancer Surviv. 2022 Feb;16(1):13-23. doi: 10.1007/s11764-021-01136-1. Epub 2022 Feb 2.
To assess the feasibility of an app-based, electronic health record (EHR)-integrated, interactive care plan (ICP) for breast cancer (BC) survivors.
A single-arm pilot study was conducted with female BC survivors. ICP tasks included quarterly quality of life (QOL) questionnaire; monthly assessments of fatigue, insomnia, sexual dysfunction, hot flashes, and recurrence symptoms; and daily activity reminders. Embedded decision trees escalated recurrence symptoms to providers. On-demand education was available for self-management of treatment-related toxicities. The primary objective was to assess patients' engagement with ICP tasks against feasibility thresholds of 75% completion rate. Secondary objectives were evaluation of the system's functionality to track and escalate symptoms appropriately, and care team impact measured by volume of escalation messages generated. We report preliminary results 6 months after the last patient enrolled.
Twenty-three patients enrolled August to November 2020. Mean age was 50.1 years. All patients engaged with at least one ICP task. The monthly average task completion rates were 62% for the QOL questionnaire, 59% for symptom assessments, and 37% for activity reminders. Task completion rate decreased over time. Eleven of 253 symptoms and QOL questionnaires (4.3%) generated messages for care escalation.
Implementation of an app-based, EHR-integrated ICP in BC survivors was feasible and created minimal provider burden; however, patient engagement was below the feasibility threshold suggesting that changes may enhance broad implementation and adoption.
An ICP may facilitate remote monitoring, symptom control, and recurrence surveillance for cancer survivors as strategies to enhance patient engagement are applied.
评估基于应用程序、与电子健康记录 (EHR) 集成的交互式护理计划 (ICP) 在乳腺癌 (BC) 幸存者中的应用可行性。
采用单臂试点研究，纳入女性 BC 幸存者。ICP 任务包括每季度进行一次生活质量 (QOL) 问卷调查；每月评估疲劳、失眠、性功能障碍、热潮红和复发症状；以及每日活动提醒。嵌入式决策树将复发症状升级至医护人员。还提供按需教育，用于治疗相关毒性的自我管理。主要目标是根据 75%完成率的可行性标准评估患者对 ICP 任务的参与度。次要目标是评估系统跟踪和适当升级症状的功能，以及通过生成的升级消息量来衡量对护理团队的影响。我们报告了最后一名患者入组后 6 个月的初步结果。
2020 年 8 月至 11 月期间共纳入 23 名患者。平均年龄为 50.1 岁。所有患者均参与了至少一项 ICP 任务。每月平均任务完成率为 QOL 问卷 62%、症状评估 59%和活动提醒 37%。随着时间的推移，任务完成率逐渐下降。在 253 个症状和 QOL 问卷中，有 11 个（4.3%）生成了护理升级消息。
在 BC 幸存者中实施基于应用程序、与 EHR 集成的 ICP 是可行的，且不会增加医护人员负担；然而，患者参与度低于可行性标准，这表明可能需要进行更改以增强广泛实施和采用。
ICP 可能促进远程监测、症状控制和复发监测，作为增强患者参与度的策略。
