Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
Qual Life Res. 2022 Aug;31(8):2341-2355. doi: 10.1007/s11136-022-03093-3. Epub 2022 Feb 8.
PURPOSE: PRO-cision medicine refers to personalizing care using patient-reported outcomes (PROs). We developed and feasibility-tested a PRO-cision Medicine remote PRO monitoring intervention designed to identify symptoms and reduce the frequency of routine in-person visits. METHODS: We conducted focus groups and one-on-one interviews with metastatic breast (n = 15) and prostate (n = 15) cancer patients and clinicians (n = 10) to elicit their perspectives on a PRO-cision Medicine intervention's design, value, and concerns. We then feasibility-tested the intervention in 24 patients with metastatic breast cancer over 6-months. We obtained feedback via end-of-study surveys (patients) and interviews (clinicians). RESULTS: Focus group and interview participants reported that remote PRO symptom reporting could alert clinicians to issues and avoid unneeded/unwanted visits. However, some patients did not perceive avoiding visits as beneficial. Clinicians were concerned about workflow. In the feasibility-test, 24/236 screened patients (10%) enrolled. Many patients were already being seen less frequently than monthly (n = 97) or clinicians did not feel comfortable seeing them less frequently than monthly (n = 31). Over the 6-month study, there were 75 total alerts from 392 PRO symptom assessments (average 0.19 alert/assessment). Patients had an average of 4 in-person visits (vs. expected 6.5 without the intervention). Patients (n = 19/24) reported high support on the end-of-study survey, with more than 80% agreeing with positive statements about the intervention. Clinician end-of-study interviews (n = 11/14) suggested that PRO symptom monitoring be added to clinic visits, rather than replacing them, and noted the increasing role of telemedicine. CONCLUSIONS: Future research should explore combining remote PRO symptom monitoring with telemedicine and in-person visits.
目的:精准医学是指利用患者报告的结果(PROs)来实现个体化治疗。我们开发并测试了一种 PRO 精准医学远程 PRO 监测干预措施的可行性,旨在识别症状并减少常规门诊就诊的频率。
方法:我们对 15 例转移性乳腺癌和 15 例前列腺癌患者以及 10 例临床医生进行了焦点小组和一对一访谈,以了解他们对 PRO 精准医学干预措施设计、价值和关注点的看法。然后,我们在 24 例转移性乳腺癌患者中进行了为期 6 个月的干预可行性测试。我们通过结束研究的调查(患者)和访谈(临床医生)获得反馈。
结果:焦点小组和访谈参与者报告说,远程 PRO 症状报告可以提醒临床医生注意问题,避免不必要/不想要的就诊。然而,一些患者并不认为避免就诊有益。临床医生担心工作流程。在可行性测试中,236 名筛选患者中有 24 名(10%)入组。许多患者已经比每月一次的就诊频率要低(n=97),或者临床医生认为他们不适合每月就诊少于一次(n=31)。在 6 个月的研究期间,392 次 PRO 症状评估中有 75 次发出了警报(平均 0.19 次警报/评估)。患者平均有 4 次门诊就诊(而没有干预时预计为 6.5 次)。患者(n=24/24)在结束研究的调查中报告了高度支持,超过 80%的患者同意关于干预的积极陈述。临床医生结束研究的访谈(n=11/14)表明,PRO 症状监测应添加到临床就诊中,而不是替代它们,并注意到远程医疗的作用不断增加。
结论:未来的研究应探索将远程 PRO 症状监测与远程医疗和门诊就诊相结合。
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