Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Cancer Med. 2023 Apr;12(7):8804-8814. doi: 10.1002/cam4.5625. Epub 2023 Jan 16.
Cancer supportive care interventions often have limited generalizability, goal misalignment, and high costs. We developed and piloted a health coaching intervention, UNC HealthScore, in patients undergoing cancer treatment (ClinicalTrials.gov identifier NCT04923997). We present feasibility, acceptability, and preliminary outcome data.
HealthScore is a six-month, theory-based, multicomponent intervention delivered through participant-driven coaching sessions. For the pilot study, participants were provided a Fitbit, responded to weekly symptom and physical function digital surveys, and met with a health coach weekly to develop and monitor goals. Coaching notes were discussed in weekly interdisciplinary team meetings and provided back to the treating oncology team. Symptom alerts were monitored and triaged through a study resource nurse to relevant supportive care services. Feasibility was determined based on intervention enrollment and completion. Acceptability was based on satisfaction with coaching and Fitbit-wearing and was informed by semistructured exit interviews. Outcomes evaluated for signs of improvement included several PROMIS (Patient-Reported Outcomes Measurement Information System) measures, including the primary intervention target, physical function.
From May 2020 to March 2022, 50 participants completed the single-arm pilot. Feasibility was high: 66% enrolled and 71% completed the full intervention. Participants reported an average of 4.8 and 4.7 (out of 5) on the acceptability of coaching calls and using the Fitbit, respectively. Physical function scores rose 3.1 points (SE = 1.1) from baseline to 3 months, and 4.3 (SE = 1.0) from baseline to 6 months, above established minimal clinically important difference (MCID). Improvements above MCID were also evident in anxiety and depression, and smaller improvements were demonstrated for emotional support, social isolation, cognitive function, symptom burden, and self-efficacy.
HealthScore shows feasibility, acceptability, and promising preliminary outcomes. Randomized studies are underway to determine the efficacy of preserving physical function in patients with advanced cancer.
癌症支持性护理干预措施通常具有有限的通用性、目标不一致和高成本。我们开发并试点了一种健康教练干预措施，UNC HealthScore，用于接受癌症治疗的患者（ClinicalTrials.gov 标识符 NCT04923997）。我们介绍了可行性、可接受性和初步结果数据。
HealthScore 是一项为期六个月的基于理论的多组分干预措施，通过参与者驱动的教练会议进行。在试点研究中，参与者配备了 Fitbit，每周回答症状和身体功能数字调查，并每周与健康教练会面以制定和监测目标。教练笔记在每周的跨学科团队会议上进行讨论，并提供给治疗肿瘤学团队。通过研究资源护士监测和分类症状警报，以提供给相关的支持性护理服务。可行性基于干预的参与和完成情况确定。可接受性基于对教练和 Fitbit 佩戴的满意度，并通过半结构化退出访谈提供信息。评估改善迹象的结果包括多个 PROMIS（患者报告的结果测量信息系统）措施，包括主要干预目标，身体功能。
从 2020 年 5 月到 2022 年 3 月，50 名参与者完成了单臂试点。可行性很高：66%的参与者入组，71%的参与者完成了完整的干预。参与者报告了平均 4.8 和 4.7（满分 5 分）的教练通话和使用 Fitbit 的可接受性。身体功能评分从基线到 3 个月上升了 3.1 分（SE=1.1），从基线到 6 个月上升了 4.3 分（SE=1.0），高于既定的最小临床重要差异（MCID）。焦虑和抑郁方面也有明显的改善，情绪支持、社会隔离、认知功能、症状负担和自我效能方面的改善较小。
HealthScore 显示了可行性、可接受性和有希望的初步结果。正在进行随机研究以确定在晚期癌症患者中保持身体功能的疗效。
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