护士导航员在癌症护理数字远程监测中的作用：基于结构方程模型的案例研究

The Effect of Nurse Navigators in Digital Remote Monitoring in Cancer Care: Case Study Using Structural Equation Modeling.

作者信息

Minvielle Etienne, Perez-Torrents Joel, Salma Israa, Aegerter Philippe, Ferrua Marie, Ferté Charles, Leleu Henri, Mathivon Delphine, Sicotte Claude, Di Palma Mario, Scotté Florian

机构信息

Interdisciplinary Department for the Organization of Patient Pathways, Gustave Roussy, Villejuif, France.

i3-CRG, École Polytechnique, Institut Polytechnique de Paris, Palaiseau, France.

出版信息

J Med Internet Res. 2025 Mar 28;27:e66275. doi: 10.2196/66275.

DOI:10.2196/66275

PMID:40153795

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11992497/

Abstract

BACKGROUND

The purpose of digital remote monitoring (DRM) is improving cancer care management. However, its effectiveness largely depends on the role of nurse navigators (NNs) within these systems to process data and lead action.

OBJECTIVE

This study aims to fill gaps in our understanding of the role of NNs within a specific system, drawing on the Cancérologie parcours région Ile-de-France (CAPRI) DRM program applied to oncology patients.

METHODS

The CAPRI DRM, targeting patients taking oral anticancer agents, combines digital interfaces with NN interventions. A phase 3 randomized controlled trial involving 559 patients assessed its safety and efficacy, with the primary end point being the relative dose intensity. This report focuses on patients in the CAPRI arm, evaluating the impact of NN interventions on outcomes such as toxicity, hospitalization, and emergency visits. Data on patient characteristics, NN interventions, and patient satisfaction surveys were analyzed using structural equation modeling.

RESULTS

The study included 187 patients. Patient characteristics were significantly correlated with outcomes. Across all the models we used, the quality of NN interventions was consistently associated with higher patient satisfaction, with correlation coefficients ranging from 0.332 (95% CI 0.154-0.510; P<.001) to 0.366 (95% CI 0.182-0.550; P<.001). The number of grade ≥3 toxicity events correlated positively with NN referrals to oncologists. Hospitalization length was positively related to NN referral (coefficient 0.102, 95% CI 0.051-0.153; P<.001) and inversely to NN advice (coefficient -0.045, 95% CI -0.096 to 0.006; P=.08). Emergency visits showed a negative correlation with NN actions (coefficient -0.478, 95% CI -0.923 to 0.033; P=.04) and a positive correlation with NN calls and referrals (coefficient 0.516, 95% CI 0.069-0.963; P=.02).

CONCLUSIONS

This study shows the central role of NNs in making DRM effective. Despite the study's limitations, these results support the design of DRM as a hybrid model of automated digital tools and human support. Future research should explore the applicability of such a DRM model in various clinical settings to clarify the optimal association between automated systems and NN expertise.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02828462; https://www.clinicaltrials.gov/study/NCT02828462.

摘要

背景

数字远程监测（DRM）的目的是改善癌症护理管理。然而，其有效性很大程度上取决于护士导航员（NNs）在这些系统中处理数据和引领行动的作用。

目的

本研究旨在填补我们对特定系统中NNs作用理解上的空白，借鉴应用于肿瘤患者的法兰西岛大区癌症诊疗路径（CAPRI）DRM项目。

方法

CAPRI DRM针对口服抗癌药物的患者，将数字界面与NN干预相结合。一项涉及559名患者的3期随机对照试验评估了其安全性和有效性，主要终点是相对剂量强度。本报告重点关注CAPRI组的患者，评估NN干预对毒性、住院和急诊就诊等结局的影响。使用结构方程模型分析了患者特征、NN干预和患者满意度调查的数据。

结果

该研究纳入了187名患者。患者特征与结局显著相关。在我们使用的所有模型中，NN干预的质量始终与较高的患者满意度相关，相关系数范围从0.332（95%CI 0.154 - 0.510；P <.001）到0.366（95%CI 0.182 - 0.550；P <.001）。≥3级毒性事件的数量与NN转诊给肿瘤学家呈正相关。住院时间与NN转诊呈正相关（系数0.102，95%CI 0.051 - 0.153；P <.001），与NN建议呈负相关（系数 - 0.045，95%CI - 0.096至0.006；P = 0.08）。急诊就诊与NN行动呈负相关（系数 - 0.478，95%CI - 0.923至0.033；P = 0.04），与NN呼叫和转诊呈正相关（系数0.516，95%CI 0.069 - 0.963；P = 0.02）。