Bilingual Electronic Symptom Management Program Across Multi-site, Comprehensive Cancer Center

Northwestern University4,104 enrolled

Overview

Cancer, and cancer treatment, cause many symptoms that can negatively affect quality of life. Despite the development of improved symptom management interventions and several evidence- and consensus-based guidelines, their timely delivery remains uneven in the health care system. Our research center, Northwestern University IMPACT (NU IMPACT), builds upon an electronic health record (EHR)-integrated cancer symptom monitoring and management system, currently deployed by our health care system. We are testing the effectiveness of a system-wide symptom management intervention and the EHR-integrated enhanced care approach, which offers a more personalized symptom monitoring and management experience based on a person's unique needs and language (i.e., English or Spanish).

Using a clinic-level randomized roll-out implementation trial design, we will test the effectiveness of an enhanced care (EC) approach aimed to engage participants actively, and to increase self-efficacy, in the monitoring and managing of their symptoms. The existing EHR-integrated symptom monitoring system will constitute usual care (UC), and added patient engagement and activation features will comprise the EC condition. Project aims target both patient- and system-level outcomes. Aim 1: Implement a fully-integrated oncology symptom assessment and management program across six clinical units that are part of the NMHC healthcare delivery system; Aim 2: Evaluate the impact of the program by conducting a hybrid Type I effectiveness-implementation trial to evaluate the enhanced care program (EC: symptom monitoring \& self-management intervention), relative to usual care (UC) on patient- and system-level outcomes; Aim 3: Identify facilitators and barriers to implementation and disseminate to other health systems. We will enroll an estimated 12,671 participants. To address possible contamination effects within each clinical unit, and allow for unit-level data collection for pre- and post-implementation comparison within and across clinical units, 50% will be enrolled and followed prior to program implementation. The other half will be enrolled post-implementation and will be randomly assigned at a 1:1 ratio (stratified by sex and cancer phase; curative intent, non-curative intent \& survivorship) to UC versus EC. Fatigue, pain, anxiety, and depression will be assessed using Patient Reported Outcome Measurement Information System (PROMIS®) computerized adaptive tests (CATs). In addition, we will assess patient clinical outcomes, including healthcare utilization, and cancer treatment delivery outcomes.

Study Type

INTERVENTIONAL

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: Curative Intent Group: * ≥ 18 years of age; * medical chart confirmed diagnosis of a solid or hematological malignancy; * willingness to be randomized (post-implementation only); * have initiated primary treatment with curative intent within the past 3 months (i.e., as patients receive surgery, standard- or high-dose chemotherapy, biological therapy, and/or radiotherapy); * provider confirmed planned treatment and follow-up within the Northwestern Medicine HealthCare (NMHC) hospital and clinics; * able to read English or Spanish; and * no evidence of dementia; severe psychopathology (i.e., inpatient psychiatric treatment within past 3-months) or visual or motor impairment that would prevent completion of study procedures. Non-Curative/Palliative Intent Group: * ≥ 18 years of age; * medical chart confirmed diagnosis of advanced or metastatic solid or hematological malignancy; * willingness to be randomized (post-implementation only); * undergoing cancer treatment with non-curative/palliative intent (e.g., patients with advanced or metastatic disease who receive chemotherapy, biological therapy, and/or radiotherapy to control or slow advance of their disease); * provider confirmed planned treatment and follow-up within the NMHC hospital and clinics; * able to read English or Spanish; and * no evidence of dementia; severe psychopathology (i.e., inpatient psychiatric treatment within past 3-months) or visual or motor impairment that would prevent completion of study procedures. Cancer Survivorship Group: * ≥ 18 years of age; * medical chart confirmed diagnosis of solid or hematological malignancy within the past 2 years; * willingness to be randomized (post-implementation only); * completed active cancer treatment with curative intent, including those who may be receiving maintenance or prophylactic cancer treatment; * provider confirmed planned follow-up (with or without treatment) within the NMHC e hospital and clinics; * able to read English or Spanish; and * no evidence of dementia; severe psychopathology (i.e., inpatient psychiatric treatment within past 3-months) or visual or motor impairment that would prevent completion of study procedures. Exclusion Criteria: \-

Outcomes

Primary Outcomes

Individual-level change overtime related to cancer and cancer treatment symptoms

Symptom severity will be assessed using Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) related to symptoms of pain, fatigue, depression, anxiety, and physical function. CAT question items are dynamically selected for administration from an item bank based upon the respondent's previous answers. Patient usually completes 4-12 items with a high level of measurement precision for each domain.

Time frame: Change from baseline adverse symptom severity at 12 months

Adverse symptom severity related to cancer and cancer treatment

Adverse symptom severity will be assessed using Patient-Reported Outcomes- Common Terminology for Adverse Events (PRO-CTCAE™) assessment. The PRO-CTCAE questionnaire will ask about nausea, constipation, insomnia, vomiting, shortness of breath, and diarrhea.

Time frame: Change from baseline PRO-CTCAE adverse event severity at 12 month

Healthcare utilization by participant related to managing their cancer and cancer treatment

Participant utilization of healthcare services, such as number of emergency room visits, oncology urgent care visits, unscheduled doctor visits, doctor visits, hospital admissions and length of stay, and supportive care needs to manage their cancer and cancer treatment, will be assessed by electronic health records.

Time frame: Change from baseline healthcare utilization at 12 months

Patient Treatment Delivery Satisfaction

Patient satisfaction of their cancer-related care will be assessed using Consumer Assessment of Healthcare Providers and Systems (CAHPS) Cancer Care survey composite measures.

Time frame: Change from baseline treatment delivery satisfaction at 12 months

Secondary Outcomes

Patient clinical outcome of cancer recurrence (i.e., cancer has come back)

Cancer recurrence will be assessed by electronic health record diagnosis codes in patients in curative intent and survivorship groups.

Time frame: Cancer recurrance at 12 months

Patient clinical outcome of cancer progression (i.e., cancer has becomes worse)

Cancer progression will be assessed by electronic health records diagnosis codes in curative intent and non-curative intent groups.

Time frame: Cancer progression at 12 months

Patient clinical outcome of second cancer (i.e., completely new and a different type of cancer than the first one)

Second cancer will be assessed by patient medical record diagnosis codes in curative intent, non-curative intent, and survivorship groups.

Time frame: Second cancer at 12 months

Overall Survival (i.e., the time from study randomization until death due to any cause)

Overall survival will be assessed by electronic health records in the curative intent and non-curative intent groups.

Time frame: Overall survival at 12 months (or end of study)

Bilingual Electronic Symptom Management Program Across Multi-site, Comprehensive Cancer Center

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes