Electronic Symptom Monitoring Program for Triggered Palliative Referrals in Patients With Thoracic Cancer

Ohio State University Comprehensive Cancer Center157 enrolled

Overview

This clinical trial evaluates earlier symptom management through remote electronic symptom monitoring (such as through an app on patient's phone), and accessibility of palliative care self-referral by patients with thoracic cancer and caregivers by proxy (legal representative). Thoracic cancer occurs in the chest and often causes symptoms for patients. Patients and/or their caregivers are often unable to attend in-person clinic visits for various reasons. The most frequently reported symptom by patients at initial palliative care consultations is pain, and caregivers' most common concerns are pain management for the patient, stress reduction, and fears about patient decline. Earlier palliative care referral can help control these symptoms before they worsen, providing a better quality of life for patients and caregivers. improve physical and emotional functioning for patients and caregivers in cancer care. This study may help researchers learn how an electronic symptom monitoring program may provide an earlier and more accessible way for patients with thoracic cancer to receive palliative care.

PRIMARY OBJECTIVE: I. Develop and assess feasibility of a remote electronic symptom monitoring program with a prompted option for palliative care self-referral for patients or caregivers by proxy after diagnosis of a thoracic malignancy. SECONDARY OBJECTIVE: I. Evaluate palliative care referral patterns after implementation of a remote electronic symptom monitoring program. OUTLINE: Patients and their caregivers use the electronic symptom monitoring program to log symptoms once a week (QW) for 24 weeks. Patients and their caregivers also watch a video and review education materials prior to starting the remote symptom monitoring program. After completion of study intervention, participants are followed up to 2 years.

Study Type

INTERVENTIONAL

Allocation

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

Interventions

Educational ActivityOTHER

Review education materials

Electronic Health Record ReviewOTHER

Ancillary studies

Internet-Based InterventionOTHER

Participate use the electronic symptom monitoring program to log symptoms

Media InterventionOTHER

Watch a video

Survey AdministrationOTHER

Ancillary studies

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * PATIENTS: Age ≥ 18 years * PATIENTS: Diagnosed with any stage (1-4) or type (non-small cell lung cancer, small cell lung cancer, mesothelioma, thymic carcinoma) of thoracic malignancy * PATIENTS: ≥ 2 visits at the Ohio State University Comprehensive Cancer Center (OSUCCC) Thoracic Oncology Clinic * PATIENTS: Study enrollment within 12 weeks of initial Thoracic Medical Oncology appointment * PATIENTS: Ability to understand and willingness to sign an informed consent document (or indicate approval or disapproval by another means) * PATIENTS: Ability to read and understand English * PATIENTS: Access to a device with email or text messaging capability * CAREGIVERS: Age ≥ 18 years * CAREGIVERS: Identified by patient participant as primary caregiver * CAREGIVERS: Corresponding patient participant has consented to participate in the study * CAREGIVERS: Ability to understand and willingness to sign an informed consent document (or indicate approval or disapproval by another means) * CAREGIVERS: Ability to read and understand English * CAREGIVERS: Access to a device with email or text messaging capability Exclusion Criteria: * PATIENTS: Patients who have been previously referred to ambulatory palliative care are excluded from participation * PATIENTS: Prisoners are excluded from participation * PATIENTS: Pregnant patients are excluded from participation * PATIENTS: Patients who lack capacity for medical decision-making as determined by their primary oncologist are excluded from participation * PATIENTS: There is NO exclusion criteria pertaining to Eastern Cooperative Oncology Group (ECOG) performance status, laboratory values, prior cancer diagnoses, presence of comorbidities or brain metastases

Outcomes

Primary Outcomes

Frequency of symptom logging

Will estimate that ≥ 50% of patient participants will log symptoms at least monthly through the remote electronic symptom monitoring program.

Time frame: At 6 months after enrollment

Proportion of patients enrolled (Feasibility)

Descriptive statistics will include study enrollment rates (eligible vs. ineligible participants, consented vs. refused), completion rate of weekly symptom monitoring (patient vs. caregiver by proxy), and person requesting palliative care services (patient vs. caregiver by proxy vs. medical provider), if applicable. Will be considered feasible if within 20% of target enrollment.

Time frame: At enrollment and 3 months

Symptom scores and Palliative Referral Association

Symptom scores (Edmonton Symptom Assessment Scale revised with Constipation and Sleep \[ESAS-r-CS\]) reported by patients and caregivers will be tracked and their association with palliative care referral, if applicable, will be assessed.

Time frame: At enrollment and 3 months and 6 months

Patient and Caregiver Symptom Reporting Congruency

Descriptive statistics will be used to assess for congruency between patient and proxy-reported symptom assessments. Patients' oncologic treatment (chemotherapy, immunotherapy, radiation therapy, surgery) will be abstracted from the electronic medical record (EMR) at the time of each ESAS-r-CS survey completed by either the patient or caregiver by proxy.

Time frame: At enrollment and 3 months and 6 months

Secondary Outcomes

Palliative care referral patterns

Palliative care referrals pre- and post- launch of the SyMPLER study will be evaluated for trends. Historical control data collecting palliative referrals by month will be compared between groups (pre-post- launch).

Time frame: Up to 24 months