Pilot randomized trial of an electronic symptom monitoring intervention for hospitalized patients with cancer.

ABSTRACT: BACKGROUND:Hospitalized patients with cancer experience a high symptom burden, which is associated with poor health outcomes and increased health care utilization. However, studies investigating symptom monitoring interventions in this population are lacking. We conducted a pilot randomized trial to assess the feasibility and preliminary efficacy of a symptom monitoring intervention to improve symptom management in hospitalized patients with advanced cancer. PATIENTS AND METHODS:We randomly assigned patients with advanced cancer who were admitted to the inpatient oncology service to a symptom monitoring intervention or usual care. Patients in both arms self-reported their symptoms daily (Edmonton Symptom Assessment System and Patient Health Questionnaire-4). Patients assigned to the intervention had their symptom reports presented graphically with alerts for moderate/severe symptoms during daily team rounds. The primary end point of the study was feasibility. We defined the intervention as feasible if >75% of participants hospitalized >2?days completed >2 symptom reports. We observed daily rounds to determine whether clinicians discussed and developed a plan to address patients' symptoms. We used regression models to assess intervention effects on patients' symptoms throughout their hospitalization, readmission risk, and hospital length of stay (LOS). RESULTS:Among 150 enrolled patients (81.1% enrollment), 94.2% completed >2 symptom reports. Clinicians discussed 60.4% of the symptom reports and developed a plan to address the symptoms highlighted by the symptom reports 20.8% of the time. Compared with usual care, intervention patients had a greater proportion of days with lower psychological distress (B?=?0.12, P?=?0.008), but no significant difference in the proportion of days with improved Edmonton Symptom Assessment System-physical symptoms (B?=?0.07, P?=?0.138). Intervention patients had lower readmission risk (hazard ratio?=?0.68, P?=?0.224), although this difference was not significant. We found no significant intervention effects on hospital LOS (B?=?0.16, P?=?0.862). CONCLUSIONS:This symptom monitoring intervention is feasible and demonstrates encouraging preliminary efficacy for improving patients' symptoms and readmission risk.ClinicalTrials.gov identifier NCT02891993.

SUBMITTER: Nipp RD 

PROVIDER: S-EPMC6386022 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature