Mary E Cooley1, Emanuele Mazzola2, Niya Xiong2, Fangxin Hong2, David F Lobach3, Ilana M Braun4, Barbara Halpenny5, Michael S Rabin6, Ellis Johns7, Kathleen Finn8, Donna Berry9, Ruth McCorkle10, Janet L Abrahm4. 1. Research in Nursing and Patient Care (M.E.C, B.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA. Electronic address: Mary_cooley@dfci.harvard.edu. 2. Data Sciences (E.M., N.X., F.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA. 3. Klesis Healthcare (D.F.L.), Durham, North Carolina, USA. 4. Psychosocial Oncology and Palliative Care (I.M.B., J.L.A.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA. 5. Research in Nursing and Patient Care (M.E.C, B.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA. 6. Lowe Center for Thoracic Oncology (M.S.R.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA. 7. Family Medicine (E.J.), Virginia Commonwealth University, Richmond, Virginia, USA. 8. Clinical Research (K.F.), City of Hope, Duarte, California, USA. 9. Biobehavioral Nursing and Health Informatics (D.B.), University of Washington, Seattle, Washington, USA. 10. School of Nursing (R.M.), Yale University, New Haven, Connecticut, USA.
Abstract
CONTEXT: Clinical guidelines are available to enhance symptom management during cancer treatment but often are not used in the practice setting. Clinical decision support can facilitate the implementation and adherence to clinical guidelines. and improve the quality of cancer care. OBJECTIVES: Clinical decision support offers an innovative approach to integrate guideline-based symptom management into oncology care. This study evaluated the effect of clinical decision support-based recommendations on clinical management of symptoms and health-related quality of life (HR-QOL) among outpatients with lung cancer. METHODS: Twenty providers and 179 patients were allotted in group randomization to attention control (AC) or Symptom Assessment and Management Intervention (SAMI) arms. SAMI entailed patient-report of symptoms and delivery of recommendations to manage pain, fatigue, dyspnea, depression, and anxiety; AC entailed symptom reporting prior to the visit. Outcomes were collected at baseline, two, four and six-months. Adherence to recommendations was assessed through masked chart review. HR-QOL was measured by the Functional Assessment of Cancer Therapy-Lung questionnaire. Descriptive statistics with linear and logistic regression accounting for the clustering structure of the design and a modified chi-square test were used for analyses. RESULTS: Median age of patients was 63 years, 58% female, 88% white, and 32% ≤high school education. Significant differences in clinical management were evident in SAMI vs. AC for all target symptoms that passed threshold. Patients in SAMI were more likely to receive sustained-release opioids for constant pain, adjuvant medications for neuropathic pain, opioids for dyspnea, stimulants for fatigue and mental health referrals for anxiety. However, there were no statistically significant differences in HR-QOL at any time point. CONCLUSION: SAMI improved clinical management for all target symptoms but did not improve patient outcomes. A larger study is warranted to evaluate effectiveness.
CONTEXT: Clinical guidelines are available to enhance symptom management during cancer treatment but often are not used in the practice setting. Clinical decision support can facilitate the implementation and adherence to clinical guidelines. and improve the quality of cancer care. OBJECTIVES: Clinical decision support offers an innovative approach to integrate guideline-based symptom management into oncology care. This study evaluated the effect of clinical decision support-based recommendations on clinical management of symptoms and health-related quality of life (HR-QOL) among outpatients with lung cancer. METHODS: Twenty providers and 179 patients were allotted in group randomization to attention control (AC) or Symptom Assessment and Management Intervention (SAMI) arms. SAMI entailed patient-report of symptoms and delivery of recommendations to manage pain, fatigue, dyspnea, depression, and anxiety; AC entailed symptom reporting prior to the visit. Outcomes were collected at baseline, two, four and six-months. Adherence to recommendations was assessed through masked chart review. HR-QOL was measured by the Functional Assessment of Cancer Therapy-Lung questionnaire. Descriptive statistics with linear and logistic regression accounting for the clustering structure of the design and a modified chi-square test were used for analyses. RESULTS: Median age of patients was 63 years, 58% female, 88% white, and 32% ≤high school education. Significant differences in clinical management were evident in SAMI vs. AC for all target symptoms that passed threshold. Patients in SAMI were more likely to receive sustained-release opioids for constant pain, adjuvant medications for neuropathic pain, opioids for dyspnea, stimulants for fatigue and mental health referrals for anxiety. However, there were no statistically significant differences in HR-QOL at any time point. CONCLUSION: SAMI improved clinical management for all target symptoms but did not improve patient outcomes. A larger study is warranted to evaluate effectiveness.
Authors: S L Du Pen; A R Du Pen; N Polissar; J Hansberry; B M Kraybill; M Stillman; J Panke; R Everly; K Syrjala Journal: J Clin Oncol Date: 1999-01 Impact factor: 44.544
Authors: Mary E Cooley; David F Lobach; Ellis Johns; Barbara Halpenny; Toni-Ann Saunders; Guilherme Del Fiol; Michael S Rabin; Pamela Calarese; Isidore L Berenbaum; Ken Zaner; Kathleen Finn; Donna L Berry; Janet L Abrahm Journal: J Pain Symptom Manage Date: 2013-05-13 Impact factor: 3.612
Authors: Jesse R Fann; Donna L Berry; Seth Wolpin; Mary Austin-Seymour; Nigel Bush; Barbara Halpenny; William B Lober; Ruth McCorkle Journal: Psychooncology Date: 2009-01 Impact factor: 3.894
Authors: Donna L Berry; Fangxin Hong; Barbara Halpenny; Anne Partridge; Erica Fox; Jesse R Fann; Seth Wolpin; William B Lober; Nigel Bush; Upendra Parvathaneni; Dagmar Amtmann; Rosemary Ford Journal: BMC Cancer Date: 2014-07-12 Impact factor: 4.430