Background. Given the growing strain on VAHCS resulting from increasing caseloads of cancer patients,interventions are badly needed that assist patients in managing their illness, improve quality of life, and avoid acute episodes that result in urgent care use and increased mortality. Previous studies have found that cancer patients undergoing chemotherapy can effectively manage their own symptoms when monitored using Interactive Voice Response technology. Such technology, however, may challenge the number of veterans who lack social support and/or independence. Our goal is to develop and test a technology that not only monitors patients automatically, but also gives them self management advice and engages a friend or family member to serve as a 'CarePartner' (CP) willing to play a limited role in identifying patient symptoms and psychosocial needs to reinforce self management and provide social support. Should such technology be successful, it could substantially improve the quality of life of veterans and their families during the stresses of chemotherapy without substantially increasing the cost of care. Objectives. (1) To determine if VA patients undergoing chemotherapy who receive automated telephonic symptom assessment (ATSA) and symptom management advice with provider alerts plus Web-based feedback to inform and engage a CP report significant improvement in the number and severity of symptoms compared to patients receiving monitoring with provider alerts only. Secondary patient outcomes include adherence to chemotherapy, function, and utilization. (2) To determine if CPs receiving weekly notification of patients' symptom severity and psychosocial needs with problem solving advice through a Web-based system provide significantly more social support to patients than do control CPs. Secondarily, to determine if CPs receiving the intervention experience more caregiver burden and distress than do control CPs. (3) To determine whether the impacts on patients are moderated by the presence of an in-home caregiver. (4) To determine whether the impacts on patients are mediated by improved general adherence and whether this association is moderated by the presence of other caregivers as well as patient clinical and socio-demographic characteristics. (5) To determine whether the abovementioned impacts on CPs are mediated by improvements in their knowledge of patients' symptoms and mastery, and whether this association is moderated by CP location (in-home vs. out-of-home), presence of other caregivers, family structure, relationship quality, CP socio-demographics, and geographic access to the patient. Methods. 292 patients with solid tumors undergoing chemotherapy at the AAVAMC and reporting symptoms who can identify CPs will be assigned to either 10w of ATSA with provider alerts or 10w of ATSA with provider alerts PLUS symptom management advice to patients and notification of symptom severity and problem solving advice to CPs. Patients and CPs will be surveyed at intake, 10w and 14w. Both groups will receive standard oncology, hospice, and palliative care.
This research represents the next step in advancing the science of cognitive behavioral interventions for managing symptoms in cancer. It is the first trial to address the difficulties many veterans face when attempting to manage their symptoms with inadequate support from social network members, by providing a mechanism so that any caregiver can be more informed about the patient's status and needs, and provide structured support in key areas over the phone. If successful, our program stands to help thousands of veterans with cancer symptoms for whom self-care is a challenge and who experience preventable morbidity and health service use as a consequence.
