The candidate's long-term career goal is to become an independently funded physician-scientist who is actively engaged in health information technology (HIT) interventions that improve the process and outcomes of care of surgical patients following discharge. The proposed career development plan integrates didactic coursework with practical mentored research experience in the design and conduct of intervention studies that are critical for the candidate to have a successful career in patient-oriented research. The candidate's educational aims are to 1) obtain education and skills in intervention development, patient-centered outcomes (PCO) research, qualitative research and clinical trials 2) develop expertise to implement HIT and mHealth technologic advances in the surgical field 3) gain experience in quality improvement methodology, and 4) obtain pilot data to support a multi-institutional trial. In addition, under the mentorship of Drs. Ethan Basch and Morris Weinberger, the candidate will cultivate professional aptitudes including grant writing, efficient balance between clinical and research activities, and an improved understanding of ethics in research. Using radical cystectomy as a model, the proposed research seeks to develop and pilot test an electronic, internet-based mHealth tool that prospectively collects PCO data on key symptoms, functional status, and medication adherence while providing timely feedback to patients and clinicians. The work will provide the preliminary data for a multi-site, randomized trial to rigorously test the effectiveness of the mHealth tool. The mHealth tool is significant because it is a practical way to improve the quality of care for cancer patients undergoing major surgery and, ultimately, to reduce the high rate of post-discharge complications and readmissions. The research is innovative because it involves an mHealth intervention which uses patient- centered outcomes to provide meaningful, real-time feedback to surgical patients and their providers. This mHealth tool can be adapted to other surgical procedures, incorporated into the electronic health record and will have the flexibility to be modified for specific patient populations.

Public Health Relevance

Readmissions following major surgical oncology procedures are prevalent and costly with cystectomy for bladder cancer having the highest rate of complications and readmissions. Patient-centered outcomes, including symptoms, functional status, and medication adherence, represent potential treatment targets following hospital discharge. Novel strategies which incorporate patient-centered outcomes and improve post- discharge care for radical cystectomy and other surgical oncology procedures have the potential to reduce post-surgical readmissions, with the potential for dramatic public health impact.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Clinical Investigator Award (CIA) (K08)
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HSR Health Care Research Training SS (HCRT)
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Willis, Tamara
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University of North Carolina Chapel Hill
Schools of Medicine
Chapel Hill
United States
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Smith, Angela B; Meyer, Anne-Marie; Meng, Ke et al. (2018) The relationship of travel distance with cystectomy access and outcomes. Urol Oncol 36:308.e1-308.e9
Smith, Angela B; Basch, Ethan (2017) Role of Patient-Reported Outcomes in Postsurgical Monitoring in Oncology. J Oncol Pract 13:535-538