Coping with advanced cancer is facilitated by exchanges between patients, caregivers and clinicians. Clinicians need information about the patient's status to intervene appropriately. Patients and partners need information and support from clinicians. Clinicians need to facilitate end of life communication with and between patients and families. But clinicians are being forced to reduce visit time and many patients and partners avoid bothering the doctor. Hence, methods are needed to improve these communications. The proposed research evaluates whether ICCSs improve palliative care and the impact of sharing patient information with clinicians. The ICCS is CHESS (Comprehensive Health Enhancement Support System) a non-commercial home-based system created University of Wisconsin scientists. Previous research shows CHESS to be widely accepted, used and to improve quality of life and health services use. Built on a model of coping self-efficacy, CHESS monitors user health status, guides users to information and support, assists in health decisions and teaches coping skills. An enhanced system, [CHESS + Clinician Report (CR)] will communicate patient and partner information to the palliative care team when the team wants it, prior to a scheduled clinic visit and when a symptom exceeds a threshold. Lung cancer patients and partners (25% minority) from Detroit, Madison and Boston (n=380) will be randomly assigned to: 1) a control group of patients receiving Usual Care (and Intemet access), 2) CHESS and 3) CHESS with a Clinician Report (CHESS+CR). Partners will be followed until 13 months after the patient dies. Hypotheses: compared to a Usual Care control, CHESS will improve patient quality of life, symptom distress, partner negative affect and bereavement. CHESS+CR will have more impact and decrease emergency health services use. Minority and female partners will benefit most. Process analyses will examine how these effects are mediated by symptom management, calls from clinicians, partner caregiving burden, coping self-efficacy, information competence, needs met at clinical visits and how they are moderated by amount of CHESS use.
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