People with advanced lung cancer often experience multiple, debilitating symptoms related to their disease and treatment. Many symptoms emerge when patients are home, between clinic appointments. Unrecognized symptoms can result in reduced health-related quality of life (HRQL), decreased treatment efficacy due to interrupted therapy or reduced doses of chemotherapy, and emergency room visits and hospitalizations. Barriers to adequate and timely symptom management exist on patient, physician, and system levels: patient reluctance to communicate about symptoms with their physicians; lack of routine systematic symptom assessment by clinicians; and clinic time and resource constraints, making thorough symptom assessment impractical. To address these barriers, we propose a randomized clinical trial (RCT) of a Symptom Monitoring and reporting system for advanced Lung cancer (SyMon-L), which we have been piloting for 2 years. To optimize Symon-L's feasibility in a range of health care settings, we will determine barriers unique to a public hospital prior to RCT implementation. Symon-L's combination of computer and interactive voice response (IVR) technologies allows routine, systematic symptom assessment of patients at home, between office visits, with minimal burden on staff and patients. Patients telephone the system on a weekly basis for 12 weeks to complete a brief symptom measure. A nurse monitors weekly symptom scores and contacts the patient and physician for consultation when scores reach a pre-defined threshold warranting clinical attention. SyMon-L generates longitudinal graphic displays of patients' symptom experience for discussion by patient and physician during clinic visits. Our preliminary data suggest that patients and physicians are highly receptive to SyMon-L and that the system promotes symptom-focused communication between provider and patient. The proposed RCT seeks to demonstrate that this system identifies clinically significant problems before they are detected in routine clinical care and results in enhanced clinical management of symptoms. The primary outcome is symptom burden over 12 weeks; secondary endpoints include patient HRQL, treatment satisfaction, self-efficacy, patient-perceived barriers to symptom management, healthcare utilization, and patient and provider satisfaction with SyMon-L. SyMon-L has the potential to feasibly and effectively address barriers to optimal symptom management for people with cancer.
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