The traditional procedure for cancer symptom and quality of life assessment is a paper questionnaire completed by the patient or research participant. The use of standardized, patient report instruments as routine assessment in clinical cancer care has been promoted, but infrequently reported and the utilization rate is low. Barriers to clinical use include the personnel cost of data collection, management of written questionnaires and the clinicians' unfamiliarity with the nature of the queries and numerical scale scores. Web-based technology has been developed and tested for feasibility using touch screen, notebook computers and a computerized screening assessment program providing usable and easily interpreted graphic output to cancer clinicians. The purpose of this study is to enhance and evaluate the web-based computerized assessment, ESRA-C, in a major, multi-disciplinary medical center and cancer center. This is a randomized controlled trial with ESRA-C output as the experimental intervention and a control condition of no output. All clinicians who are conducting patient consults and on-treatment visits will be invited to participate. Eight hundred and fifty outpatients who are evaluated for cancer therapy in each of the two sites, the University of Washington Medical Center and the Seattle Cancer Care Alliance, are able to communicate in English (or through one of the many interpreters available at the institutions), and are competent to understand the study information and give informed consent also will be invited to participate. We will compare conducting assessment in the usual practices and procedures to the clinical provision of the computerized ESRA-C program on the following outcomes: communication about, and documentation of, symptoms and quality of life concerns, appropriateness of symptom management referrals, efficiency and usability. We expect that the ESRA-C system will decrease assessment time, enhance clinician-patient communication about symptoms and quality of life concerns, increase the number of specific interventions for symptom prevention and management and increase appropriate referrals to support services. The patient will complete the computerized assessment at the first clinic visit and again at the four-week on-treatment visit. Graphical output will be immediately available to clinicians. Comparative statistics will be used to evaluate the impact of the providing the computerized assessments output to the clinician. We will analyze the clinical significance of the quality of life scores using a within-subject health transition method to determine the subjective significance to patients of change in quality of life score over time.
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