Pilot Randomized Trial of an Electronic Symptom Monitoring Intervention for Hospitalized Patients with Cancer

Abstract

Background

Hospitalized patients with cancer experience a high symptom burden, which is associated with poor health outcomes and increased healthcare utilization. However, studies investigating symptom monitoring interventions in this population are lacking. We conducted a pilot randomized trial to assess the feasibility and preliminary efficacy of a symptom monitoring intervention to improve symptom management in hospitalized patients with advanced cancer.

Patients and Methods

We randomly assigned patients with advanced cancer who were admitted to the inpatient oncology service to a symptom monitoring intervention or usual care. Patients in both arms self-reported their symptoms daily (Edmonton Symptom Assessment System and Patient Health Questionnaire-4). Patients assigned to the intervention had their symptom reports presented graphically with alerts for moderate/severe symptoms during daily team rounds. The primary endpoint of the study was feasibility. We defined the intervention as feasible if > 75% of participants hospitalized >2 days completed >2 symptom reports. We observed daily rounds to determine if clinicians discussed and developed a plan to address patients' symptoms. We used regression models to assess intervention effects on patients' symptoms throughout their hospitalization, readmission risk, and hospital length of stay (LOS).

Results

Among 150 enrolled patients (81.1% enrollment), 94.2% completed >2 symptom reports. Clinicians discussed 60.4% of the symptom reports and developed a plan to address the symptoms highlighted by the symptom reports 20.8% of the time. Compared with usual care, intervention patients had a greater proportion of days with lower psychological distress (B=0.12, P=0.008), but no significant difference in the proportion of days with improved ESAS-physical symptoms (B=0.07, P=0.138). Intervention patients had lower readmission risk (hazard ratio=0.68, P=0.224), although this difference was not significant. We found no significant intervention effects on hospital LOS (B=0.16, P=0.862).

Conclusions

This symptom monitoring intervention is feasible and demonstrates encouraging preliminary efficacy for improving patients' symptoms and readmission risk.ClinicalTrials.gov identifier NCT02891993

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