Abstract
Background
The prevalence of inadequate symptom control among cancer patients is quite high despite the availability of definitive care guidelines and accurate and efficient assessment tools.
Methods
We will conduct a hybrid type 2 stepped wedge pragmatic cluster randomized clinical trial to evaluate a guideline-informed enhanced, electronic health record (EHR)-facilitated cancer symptom control (E2C2) care model. Teams of clinicians at five hospitals that care for patients with various cancers will be randomly assigned in steps to the E2C2 intervention. The E2C2 intervention will have two levels of care: level 1 will offer low-touch, automated self-management support for patients reporting moderate sleep disturbance, pain, anxiety, depression, and energy deficit symptoms or limitations in physical function (or both). Level 2 will offer nurse-managed collaborative care for patients reporting more intense (severe) symptoms or functional limitations (or both). By surveying and interviewing clinical staff, we will also evaluate whether the use of a multifaceted, evidence-based implementation strategy to support adoption and use of the E2C2 technologies improves patient and clinical outcomes. Finally, we will conduct a mixed methods evaluation to identify disparities in the adoption and implementation of the E2C2 intervention among elderly and rural-dwelling patients with cancer.
Discussion
The E2C2 intervention offers a pragmatic, scalable approach to delivering guideline-based symptom and function management for cancer patients. Since discrete EHR-imbedded algorithms drive defining aspects of the intervention, the approach can be efficiently disseminated and updated by specifying and modifying these centralized EHR algorithms.
Trial registration
ClinicalTrials.gov, NCT03892967. Registered on 25 March 2019.
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Details
1 Mayo Clinic, Department of Health Sciences Research, Rochester, USA (GRID:grid.66875.3a) (ISNI:0000 0004 0459 167X); Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, USA (GRID:grid.66875.3a) (ISNI:0000 0004 0459 167X)
2 Mayo Clinic, Division of Medical Oncology, Rochester, USA (GRID:grid.66875.3a) (ISNI:0000 0004 0459 167X)
3 Mayo Clinic, Department of Nursing, Rochester, USA (GRID:grid.66875.3a) (ISNI:0000 0004 0459 167X)
4 Yale University School of Medicine, New Haven, USA (GRID:grid.47100.32) (ISNI:0000000419368710)
5 Mayo Clinic, Department of Health Sciences Research, Rochester, USA (GRID:grid.66875.3a) (ISNI:0000 0004 0459 167X); Mayo Clinic, Knowledge and Evaluation Research Unit, Rochester, USA (GRID:grid.66875.3a) (ISNI:0000 0004 0459 167X)
6 Mayo Clinic, Center for Palliative Care, Minnesota, USA (GRID:grid.66875.3a) (ISNI:0000 0004 0459 167X)
7 Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, USA (GRID:grid.66875.3a) (ISNI:0000 0004 0459 167X)
8 Mayo Clinic, Department of Health Sciences Research, Rochester, USA (GRID:grid.66875.3a) (ISNI:0000 0004 0459 167X)
9 Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, USA (GRID:grid.66875.3a) (ISNI:0000 0004 0459 167X); Mayo Clinic, Division of Community Palliative Medicine, Rochester, USA (GRID:grid.66875.3a) (ISNI:0000 0004 0459 167X)