Telephone-linked care for cancer symptom monitoring: a pilot study.

PURPOSE The purpose of this pilot project was to explore the feasibility of using a telephone-based computerized system to monitor postchemotherapy symptoms and to test the mechanism of generating alert communications to healthcare providers about symptoms that are poorly controlled. DESCRIPTION OF STUDY Twenty-seven patients with cancer participated in the study by calling the telephone-linked care (TLC) system daily during a single cycle of chemotherapy and reporting on seven common chemotherapy-related symptoms. Using selected symptom data, symptoms that met a preset threshold for severity generated a fax notification of the patient's symptom pattern to the physician. Patients then were interviewed about their satisfaction with TLC and about suggestions for improvement. RESULTS The study demonstrated that TLC is easy to learn and use and that it captures daily symptom information from patients in their homes. A majority of patients experienced symptoms that were severe enough to generate symptom-alert faxes. Patient satisfaction with TLC was high. The technique, TLC voice, and the duration of the calls were acceptable to patients. There were few technical problems. CLINICAL IMPLICATIONS The TLC system has the potential to improve dramatically symptom monitoring and symptom care of patients with cancer at home. Further testing is needed, but the TLC chemotherapy monitoring application shows promise for improving supportive-care service delivery for cancer patients. In its initial test, the TLC chemotherapy monitoring application has been shown to be highly acceptable to patients, able to generate useful symptom data, and able to generate faxed alerts to healthcare providers, thus improving communication about poorly controlled symptoms.

[1]  P J Anastasia,et al.  Outpatient chemotherapy: telephone triage for symptom management. , 1997, Oncology nursing forum.

[2]  F Alemi,et al.  Reaction to “Talking” Computers Assessing Health Risks , 1995, Medical care.

[3]  A. Gafni,et al.  The supportive care needs of newly diagnosed cancer patients attending a regional cancer center , 1997, Cancer.

[4]  S. Thorne.  Communication in cancer care: what science can and cannot teach us. , 1999, Cancer nursing.

[5]  L. Nail,et al.  Nursing care by telephone: describing practice in an ambulatory oncology center. , 1989, Oncology nursing forum.

[6]  J. Piette,et al.  The Feasibility of Automated Voice Messaging as an Adjunct to Diabetes Outpatient Care , 1997, Diabetes Care.

[7]  R. Friedman.  Automated Telephone Conversations to Assess Health Behavior and Deliver Behavioral Interventions , 1998, Journal of Medical Systems.

[8]  Moinpour Cm.  Measuring quality of life: an emerging science. , 1994 .

[9]  D. Cella,et al.  Quality of life: concepts and definition. , 1994, Journal of pain and symptom management.

[10]  K. Huss,et al.  Computer-assisted reinforcement of instruction: effects on adherence in adult atopic asthmatics. , 1991, Research in nursing & health.

[11]  F Alemi,et al.  Computer reminders improve on-time immunization rates. , 1996, Medical care.

[12]  M. Oberst,et al.  Appraisal of illness, symptom distress, self-care burden, and mood states in patients receiving chemotherapy for initial and recurrent cancer. , 1992, Oncology nursing forum.

[13]  R. Friedman,et al.  An automated telephone-based smoking cessation education and counseling system. , 1999, Patient education and counseling.

[14]  P. Hinds,et al.  Quality of life and the cancer experience: the state-of-the-knowledge. , 1997, Oncology nursing forum.

[15]  Robert H. Friedman,et al.  Synthesis of Research: The Virtual Visit: Using Telecommunications Technology to Take Care of Patients , 1997, J. Am. Medical Informatics Assoc..

[16]  M Ben Said,et al.  Benefits of a computer-assisted education program for hypertensive patients compared with standard education tools. , 1995, Patient education and counseling.

[17]  R. Cady.  Pitfalls in telephone triage. , 1999, MCN, The American Journal of Maternal Child Nursing.

[18]  T Heeren,et al.  An automated telephone system for monitoring the functional status of community-residing elders. , 1999, The Gerontologist.

[19]  John E. Stollerman,et al.  A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control. , 1996, American journal of hypertension.

[20]  J. Sitzia,et al.  Patients' experiences of chemotherapy: side-effects of carboplatin in the treatment of carcinoma of the ovary. , 1997, European journal of cancer care.

[21]  M. Dodd,et al.  Differences in nausea, vomiting, and retching between younger and older outpatients receiving cancer chemotherapy. , 1996, Cancer nursing.

[22]  L. G. Peterson,et al.  Neuropsychiatric effects of chemotherapeutic agents for cancer. , 1980, Psychosomatics.

[23]  J. Piette,et al.  Patient education via automated calls: a study of English and Spanish speakers with diabetes. , 1999, American journal of preventive medicine.

[24]  J. Piette,et al.  The effect of automated calls with telephone nurse follow-up on patient-centered outcomes of diabetes care: a randomized, controlled trial. , 2000, Medical care.

[25]  J. Sitzia,et al.  Side effects of CHOP in the treatment of non-hodgkin's lymphoma. , 1997, Cancer nursing.

[26]  J. Sitzia,et al.  Side effects of cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) chemotherapy for breast cancer. , 1998, Cancer practice.

[27]  V. Leirer,et al.  Use of automated reminders for tuberculin skin test return. , 1997, American journal of preventive medicine.

[28]  F Alemi,et al.  Automated Monitoring of Outcomes , 1994, Medical decision making : an international journal of the Society for Medical Decision Making.

[29]  V. Leirer,et al.  Automated Telephone Reminders in Tuberculosis Care , 1994, Medical care.

[30]  M. Gallagher,et al.  Telephone triage of acute illness by a practice nurse in general practice: outcomes of care. , 1998, The British journal of general practice : the journal of the Royal College of General Practitioners.