Cancer
Conditions
Keywords
Cancer, Home Care, Remote Monitoring
Brief summary
This study is evaluating if a program that involves remote monitoring and home-based care may improve the post-discharge care of recently hospitalized patients with advanced cancer. The Supportive Oncology Care at Home intervention consists of three key components: 1. Remote patient monitoring (e.g. patient-reported symptoms, home-monitored vital signs and body weight); 2. A Medically Home care model for symptom assessment, evaluation, and management (e.g. triggers for phone calls and visits to patients' homes to address and manage any concerning issues identified); 3. Structured communication with the oncology team to ensure continuity of care.
Detailed description
This is a single-arm pilot study of recently hospitalized patients with advanced cancer to assess the the feasibility of delivering a remote monitoring and home-based program, Supportive Oncology Care at Home, the acceptability and satisfaction with the Supportive Oncology Care at Home program, and changes in the quality of life and symptoms of patients who receive the Supportive Oncology Care at Home program. Oncologists at the MGH Cancer Center developed the Supportive Oncology Care program to address the symptoms and frequent hospital visits that patients face as a result of their cancer and the treatment they receive. The research study procedures include: * Remote monitoring of symptoms, vital signs, and body weight * Questionnaires asking about demographic information (e.g. gender, ethnicity, income) and participant experience with cancer (e.g. your quality of life, your symptoms) * Interviews to assess participant impressions of the program * Caregiver Interviews, Questionnaires and Surveys to assess caregiver impressions of the program and caregiver perceptions of participant symptoms while in the program * Clinician Interviews and Questionnaires to assess impressions of the program * Data collection from participant medical record. Patients will take part in the program for two weeks following hospital discharge. It is expected that between 75 and 110 people will enroll, including up to 30 patients, up to 30 caregivers, and up to 15 clinicians. Medically Home Group, Inc. is supporting this research study by providing funding for this research study.
Interventions
Intervention entailing remote monitoring of patients' symptoms, vital signs, and body weight with home-based care.
Sponsors
Massachusetts General Hospital
Medically Home Group, Inc.
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patient Eligibility * Age 18 or older * Diagnosed with advanced cancer (defined as receiving treatment with palliative intent per chemotherapy order entry treatment intent designation and/or trial consent forms OR based on documentation in the oncology clinic notes for those not receiving chemotherapy) * Admitted with an unplanned or non-elective hospitalization at Massachusetts General Hospital (MGH) * Not requiring ICU-level care during their hospitalization * Receiving care at the MGH Cancer Center * Ability to read and respond to question in English * Residing within 50 miles of MGH. Caregiver Eligibility * Relative or friend of eligible patient * Verbally fluent in English * Age 18 or older Clinician Eligibility \-- Outpatient oncology physicians and advanced practice clinicians who care for patients that receive the Supportive Oncology Care at Home intervention
Exclusion criteria
Patient Exclusion * Are admitted to the intensive care unit * Have a high oxygen requirement (FIO2 \> 0.40) * Experience active angina or cardiac arrythmias * Have a planned inpatient surgical or interventional procedure * Have uncontrolled psychiatric illness or impaired cognition interfering with their ability to understand study procedures and provide written informed consent * Are deemed ineligible for home-based care based on the inpatient oncology clinician assessment * Are planning to be discharged to hospice or to any location other than their home Caregiver Exclusion -- Caregivers who are unwilling or unable to participate in the study. Clinician Exclusion \-- Clinicians who are unwilling or unable to participate in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rates of study enrollment | 2 years | Proportion of patients who agree to participate in the study and sign informed consent. |
| Rates of completion of daily symptom assessment | 2 years | Proportion of daily patient-reported symptom assessments completed throughout the study period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rates of completion of daily vital signs | 2 years | Proportion of daily vital signs completed throughout the study period. |
| Rates of completion of daily body weight | 2 years | Proportion of daily reporting body weights completed throughout the study period. |
| Number of home visits required | Baseline to 2 weeks post-enrollment | Number of home visits required, their average duration, the issues addressed at home, and the interventions delivered to patients at their home. |
| Duration of home visits | Baseline to 2 weeks post-enrollment | Average duration of home visits required during the study period. |
| Issues addressed during home visits | Baseline to 2 weeks post-enrollment | Issues addressed during home visit throughout the study period. |
| Interventions delivered during home visits | Baseline to 2 weeks post-enrollment | Interventions delivered to patients at their home throughout the study period. |
| Number of phone calls required | Baseline to 2 weeks post-enrollment | Number of phone calls required per patient. |
| Duration of phone calls | Baseline to 2 weeks post-enrollment | Average duration of phone calls required for patients. |
| Number of emails required | Baseline to 2 weeks post-enrollment | Number of emails from Medically Home to the primary oncology team. |
| Patient acceptability | 1 year | Qualitative interview acceptability ratings from patients regarding usefulness, effectiveness, and relevance of the study. |
| Family caregiver acceptability | 1 year | Qualitative interview acceptability ratings from caregivers regarding usefulness, effectiveness, and relevance of the study. |
| Clinician acceptability | 1 year | Qualitative interview acceptability ratings from clinicians regarding usefulness, effectiveness, and relevance of the study. |
| Change in symptoms burden longitudinally throughout the study | Baseline to 2 weeks post-enrollment | Change in symptom burden (assessed using Edmonton Symptom Assessment System-revised \[ESAS-r\], range 0-10 for each symptom with higher score indicating worse symptom burden) throughout the study. |
| Change in psychological distress score longitudinally throughout the study | Baseline to 2 weeks post-enrollment | Change in psychological distress (assessed using Hospital Anxiety and Depression Scale \[HADS\], range 0-21 for scores of anxiety and depression with higher score indicating worse anxiety or depression) throughout the study. |
| Change in quality of life score longitudinally throughout the study | Baseline to 2 weeks post-enrollment | Change in quality of life (assessed using Functional Assessment of Cancer Therapy-General \[FACT-G\] questionnaire, assessing physical, functional, emotional, and social well-being during the prior seven days, with total score ranging from 0-108 with higher scores indicating better quality of life) throughout the study. |
| Change in care satisfaction score longitudinally throughout the study | Baseline to 2 weeks post-enrollment | Change in patient care satisfaction (assessed using the 16-item FAMCARE questionnaire \[FAMCARE-P\], range of 16-80 with higher score indicating higher care satisfaction) throughout the study. |
| Number of emergency department visits | Baseline up to one month post-enrollment | The number of emergency department \[ED\] visits per patient. |
| Rates of emergency department visits | 1 year | Proportion of patients needing an emergency department \[ED\] visit. |
| Number of urgent visits | Baseline up to one month post-enrollment | The number of urgent visits to clinic per patient. |
| Rates of urgent visits | 1 year | Proportion of patients needing an urgent visit to clinic. |
| Number of hospital readmissions | Baseline up to one month post-enrollment | The number of hospital readmissions per patient. |
| Rates of hospital readmissions | 1 year | Proportion of patients needing hospital readmission. |
| Length of hospital readmissions | Baseline up to one month post-enrollment | The length of stay (LOS) per each hospital readmission for patients who are readmitted. |
| Days outside of hospital | Baseline to 2 weeks post-enrollment | The proportion of days patients spent outside the hospital during the study period. |
| Hospitalization length of stay | Baseline to 2 weeks post-enrollment | The index hospitalization length of stay (LOS). |
| Change in caregivers reports of patients' symptom burden longitudinally throughout the study | Baseline to 2 weeks post-enrollment | Change in symptom burden (assessed using Edmonton Symptom Assessment System-revised \[ESAS-r\], range 0-10 for each symptom with higher score indicating worse symptom burden) throughout the study. |
| Concordance between caregiver and patient reports of patient symptom burden | Baseline to 2 weeks post-enrollment | Difference in symptom burden (assessed using Edmonton Symptom Assessment System-revised \[ESAS-r\], range 0-10 for each symptom with higher score indicating worse symptom burden) between patients and caregivers throughout the study. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORAreej El-Jawahri, MD
Massachusetts General Hospital
Outcome results
None listed