Pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2)

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.

Telehealth Strategies to Support Patients and Families Across the Cancer Trajectory

“…Nonetheless, these losses exact a uniformly high monetary and human toll. The COPE 25,26 and electronic health record-facilitated E2C2 27 trials use cases that highlight the capabilities that make "tele-rehabilitation" more accessible and potentially more effective than conventional center-based care. These include the ability to: (…”

“…26,29 The population-based, pragmatic E2C2 trial is ongoing and draws heavily from COPE in its collaborative care model-based telecare delivery. 27 The E2C2 trial intervention targets a total of five symptoms and functional decline, and spans all cancer stages.…”

Iterative development and pilot testing of an intervention fidelity monitoring plan for the enhanced, electronic health record-facilitated pragmatic clinical trial: Implications for training and protocol integrity

“…The overall goal of this trial is to provide evidence for the impact of the E2C2 intervention on the management of SPADE symptoms and functional limitations, as well as outcomes of healthcare utilization, adherence to cancer treatment, and survival. Details of the E2C2 protocol are published elsewhere [ 5 ].…”

“…Algorithms underwent several iterations to ensure they could be consistently and usefully implemented to guide symptom assessment and management by the RN SCMs during patient interactions. Details on the individual symptom management algorithms are available elsewhere [ 5 ].…”

Steigerung der Versorgungsqualität in der Palliativversorgung durch elektronische Gesundheitsakten

“…Doch auch wenn die Symptome ganzheitlich dokumentiert werden können: Die Symptomkontrolle ist, selbst bei Patient*innen die leitlinienkonform behandelt werden könnten, häufig unzureichend (Rutten et al 2020). In einer Studie zeigte sich die Alarmierung von Versorger*innen bei dem Überschreiten eines vorgegebenen Schweregrads als hilfreich.…”