Impact of Providing an Automated Telephone Option to Report Weekly Patient-Reported Outcome Measures in the PRO-TECT Trial (AFT-39) on Disparity Gaps in Symptom Management and Outcomes.
Angela M Stover, Allison M Deal, Brenda Ginos, Amylou Dueck, Patricia A Spears, Jennifer Jansen, Philip Carr, Sydney Henson, Antonia V Bennett, Mattias Jonsson, Claire Snyder, Ethan Basch
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引用次数: 0
Abstract
Purpose: Many trials ask patients to complete patient-reported outcome measures (PROMs) via the web, excluding patients unable to use/access the Internet. The PRO-TECT trial (AFT-39, ClinicalTrials.gov identifier: NCT03249090) also offered a telephone interface option (interactive voice response [IVR]). We compared patients choosing IVR versus web on alert rates to nurses and clinical outcomes to determine if a telephone option can close disparities in symptom management.
Methods: PRO-TECT randomized 26 community oncology practices to the PROM intervention arm where concerning symptoms generated automated alerts to nurses. IVR and web patients were compared for social determinants of health (SDOH) using analysis of variance and chi-square tests. After accounting for clustering and confounders, we used generalized estimating equations to compare alert rates, mixed models for quality of life (QOL) at 3 months, and Cox regression for emergency visits and survival at 12 months.
Results: Among 593 patients, 215 (36%) chose IVR and 378 (64%) chose web. IVR patients were older (65.2 v 60.8 years) and were more often rural residents (32% v 23%), Black (27% v 11%), and with less education (54% v 27% ≤high school; all P < .01). Patients choosing IVR had more surveys with concerning symptoms (49% v 37%) and nurses felt clinical attention was warranted more often (4.8 surveys v 3.4 surveys; all P < .001) but ultimately experienced similar benefits as web in QOL, emergency visits, and survival.
Conclusion: One third of community patients choose a telephone option over the web for reporting PROMs during cancer care. These patients are disproportionately from SDOH backgrounds at risk of poor clinical outcomes and have higher symptom management needs but ultimately experience similar clinical benefits as patients choosing the web. PROM programs should offer web alternatives to close disparities in symptom management.
目的：许多试验要求患者通过网络完成患者报告的结果测量（PROMs），排除了无法使用/访问互联网的患者。PRO-TECT试验（AFT-39, ClinicalTrials.gov识别码：NCT03249090）还提供了一个电话界面选项（交互式语音应答[IVR]）。我们比较了选择IVR和网络的患者对护士的报警率和临床结果，以确定电话选项是否可以缩小症状管理方面的差异。方法：PRO-TECT将26个社区肿瘤学实践随机分配到PROM干预组，其中有关症状会自动向护士发出警报。使用方差分析和卡方检验比较IVR和web患者的健康社会决定因素（SDOH）。在考虑聚类和混杂因素后，我们使用广义估计方程来比较警觉率、3个月时生活质量（QOL）的混合模型，以及12个月时急诊就诊和生存率的Cox回归。结果：593例患者中，215例（36%）选择IVR， 378例（64%）选择web。IVR患者年龄较大（65.2 v 60.8岁），多为农村居民（32% v 23%），黑人（27% v 11%），受教育程度较低(54% v 27%≤高中；P < 0.01)。选择IVR的患者有更多关于症状的调查（49% vs 37%），护士认为临床关注更有必要(4.8项调查vs 3.4项调查；均P < 0.001)，但最终在生活质量、急诊就诊和生存率方面与web有相似的获益。结论：三分之一的社区患者在癌症治疗期间选择通过网络电话报告PROMs。这些患者大多来自SDOH背景，有不良临床结果的风险，有更高的症状管理需求，但最终获得的临床益处与选择网络的患者相似。PROM程序应提供网络替代方案，以缩小症状管理方面的差距。
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