Automated Coaching with NP Follow-up Effectively Reduced Symptom Burden

Patient-reported outcome (PRO) assessment with automated coaching and nurse practitioner (NP) decision-supported follow-up resulted in better symptom reduction in patients with moderate to severe symptoms compared with either of those three individual components.

Kathi Mooney, PhD, RN, of Huntsman Cancer Institute, University of Utah, reported the results of a study looking at the combined intervention at the 2022 ASCO Annual Meeting.

The researchers deconstructed the Symptom Care at Home (SCH) monitoring and management system, a multicomponent intervention found to be effective in reducing symptom burden for patients at home. SCH remotely monitors daily PROs, provides tailored automated self-management coaching based on the severity pattern reported for 11 monitored symptoms and alerts an NP of poorly controlled moderate to severe symptoms. The NP follows up to intensify symptom care utilizing the SCH decision support system based on national guidelines.

In the study, 755 patients were randomly assigned to one of five groups: Group 1, automated self-management coaching, Group 2, automated self-management coaching plus an activity tracker, Group 3, NP follow-up without decision support, Group 4, NP follow-up with decision support, or Group 5, automated coaching plus NP follow-up with decision support.

The primary outcome was maximum likelihood estimation of overall symptom severity over the duration for the study.

Median study participation was 62 days. The majority of participants  (65.7%) had stage 3 or 4 cancer, most commonly breast (17.1%), lung (13.9%), or colorectal cancer (12.9%).

Daily symptom reports were completed 73.8% of the time with no difference between study groups. The majority of patients (84.2%) reported one or more moderate or severe symptoms. The most common symptoms were fatigue (70.1%), pain (64.8%), and trouble sleeping (56.0%).

Group 5 had significantly greater symptom relief than any other group. Additionally, the two groups with NP follow-up had similar outcomes and were significantly better than the groups with automated coaching.

The researchers concluded that “better symptom relief can be obtained for patients at home through a synergistic, multicomponent intervention that combines a tailored symptom coaching component with notification and follow up by clinicians when symptoms rise to moderate or severe levels—both components contribute to better outcomes.”

Mooney K, et al. A randomized control trial to determine necessary intervention elements to achieve optimal symptom outcomes for a remote symptom management system. J Clin Oncol. 40, 2022 (suppl 16; abstr 12008)