Nurse AMIE: Addressing Metastatic Individuals Everyday in Rural PA and WV

AMIE 护士：每天应对宾夕法尼亚州和西弗吉尼亚州农村地区的转移性个体

• 批准号: 10734909
• 负责人: Kathryn H. Schmitz
• 金额: $ 54.5万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-24 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10734909
• 关键词: Nurse; AMIE; Addressing; Metastatic; Individuals

Project Summary/Abstract Individuals with cancer who live in rural settings experience worse outcomes as compared to those in urban settings. Individuals in rural regions have difficulty accessing supportive care services due to travel challenges, cost of services, and overall lack of available supportive care resources. The latter issue likely contributes greatly to the urban/rural survival differences, given that multiple studies document that regularly addressing patient symptoms has a survival benefit in the setting of advanced cancer. Technology may provide solutions to overcome issues of rurality, however, little work has been done to specifically leverage technology- based solutions to deliver high quality supportive care in rural settings. Our team has developed and pilot tested a tablet-based symptom assessment and supportive care intervention called Nurse AMIE (Addressing Metastatic Individuals Everyday) that was well received by patients with metastatic cancer, including a subset of rural patients living in non-metropolitan counties (Rural Urban Continuum Code (RUCC) counties of 4 or higher). Patients were provided a tablet and cellular data plan to allow them to answer symptom questions daily, and an embedded personalized decision tree then offered evidence based self-care interventions to address the self-reported symptom with a goal of improving overall health and well-being. A pedometer and resistance band were also provided, given evidence that physical activity can assist with all four of the symptoms addressed in Nurse AMIE (fatigue, sleep, distress, and pain). These four symptoms form the basis of the psychoneurological symptom cluster that has been noted to be associated with quality of life and survival in oncology patients. Nurse AMIE can conduct symptom assessment, track data, and provide interventions offline if internet access is unavailable. Our preliminary evidence demonstrates acceptability and feasibility of the tablet-based approach as our patients logged on 57% of intervention days. Furthermore, patients using Nurse AMIE reported high patient satisfaction with the self-care system. Based on findings from the pilot, we propose to add a weekly survey similar to that from prior research by Basch et al. and Denis et al. to expand the symptom assessment aspect of the platform. We propose that this distance based supportive care intervention (Nurse AMIE) will have significant effects on rural patients overall survival (primary outcome), cancer treatment-related symptoms, function, and health related quality of life. We will focus our efforts on N=344 underserved or low-income adult men and women living in non-metropolitan counties (RUCC codes 4- 9) that have low access to supportive care. This work will be carried out with the help of a strong community advisory board, and guided by the PA and WV State Offices of Rural Health. We will enroll and randomize patients to receive the Nurse AMIE supportive care intervention or usual care. Enrollment will occur at regularly scheduled medical visits and the intervention will extend for the length of follow-up (2 years). We will also examine the cost effectiveness of Nurse AMIE.

项目摘要/摘要 与城市的人相比 设置。农村地区的个人很难获得旅行的支持护理服务 挑战，服务成本以及总体缺乏可用的支持护理资源。后一个问题可能 鉴于多项研究经常证明，有助于城市/农村生存差异 解决患者症状在晚期癌症的情况下具有生存益处。技术可能会提供 但是 基于农村环境中提供高质量支持护理的解决方案。我们的团队已经开发和飞行员 测试了基于平板电脑的症状评估和支持护理干预措施，称为护士Amie（解决 每天转移性个体）受到转移性癌症患者的好评，包括子集 居住在非全交县的农村患者（农村城市连续体法规（RUCC）县为4或4 更高）。为患者提供了平板电脑和细胞数据计划，以使他们能够回答症状问题 每天，然后嵌入的个性化决策树随后提供了基于证据的自我保健干预措施 解决自我报告的症状，目的是改善整体健康和福祉。计步器和 还提供了电阻带，鉴于证据表明体育活动可以帮助所有四个 艾米（Amie）护士（疲劳，睡眠，痛苦和疼痛）中提到的症状。这四个症状构成了基础 精神外科学症状簇已被指出与生活质量和生存有关 在肿瘤患者中。 Amie护士可以进行症状评估，跟踪数据并提供干预措施 离线如果互联网访问不可用。我们的初步证明表明可接受性和可行性 基于平板电脑的方法是我们的​​患者在干预日的57％记录。此外，患者使用 艾米（Amie）护士报告说，患者对自我护理系统的满意度很高。根据飞行员的发现，我们 建议添加与Basch等人先前研究相似的每周调查。和Denis等。扩展 平台的症状评估方面。我们建议基于距离的支持护理 干预（护士AMIE）将对农村患者的总体生存率（主要结果）产生重大影响， 与癌症治疗相关的症状，功能和与健康相关的生活质量。我们将集中精力 n = 344个居住在非大都市县的服务不足或低收入的成年男女（RUCC代码4- 9）无法获得支持护理的机会。这项工作将在一个强大的社区的帮助下进行 顾问委员会，并由PA和WV州卫生部的办事处指导。我们将注册和随机分组 患者接受护士Amie支持护理干预或通常的护理。入学将发生在 定期安排的医疗访问和干预措施将延长随访时间（2年）。我们将 还要检查艾米护士的成本效益。