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 t...
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | Trials |
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| Online Access: | http://link.springer.com/article/10.1186/s13063-020-04335-w |
| _version_ | 1818455215574089728 |
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| author | Lila J. Finney Rutten Kathryn J. Ruddy Linda L. Chlan Joan M. Griffin Jeph Herrin Aaron L. Leppin Deirdre R. Pachman Jennifer L. Ridgeway Parvez A. Rahman Curtis B. Storlie Patrick M. Wilson Andrea L. Cheville |
| author_facet | Lila J. Finney Rutten Kathryn J. Ruddy Linda L. Chlan Joan M. Griffin Jeph Herrin Aaron L. Leppin Deirdre R. Pachman Jennifer L. Ridgeway Parvez A. Rahman Curtis B. Storlie Patrick M. Wilson Andrea L. Cheville |
| author_sort | Lila J. Finney Rutten |
| collection | DOAJ |
| description | 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. Trial registration ClinicalTrials.gov, NCT03892967 . Registered on 25 March 2019. |
| first_indexed | 2024-12-14T22:07:14Z |
| format | Article |
| id | doaj.art-e810343eb40940ccaa16062365c3ced1 |
| institution | Directory Open Access Journal |
| issn | 1745-6215 |
| language | English |
| last_indexed | 2024-12-14T22:07:14Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Trials |
| spelling | doaj.art-e810343eb40940ccaa16062365c3ced12022-12-21T22:45:51ZengBMCTrials1745-62152020-06-0121111910.1186/s13063-020-04335-wPragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2)Lila J. Finney Rutten0Kathryn J. Ruddy1Linda L. Chlan2Joan M. Griffin3Jeph Herrin4Aaron L. Leppin5Deirdre R. Pachman6Jennifer L. Ridgeway7Parvez A. Rahman8Curtis B. Storlie9Patrick M. Wilson10Andrea L. Cheville11Department of Health Sciences Research, Mayo ClinicDivision of Medical Oncology, Mayo ClinicDepartment of Nursing, Mayo ClinicDepartment of Health Sciences Research, Mayo ClinicYale University School of MedicineDepartment of Health Sciences Research, Mayo ClinicCenter for Palliative Care, Mayo ClinicRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo ClinicRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo ClinicDepartment of Health Sciences Research, Mayo ClinicRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo ClinicRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo ClinicAbstract 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. Trial registration ClinicalTrials.gov, NCT03892967 . Registered on 25 March 2019.http://link.springer.com/article/10.1186/s13063-020-04335-wElectronic health recordNeoplasmPainPalliative carePatient care teamPatient-reported outcome measure |
| spellingShingle | Lila J. Finney Rutten Kathryn J. Ruddy Linda L. Chlan Joan M. Griffin Jeph Herrin Aaron L. Leppin Deirdre R. Pachman Jennifer L. Ridgeway Parvez A. Rahman Curtis B. Storlie Patrick M. Wilson Andrea L. Cheville Pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2) Trials Electronic health record Neoplasm Pain Palliative care Patient care team Patient-reported outcome measure |
| title | Pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2) |
| title_full | Pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2) |
| title_fullStr | Pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2) |
| title_full_unstemmed | Pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2) |
| title_short | Pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2) |
| title_sort | pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced ehr facilitated cancer symptom control e2c2 |
| topic | Electronic health record Neoplasm Pain Palliative care Patient care team Patient-reported outcome measure |
| url | http://link.springer.com/article/10.1186/s13063-020-04335-w |
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