Symptom Management Implementation of Patient Reported Outcomes in Oncology (SIMPRO)
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ClinicalTrials.gov Identifier: NCT03850912 |
Recruitment Status :
Active, not recruiting
First Posted : February 22, 2019
Last Update Posted : April 30, 2024
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Condition or disease | Intervention/treatment | Phase |
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Other Cancer Gastrointestinal Cancer Thoracic Cancer Gynecologic Cancer | Other: eSyM App Usage Other: SASS Questionnaire | Not Applicable |
A multi-disciplinary team of investigators from 6 health systems have formed the Symptom Management IMplementation of Patient Reported Outcomes in Oncology (SIMPRO) Research Center. SIMPRO will use functioning ePRO prototypes to create and refine the electronic symptom management system eSyM. eSyM is the name of the platform the team will refine, integrate, implement and evaluate. eSyM addresses each of the 4 evidence gaps by:
- Implementing eSyM in cancer centers in small, rural or community-based systems.
- Integrating eSyM into the EHR (electronic health record) of the predominant vendor used nationwide.
- Leveraging evidence-based tools, patient engagement, and population management.
- Executing this work using the Consolidated Framework for Implementation Research across all phases to maximize the chances that eSyM and similar systems achieve their intended goals and decrease the morbidity of cancer treatment at a population level.
This project contains 5 activities:
- Obtain stakeholder feedback
- Build and deploy eSyM
- Pilot test eSyM
- Pragmatic stepped-wedge cluster randomized trial
- Integration of eSyM data to develop algorithms to estimate the risk of experiencing an outcome, including, but not limited to, ED usage and hospitalization among cancer patients
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 25000 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Health Services Research |
Official Title: | SIMPRO Research Center: Integration and Implementation of PROs for Symptom Management in Oncology Practice |
Actual Study Start Date : | July 25, 2019 |
Actual Primary Completion Date : | March 31, 2023 |
Estimated Study Completion Date : | September 30, 2024 |
Arm | Intervention/treatment |
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No Intervention: Activity 1: Stakeholder Feedback
Obtain stakeholder feedback to inform eSyM finalization and implementation from:
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No Intervention: Activity 2: eSym Build
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Experimental: Activity 3: Pilot Test eSyM App
Pilot testing of the eSyM app will include:
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Other: eSyM App Usage
Patients (and/or proxy) will report their cancer-related symptoms and receive tailored feedback via eSyM |
Experimental: Activity 4: eSyM+ Participants
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Other: eSyM App Usage
Patients (and/or proxy) will report their cancer-related symptoms and receive tailored feedback via eSyM Other: SASS Questionnaire A subset of eSyM+ and eSyM- patients will be asked to complete a research questionnaire called the "SASS Questionnaire" asking about their Self-efficacy, Attainment of information needs, Symptom burden, and Satisfaction with care (see PROMIS, CAHPS, IAM/AIM question banks - Appendices C through G). The questionnaire will stop being administered once 1800 total surveys have been received. |
Experimental: Activity 4: eSyM- Participants
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Other: SASS Questionnaire
A subset of eSyM+ and eSyM- patients will be asked to complete a research questionnaire called the "SASS Questionnaire" asking about their Self-efficacy, Attainment of information needs, Symptom burden, and Satisfaction with care (see PROMIS, CAHPS, IAM/AIM question banks - Appendices C through G). The questionnaire will stop being administered once 1800 total surveys have been received. |
- 'Emergency Department - Treat and Release' (EDTR) Rate at 30-days [ Time Frame: 30 days ]
The primary study outcome of the stepped wedge cluster RCT (randomized controlled trial) is the EDTR rate. This outcome will be defined in relation to the date of discharge from hospital (surgical oncology) or the initiation date of a new intravenous chemo regimen (medical oncology). The investigators will evaluate the # of EDTR visits for patients using the eSyM app.
30-day EDTR rates are estimated to vary between 8% to 15% for the control group. The investigators hypothesize that EDTR rates will be 3-4% lower in the eSyM+ group. Control group rates were estimated based on EDTR rates derived from HCUP (Healthcare Cost and Utilization Project) data, institutional data and early phase analyses from CMMI's Oncology Care Model for Baptist Memorial, the only Oncology Care Model participant among our 6 sites.
- Patients' outcomes, indicated by levels of self-efficacy and symptom burden, at day 30 of eSyM usage [ Time Frame: One time survey (30-60 days after surgery or first dose of chemo) ]Patients (both Surg Onc and Med Onc) from each of the 6 sites will be surveyed in the period before and after rollout according to the stepped wedge design schema. Assuming a 75% response rate, the investigators expect to survey 400 patients per site (2400 total) to obtain 300 (1800 total) responses split evenly between eSyM+ and eSyM- subjects. Additional survey participants can readily be identified if the 75% response rate is not achieved. Yost and Cella have reported minimally important difference (MID) ranges for five PROMIS (Patient-Reported Outcomes Measurement Information System) domains including fatigue, pain, depression, anxiety, and physical functioning217, 130 Cella recommends using 0.5 SD (Standard Deviation) as the MID for PROMIS scales218,219.
- Patients' satisfaction with their cancer care at 30-days post-chemo start or post-surgery: AHRQ's (Agency for Healthcare Research and Quality) CAHPS (Consumer Assessment of Healthcare Providers & Systems) Analysis Program [ Time Frame: One time survey (30-60 days after surgery or first dose of chemo) ]The investigators will use the AHRQ's CAHPS Analysis Program to compare scores for eSyM+ and eSyM-, adjusting for case mix. Table Aim 2d (in the protocol) shows differences in satisfaction scores the investigators can detect with 80% power. For example, with 360 patients (e.g., those who have GI surgery) the investigators have >80% power to detect effect size >0.44, a meaningful difference in CAHPS scores. Patients will complete a subset of the CAHPS Cancer Care Survey. Items assessed will include: cancer care delivery, patient experience, and patient satisfaction. Responses will be assessed through the following options: a) (Never, Sometimes, Usually, Always) b) (Yes, definitely, Yes, somewhat, No) c) 0-10.
- eSyM sustainability at the patient, clinic and health system level [ Time Frame: 1-year medical record abstraction ]The investigators will be evaluating patient adoption rates and clinician usage rates by analyzing EHR data based on eSyM utilization patterns. Appropriateness and acceptability will be ascertained using Weiner's IAM (Intervention Appropriateness Measure) and AIM (Acceptability of Intervention Measure) surveys (8-items total, less than 3 minutes to complete) which will be administered along with CAHPS surveys. Appropriateness and acceptability ratings will be defined based on the % of respondents who "agree" or "completely agree" with the survey items compared to the % who are neutral, disagree, or completely disagree and characterized using descriptive statistics.81
- Impact on initiation of adjuvant chemotherapy and chemotherapy duration assessed at 1 year [ Time Frame: 1-year medical record abstraction ]
The investigators will be using the EHR to evaluate the timing of first dose to the last dose of a specific chemotherapy regimen. The investigators expect that patients exposed to eSyM may be able to: 1) initiate adjuvant therapy sooner; 2) remain on their chemotherapy regimens for longer duration. These time intervals are straightforward to measure from EHR encounter and date fields.
For medical oncology patients, the outcome is time from the first dose to the last dose of a specific regimen. The investigators will censor follow-up at 1 year. The investigators will use generalized linear mixed-effect models to compare treatment duration for eSyM+ vs. eSyM- patients. For surgical oncology patients, the denominator population consists of patients who receive any adjuvant chemotherapy within 6 postoperative months. Tumor registry stage distribution at our 6 sites indicates that this will be 202 patients per site or 1212 in total.
- Sustainability of ePRO symptom management within a health system [ Time Frame: 1-year medical record abstraction ]The investigators will evaluate sustainability at the patient, clinic and health system level using simple rates and proportions. To evaluate sustainability, the investigators will examine the consequences of withdrawing grant-funded nursing support for symptom management in the post-implementation period. The investigators will compare outcomes from Period 6 (study month 45-50, all sites eSyM+) and the post-Implementation (Post-I; study months 51-56). Sites are trained and empowered to manage eSyM autonomously without research study staff. Then, during post-implementation, dedicated nursing support to monitor eSyM is tapered in half the sites (see Figure C2). To examine whether backing off on the study support attenuates the effect, the investigators will perform difference in difference analysis.
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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Activity 1 Population:
- Age ≥ 18 years
- The potential stakeholders are: patient advisory council members, health system leaders, clinicians, clinic support staff/administration, IT/Informatics staff
Activity 3 Population:
- Age ≥ 18 years
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Priority population will be patients who meet one of the following:
- Suspected thoracic cancer [lung or bronchus] AND is inpatient following thoracic surgery.
- Suspected gastrointestinal cancer [colorectal, pancreas, liver/biliary, esophagus,or gastric] AND is inpatient following gastrointestinal surgery.
- Suspected gynecologic cancer [ovary, uterus, or cervix] AND is inpatient following gynecologic surgery.
- Diagnosis of thoracic cancer [lung or bronchus] AND scheduled to start a new treatment plan for thoracic cancer.
- Diagnosis of gastrointestinal cancer [colorectal, pancreas, liver/biliary, esophagus,or gastric] AND scheduled to start a new treatment plan for gastrointestinal cancer.
- Diagnosis of gynecologic cancer [ovary, uterus, or cervix] AND scheduled to start a new treatment plan for gynecologic cancer.
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Total population allowed to use eSyM:
- Any patient at any participating site.
Activity 4 Population:
- Age ≥ 18 years
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Priority population will be patients who meet one of the following:
- Suspected thoracic cancer [lung or bronchus] AND is inpatient following thoracic surgery.
- Suspected gastrointestinal cancer [colorectal, pancreas, liver/biliary, esophagus,or gastric] AND is inpatient following gastrointestinal surgery.
- Suspected gynecologic cancer [ovary, uterus, or cervix] AND is inpatient following gynecologic surgery.
- Diagnosis of thoracic cancer [lung or bronchus] AND scheduled to start a new treatment plan for thoracic cancer.
- Diagnosis of gastrointestinal cancer [colorectal, pancreas, liver/biliary, esophagus,or gastric] AND scheduled to start a new treatment plan for gastrointestinal cancer.
- Diagnosis of gynecologic cancer [ovary, uterus, or cervix] AND scheduled to start a new treatment plan for gynecologic cancer.
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Total population allowed to use eSyM:
- Any patient at any participating site.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03850912
United States, Maine | |
Maine Medical Center | |
Portland, Maine, United States, 04101 | |
United States, Massachusetts | |
Dana Farber Cancer Institute | |
Boston, Massachusetts, United States, 02115 | |
United States, New Hampshire | |
Dartmouth-Hitchcock Medical Center | |
Lebanon, New Hampshire, United States, 03756 | |
United States, Rhode Island | |
Lifespan | |
Providence, Rhode Island, United States, 02905 | |
United States, Tennessee | |
Baptist Memoiral HealthCare | |
Memphis, Tennessee, United States, 38120 | |
United States, West Virginia | |
West Virginia University Medical Center | |
Morgantown, West Virginia, United States, 26506 |
Principal Investigator: | Michael Hassett, MD | Dana-Farber Cancer Institute |
Other Publications:
Responsible Party: | Michael Hassett, MD, Principal Investigator, Dana-Farber Cancer Institute |
ClinicalTrials.gov Identifier: | NCT03850912 |
Other Study ID Numbers: |
18-734 1UM1CA233080-01 ( U.S. NIH Grant/Contract ) |
First Posted: | February 22, 2019 Key Record Dates |
Last Update Posted: | April 30, 2024 |
Last Verified: | April 2024 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | Yes |
Plan Description: | The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research data set used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: [contact information for Sponsor Investigator or designee]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research |
Supporting Materials: |
Study Protocol Statistical Analysis Plan (SAP) Informed Consent Form (ICF) |
Time Frame: | Data can be shared no earlier than 1 year following the date of publication |
Access Criteria: | DFCI (Dana-Farber Cancer Institute) - Contact the Belfer Office for Dana-Farber Innovations (BODFI) at innovation@dfci.harvard.edu |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Other Cancer Digital health Patient reported outcomes Symptom management |
Gastrointestinal Neoplasms Digestive System Neoplasms Neoplasms by Site |
Neoplasms Digestive System Diseases Gastrointestinal Diseases |