Smart Technology Helps Cancer Pts and Caregivers in Hospice

Roxanne Nelson

October 23, 2014

"Smart technology" may be able to help both the patient and caregiver in the hospice setting.

Early findings from a randomized trial involving 319 families that used an innovative, telephone-based symptom monitoring and coaching system during home hospice shows preliminary evidence of benefit for family caregivers and patients.

Patients assigned to the symptom care intervention group had significantly less symptom severity than those who received usual hospice care alone, the study showed.

In addition, caregivers in the intervention arm experienced 44% fewer days of moderate or severe adverse symptoms, which included fatigue, anxiety, and sleep disturbances.

Benefits for both the patient and caregiver were observed as early as the first day after using the system, and this trend continued throughout the hospice period.

The computer-based technology essentially enhanced communication between the caregiver and hospice nurse, and provided caregivers with real-time solutions or "coaching tips," said study coauthor Bob Wong, PhD, director of applied statistics, College Of Nursing, University of Utah.

Speaking at a press briefing held in advance of the inaugural 2014 Palliative Care in Oncology Symposium, which will begin later this week in Boston, Massachusetts, Dr Wong explained the study and how the system worked.

About half of the hospice families (n = 153) were randomly assigned to receive the symptom care intervention, and the other half (n = 166) received usual care.

"Every day the family caregiver from both groups would call into the system and report on 11 different patient symptoms as well as their own," said Dr Wong. "The symptoms were rated on a 0 to 10 scale, with 10 being the most severe."

Patient symptoms that were monitored included pain, difficulty breathing, change in thinking, constipation/diarrhea, bladder difficulties, nausea/vomiting, fatigue/weakness, negative mood (feeling down or blue), anxiety, trouble sleeping, and poor appetite/trouble eating.

The most commonly reported patient symptoms were fatigue (70%), pain (64%), poor appetite (54%), anxiety (39%), and change in thinking (38%).

The symptoms that were tracked for caregivers included fatigue, anxiety, trouble sleeping, and negative mood.

After symptoms were called in, the intervention group included two additional components, which separated it from usual care. First, the system would deliver an automated alert for unrelieved symptoms to the family's hospice nurse; these alerts were issued if symptoms were rated 4 or higher.

"The symptoms were reported to the nurse via a secure web page, which provided a graph that allowed the nurses to track trends over time," said Dr Wong. "This provided an additional communication link between the caregiver and the nurse."

The second additional component was coaching tips. These were automated, real-time tips that were individualized to the situation and were based on the nature and severity of symptoms that the caregiver reported.

"For example, if the patient was reported to have trouble breathing, the coaching tip might include information on repositioning the patient to help with that," explained Dr Wong.

He also pointed out that this automated system does not take the place of the "human component" and does not replace spending time face to face with the hospice nurse, but simply adds another layer of care. "When the caregiver indicates that there are unrelieved symptoms, the hospice nurse utilizes that information at the next visit or on the phone," he said. "It depends on the situation."

Preliminary analyses also showed that caregiver vitality was better in the intervention group (P = .003, mixed effects model).

For caregivers, vitality was measured by a composite three-item instrument — fatigue, trouble sleeping, and impact on daily activity. "We found that the caregivers in the usual group had a worsening in vitality, while for those using the system, the trend stayed flat," Dr Wong said.

This is the first reported evaluation of automated symptom monitoring in home end-of-life care and provides strong preliminary evidence of benefit for cancer family caregivers and patients, he concluded.

"Caregiving is truly a 7-day-a-week, 24-hour-a-day job, and most caregivers cannot do it alone," commented Jyoti Patel, MD, of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago, Illinois.

"This telemonitoring system can certainly help lessen the burden and proactively address symptoms and concerns during these difficult weeks in the patients' and caregivers' lives," added Dr Patel, who acted as moderator for the presscast.

The study was funded by the National Cancer Institute.The authors have disclosed no relevant financial relationships.

2014 Palliative Care in Oncology Symposium: Abstract 85. Presented October 24, 2014.

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