title: The electronic self report assessment and intervention for cancer: promoting patient verbal reporting of symptom and quality of life issues in a randomized controlled trial.
abstract: BACKGROUND
  The electronic self report assessment - cancer (ESRA-C), has been shown to reduce symptom distress during cancer therapy The purpose of this analysis was to evaluate aspects of how the ESRA-C intervention may have resulted in lower symptom distress (SD).
  
  
  METHODS
  Patients at two cancer centers were randomized to ESRA-C assessment only (control) or the Web-based ESRA-C intervention delivered to patients' homes or to a tablet in clinic. The intervention allowed patients to self-monitor symptom and quality of life (SxQOL) between visits, receive self-care education and coaching to report SxQOL to clinicians. Summaries of assessments were delivered to clinicians in both groups. Audio-recordings of clinic visits made 6 weeks after treatment initiation were coded for discussions of 26 SxQOL issues, focusing on patients'/caregivers' coached verbal reports of SxQOL severity, pattern, alleviating/aggravating factors and requests for help. Among issues identified as problematic, two measures were defined for each patient: the percent SxQOL reported that included a coached statement, and an index of verbalized coached statements per SxQOL. The Wilcoxon rank test was used to compare measures between groups. Clinician responses to problematic SxQOL were compared. A mediation analysis was conducted, exploring the effect of verbal reports on SD outcomes.
  
  
  RESULTS
  517 (256 intervention) clinic visits were audio-recorded. General discussion of problematic SxQOL was similar in both groups. Control group patients reported a median 75% of problematic SxQOL using any specific coached statement compared to a median 85% in the intervention group (p = .0009). The median report index of coached statements was 0.25 for the control group and 0.31 for the intervention group (p = 0.008). Fatigue, pain and physical function issues were reported significantly more often in the intervention group (all p < .05). Clinicians' verbalized responses did not differ between groups. Patients' verbal reports did not mediate final SD outcomes (p = .41).
  
  
  CONCLUSIONS
  Adding electronically-delivered, self-care instructions and communication coaching to ESRA-C promoted specific patient descriptions of problematic SxQOL issues compared with ESRA-C assessment alone. However, clinician verbal responses were no different and subsequent symptom distress group differences were not mediated by the patients' reports.
  
  
  BACKGROUND
  NCT00852852; 26 Feb 2009.
authors.affiliation: Department of Biobehavioral Nursing and Health Systems, University of Washington, Box 357366, Seattle, WA 98195-7366, USA. donnalb@uw.edu.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Berry
authors.forename: Fangxin
authors.initials: F
authors.lastname: Hong
authors.forename: Barbara
authors.initials: B
authors.lastname: Halpenny
authors.forename: Anne
authors.initials: A
authors.lastname: Partridge
authors.forename: Erica
authors.initials: E
authors.lastname: Fox
authors.forename: Jesse R
authors.initials: JR
authors.lastname: Fann
authors.forename: Seth
authors.initials: S
authors.lastname: Wolpin
authors.forename: William B
authors.initials: WB
authors.lastname: Lober
authors.forename: Nigel
authors.initials: N
authors.lastname: Bush
authors.forename: Upendra
authors.initials: U
authors.lastname: Parvathaneni
authors.forename: Dagmar
authors.initials: D
authors.lastname: Amtmann
authors.forename: Rosemary
authors.initials: R
authors.lastname: Ford
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D010353:Patient Education as Topic; D018802:Patient-Centered Care / Q000379:methods*; D011788:Quality of Life; D057566:Self Report; D011795:Surveys and Questionnaires; D055815:Young Adult