Berry et al; 2013 [26] | USA | To compare usual patient education plus the internet-based, Personal patient Profile-Prostate, versus usual care alone on conflict associated with decision making, time to treatment and treatment choice. | Prostate | RCT | N = 494 eligible men (N = 266 intervention, N = 228 control) Intervention - mean age 62 (40-84y) Control - mean age 63 (45-86y) | Provision of basic and customized education/information. Education and communication coaching/support. | Interactive Educational Intervention | Decisional conflict Intervention acceptability | The DSS significantly reduced decisional conflict for the uncertainty (estimate − 3.61; 95% CI, − 7.01,−0.22) and values clarity subscales (estimate − 3.57; 95% CI, − 5.85,−1.30). compared to the control group. DSS acceptability and usefulness was highly rated. |
Berry et al; 2018 [27] | USA | To evaluate the efficacy of the web-based Personal patient Profile-Prostate versus usual care with regard to decisional conflict, decisional regret and satisfaction. | Prostate | RCT | N = 392 men (N = 198 Intervention, N = 194 usual care) | Provision of basic and customized education/information. Education and communication coaching/support. Printed or online teaching materials/reports. | Interactive Educational Intervention | Decisional conflict | No significant difference in decisional conflict scores at follow-up between intervention and control groups (mean 10.9 (SD = 16.7) (intervention) and 9.9 (SD = 18.0) (control)). |
Cleeland et al; 2011 [28] | USA | To establish if patients in the intervention group are less likely to have symptoms that meet or exceed a predetermined severity threshold over time than patients in the control group. To identify if there are group differences in reported symptom interference, acceptability of the intervention and acceptability with symptom control | Lung Cancer/ Metastases | RCT | N = 100 − 50 per arm Intervention (N = 38 completed - mean age 59.2y, SD 13.6) Control (N = 41 completed - mean age 60.9y, SD 11.8) | System to monitor and/or report symptoms inputted by patient and/or clinician. Clinician input/response to information provided by patients through DSS. | Symptom Assessment Intervention | Multiple symptom burden Patient satisfaction/intervention acceptability | Number of symptom threshold events - The intervention group experienced great reduction in symptom threshold events than controls (19% vs 8%) and a more rapid decline in number of symptom threshold events. Mean symptom severity - There was a dramatic reduction in symptom severity between time points but this was not statistically significant between groups (reduction of 0.75 (intervention) and 0.62 (control)). Mean symptom interference – Significant reduction in overall symptom interference in the intervention group compared to control (difference in average reduction in symptom interference was − 0.36 (SE, 0.078; P = 0.02)). |
Du Pen et al; 2000 [29] | USA | To test the application of a cancer pain algorithm with community oncologists and nurses by comparing “algorithm-trained” and “non-algorithm-trained” practitioners. | Various | RCT | N = 20 oncologists and N = 38 oncology nurses N = 118 recruited. Outcome data on N = 105. N = 54 in intervention group (mean age 61years, SD 1.5); N = 51 in control (mean age 61 years, SD 1.4) | System to monitor and/or report symptoms inputted by patient and/or clinician. Clinician input/response to information provided by patients through DSS. | Symptom Assessment Intervention | Pain Patient adherence Clinician adherence | Mean usual pain - Intervention group experienced a statistically significant decrease in mean level of usual pain from baseline (mean 3.6, SD = 1.9 to mean = 2.8, SD = 1.9, P = 0.05), whereas control group had a relatively flat trajectory in their level of usual pain over 4 months of treatment (mean = 3.0, SD = 2.0). Mean worst pain - Worse pain level dropped in both groups (-0.57 (SD = 2.6) in intervention compared to -0.32, SD = 2.3 in control group (P = 0.7), but was not statistically significant Patients in the intervention group were nonadherent at 30% of the time points versus 24% for the untrained group (P = 0.2) There was a statistically significant improvement in total provider adherence scores in the intervention group compared to controls (P = 0.04). |
Fallon et al; 2018 [30] | UK | To compare the effect of adding a clinician-delivered beside pain assessment and management tool to usual care versus usual care alone on pain outcomes. | Various | RCT | N = 19 centers (N = 10 in intervention and N = 9 in control) N = 1921 patients enrolled - N = 993 in intervention and N = 928 in control. Across all patients - mean age was 59.8 years, SD 13.3 | System to monitor and/or report symptoms inputted by patient and/or clinician. Clinician input/response to information provided by patients through DSS. | Symptom Assessment Intervention | Pain Global distress Patient/clinician satisfaction Clinician adherence | Mean worst pain - Intervention centres had greater changes in the mean worst pain (difference between groups 0.75, 95% CI 0.2–1.3, P = 0.11) and mean pain subscale scores (difference between groups 0.57, 95% CI 0.1–10.3, P = 0.019). An absolute difference of 10.7% (95% CI, 0.2–21.1%; P = .046). between intervention and control groups No statistically significant differences between intervention and control centres in the percentage of patients with controlled pain, mean pain interference score, or mean severity of global distress. Intervention centres had greater improvements in good practice prescribing (difference between groups 12.2, 95% CI 1.4–23.1, P = 0.030) |
Gustafson et al; 2013 [31] | USA | To examine the effectiveness of an online support system versus the internet in relieving physical symptom distress in patients with non-small cell lung cancer. | Lung Cancer | RCT | N = 285 caregiver-patient dyads which dropped to 246 after randomization | Provision of basic and customized education/information. Education and communication coaching/support. Printed or online teaching materials/reports. | Interactive Educational Intervention | Multiple symptom burden Survival | Mean symptom distress - Intervention group reported lower patient physical symptom distress than control group (Cohen d = 0.46, P = 0.005). Survival – estimated median survival was 19.2 ± 3.2 months in intervention users compared to 9.9 ± 2.7 months for nonusers (P = 0.003) |
Kearney et al; 2009 [32] | UK | To explore the effect of an advanced symptom management system on the incidence, severity and distress of six chemotherapy-related symptoms in patients with lung, breast or colorectal cancer | Breast, lung or colorectal cancer | RCT | N = 112 (N = 56 in each arm). Mean age 56 years, SD 10.5 | System to monitor and/or report symptoms inputted by patient and/or clinician. Clinician input/response to information provided by patients through DSS. | Symptom Assessment Intervention | Multiple symptom burden | Mean symptom severity - Two of the six symptoms (fatigue and hand-foot syndrome) showed statistical significance in the difference in symptom scores between intervention and control groups. There were higher reports of fatigue in the control group compared to intervention (OR 2.29, 95% CI 1.04–5.05, P < 0.05). There were lower reports of hand-foot syndrome in the control group (OR 0.39, 95% CI 0.17–0.92, P < 0.05). Mean symptom distress - There was a trend for patients in the control group to be more distressed by their fatigue patients in the intervention group to report greater severity and distress from their mucositis however these weren't statistically significant. |
McCann et al; 2009 [34] | To evaluate the impact of a mobile phone-based, remote monitoring system on chemotherapy related toxicity in patients with lung, breast or colorectal cancer. | Patient satisfaction/perceptions | Several benefits of using the intervention were identified by participants including improved communication with health professionals; improvements in the management of their symptoms; and feeling reassured their symptoms were being monitored in the home environment. |
Lohre et al; 2020 [33] | Norway | To investigate whether there would be significant improvement in pain control if patients systematically registered patient-reported outcome measures and if physicians applied evidence-based decision support | Various | Non-randomised experimental study | N = 52 (N = 41 discharged alive). Mean age 67 (44-91y) | System to monitor and/or report symptoms inputted by patient and/or clinician. Clinician input/response to information provided by patients through DSS. | Symptom Assessment Intervention | Pain Clinician adherence | Mean pain intensity - at admission and discharge mean pain intensity was 5.8 and 2.4, respectively, a reduction in 3.4 points (CI 95% 2.7–4.1). Mean worst pain - worse pain was 7.9 and 3.8 between admission and discharge, a reduction of 4.1 points (95% CI 3.4–4.8). Clinician adherence − 55% of patients had pain intervention changes based on the DSS. |
Mooney et al; 2014 [35] | USA | To explore whether timely provider notification of poorly controlled symptoms would prompt oncology providers to communicate with patients and intensify treatment of unrelieved symptoms and lead to improved symptom outcomes. | Various | RCT | N = 250. Intervention N = 129; Control N = 121 | System to monitor and/or report symptoms inputted by patient and/or clinician. Clinician input/response to information provided by patients through DSS. | Symptom Assessment Intervention | Multiple symptom burden Patient satisfaction/intervention acceptability Patient adherence | Mean symptom severity - There were no significant differences in change of symptom severity between the two groups (mean difference = 0.06, p = 0.58). Patient satisfaction - Overall, 94.0% found the automated system quite or very easy to use, 91.0% found the call length acceptable, and 77.0% said they were quite or very satisfied with using the system. Patient adherence - The overall daily call adherence was 65.0% of expected days. There was no difference in average days called between treatment (mean = 28.72, SD = 15.62) and control (mean = 29.69, SD = 16.78), P = 0.66. |
Mooney et al; 2017 [36] | USA | To test whether an automated symptom management system can reduce the severity of chemotherapy-related symptoms. | Various | RCT | N = 358 patients. N = 180 in intervention (mean 56.8 years (10.5 SD)) and N = 178 in control (usual care) (mean 54.8 years (11.4 SD)). | System to monitor and/or report symptoms inputted by patient and/or clinician. Clinician input/response to information provided by patients through DSS. Provision of customized education/information. Education and communication coaching/support. | Symptom Assessment Intervention | Multiple symptom burden Patient adherence | Intervention group had significantly less symptom severity across all symptoms (P < 0.001). The relative symptom burden reduction for intervention participants was approximately 43% of the control group value. Intervention group had a significant reduction in severe symptom days (67% less) and moderate symptom days (39% less) compared to control. Patient adherence - Daily call adherence was high with no difference between groups (P = 0.80); on average, participants made 90% of expected calls. |
Raj et al; 2017 [37] | Norway | To identify if there are improvements in pain control as a result of implementing the COMBAT system. To identify if prescribed opioid doses are modified after implementing the COMBAT system. | Various | Non-randomised experimental study | N = 247 (N = 103 pre-intervention; N = 151 intervention period) Analysis - Before intervention group (N = 80, mean age 58.6, SD 13.3)); After intervention group (N = 134, mean age 61, SD 12.2). | System to monitor and/or report symptoms inputted by patient and/or clinician. | Symptom Assessment Intervention | Pain Clinician adherence | Mean pain – scores were 3.6 and 3.3 in the preintervention period and intervention period, respectively, with a between group difference of 0.12 (95% CI – 0.33–0.58) Mean worst pain – scores were 4.6 and 4.8 in the pre-intervention period and intervention period, respectively, with a between group difference of 0.32 (95% CI – 0.27–0.91). Clinician adherence - In the preintervention period physicians changed the dose of opioids in 18.8% of the patients compared to 21.6% of the patients in the intervention period (Chi square = 0.26, p = 0.61). |
Ruland et al; 2013 [38] | Norway | To evaluate the effects of an intervention in improving symptom distress, depression, self-efficacy and quality of life compared to the control. | Breast or prostate cancer | RCT | N = 162 in intervention group (mean age 56.9 years, SD 10.7); N = 163 in control group (mean age 56.4 years, SD 11.5). | System to monitor and/or report symptoms inputted by patient and/or clinician. Clinician input/response to information provided by patients through DSS. Provision of basic and customized education/information. Education and communication coaching/support. | Interactive Educational Intervention | Multiple symptom burden Depression Self-efficacy Health-related QoL | Mean symptom distress - Group differences on symptom distress were significant only for the GSI index of the MSAS-SF (mean difference − 0.006, P = 0.04). There was a downward trend toward less symptom distress in the intervention group on all subscales and the MSAS-SF total score whereas the control group showed a trend toward increased symptom distress. The intervention group showed significant within-group improvements in depression (-0.408, p < 0.01) and the control group significantly worsened their within-group self-efficacy (-3.765, P < 0.01) and health-related QoL (-0.008, P < 0.01, but were otherwise no significant differences between the groups. |
Sikorskii et al; 2007 [39] | USA | To assess whether nurse assisted symptom management compared to automated telephone symptom management results in lower symptom severity. | Various | RCT | N = 437 completed the baseline interview and were randomized. N = 219 to intervention group (mean age 57.1, SD 12.0) and N = 218 to control group (57.3, SD 11.8) | System to monitor and/or report symptoms inputted by patient and/or clinician. Clinician input/response to information provided by patients through DSS. Provision of customized education/information. | Symptom Assessment Intervention | Multiple symptom burden Patient adherence | Mean symptom severity - Both arms resulted in a significant reduction in symptom severity from baseline, with almost identical effect sizes that do suggest clinically significant improvements (0.56 (intervention) and 0.59 (control)). |