P3-4 Institutional implementation of electronic patient reported outcome measures and palliative care telemedicine during the COVID pandemic at the national cancer institute of milan
Notice bibliographique
Résumé
Routine assessment of Patient Reported Outcome Measures (PROMs) is an indicator of integration between oncology and palliative care (PC), yet seldom applied in clinical practice. Electronic PROMs assessment (ePROMs), are a promising option. The institutional implementation of an ePROM assessment system, integrated into the electronic clinical records, was the aim of an implementation project since 2019 at our institution. The project (‘Patients’ Voices’) underwent 4 phases, predevelopment, software development and piloting, feasibility, post-development. Convergent mixed method design was applied with a websurvey on healthcare providers (HCPs), qualitative study on patients and HCPs and quantitative studies. The program has now developed the system and its integration with the hospital electronic chart and assessed its feasibility on cross-sectional and longitudinal assessment. Cross-section and longitudinal assessment has been performed in out and inpatient oncology and palliative care settings using the Psychological distress thermometer, Edmonton Symptom Assessment Scale and Therapy Impact Questionnaire. On 441 patients screened, 309 successfully completed the ePROM at baseline (70%; 95%CI 66% to 74%). Feasibility, usability together with the association of non compliance with patients and setting characteristics will be presented. Results demonstrate good patient compliance, acceptability and usability of the system with variability among wards and tools applied, e.g. higher compliance in the Palliative care clinic. Another important technical evolution of digital medicine has been stimulated by the worldwide COVID-19 pandemic outbreak. Telemedicine emerged as an important mean to reduce risks of transmission. A review of the literature shows that, in general telemedicine access increased during the pandemic and that it was felt useful and feasible, yet its efficacy in combining or substituting in person visits needs to be further confirmed by specific research. Our experience on outpatient palliative care patients during COVID-19 is based on a longitudinal observational study and was conducted from April to December 2020 with the aim of assessing feasibility, patients’ experience and satisfaction. Consecutive patients were screened for video consultations feasibility. Either the patients or their caregivers were contacted via video or phone consultation recording reason of the call and intervention performed. Patients or caregivers contacted at least twice were eligible for a phone interview to evaluate their experience with the service. Among 572 screened patients, 282 (49%, 95%CI 45% to 52%) were eligible for video consultation (accepted, had technology, did not lack help). 112 patients had at least two contacts, and 11% had one or more video-calls. 56% of the calls were done with patients, 30% with caregivers and 14% with both. In most cases (63%) the patient/caregiver requested the consultation. Reasons for tele-consultation included uncontrolled symptoms (66%), new symptoms onset (20%), therapy clarifications (37%) and update on diagnostic tests (28%). Most interventions were therapy modifications (70%) and appointments’ rescheduling (51%). Most users reported high satisfaction scores (range 1–5, mean 3.9 and 4.2 patients and caregivers respectively), no communication issues, and the great majority declared they would use telemedicine also after the pandemics (83% and 84%). Beyond its feasibility, clinical impact and cost effectiveness of telemedicine in palliative care need to be further studied.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,017 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».