Outcomes of Home Telemonitoring for Patients with Lung Cancer Using Intention-to-Treat Approach

Monday, 18 November 2013: 3:55 PM

Yea-Jyh Chen, PhD, RN1
Georgia L. Narsavage, PhD, CRNP, CNS2
Anthony A. Sterns, PhD1
Trisha M. Petitte, MSN, FNP-BC2
Tara Forth, BSN, BA2
Charles Coole Jr., BA2
(1)College of Nursing, Kent State University, Kent, OH
(2)Morgantown Department, West Virginia University School of Nursing, Morgantown, WV

Learning Objective 1: The learner will be able to discuss health care utilization in patients diagnosed with lung cancer.

Learning Objective 2: The learner will be able to discuss potential changes in patient outcomes when patients are compliant and non-compliant during treatment.

Introduction: The purpose of this analysis is to better understand telemonitoring effectiveness using intention-to-treat (ITT) analysis in rural Appalachia with limited healthcare access/service. Non-adherence to home-treatment in patients appeared substantial. Home-telemonitoring to enhance self-management by lung cancer patients was unknown. Collecting data, even with home-telemonitoring, for a fragile patient population living in rural settings was a challenge.

Method: A pilot study of home-telemonitoring (randomized clinical trial) enrolled 41 patients with lung cancer from a university hospital/cancer center. Healthcare utilization and patient outcomes, including functional status (PFSS-11), quality of life (QOL; EQ5D VAS), # ER visits/ rehospitalizations were recorded for 60-days post-hospital discharge to determine differences between groups. The ITT analytic approach was used to evaluate outcome differences for patients using compliance with data-reporting (>80% vs. <80% completion of study data). More than half of the sample (56%) was compliant (C) versus 44% non-compliant (NC).

Results: Nonparametric tests indicated no baseline differences between groups. Telemonitored group participants were more compliant than control (66.7% vs. 45%) with data reporting. At 60-days post-hospital discharge, NC-patients used more acute-care services than C-patients (frequency—ER visit: 8>7; rehospitalization: 11>7); C-patients made more calls to doctors and nurses than NC-patients (doctor calls:12> 5;nurse calls:42>13). Compliance with telemonitoring was greater when cancer was diagnosed <one year (92%), dyspnea and pain were lower (80% NRS<5), functioning better (58.3% PFSS-11 mean score >3) and QOL higher (66.7% > 60). Although not statistically significant (p >.05), results trended to more positive outcomes for telemonitoring compared to control.

Conclusion: Data suggest improved outcomes with home telemonitoring and lower acute-care utilization. As a pilot, sample size was limited and lack of statistical significance anticipated. The pilot supports using this RCT protocol for a larger study to validate outcomes. Also, enrolling earlier stage oncology patients might maximize intervention benefits and minimize attrition.