Use of Telehealth Technologies for Symptom Management Support for People With Advanced Cancer Living in Rural Communities

Overview of study procedures - Participation in the study last for 12 weeks. Phase 1: baseline data collection and orientation to the intervention (week 0); Phase 2: 8 weeks of daily tracking on website and weekly eHealth visits from a nurse and two data collection points (week 4 and week 8); Phase 3: Optional continuation of tracking on website and as needed eHealth visits from a nurse and final data collection (week 12)

Description of the intervention: For a period of eight weeks patients will use the OASIS web-application daily to help them get better control of their cancer symptoms. In addition, to daily symptom and strategy tracking, participants will have eight e-visits with the nurse-coach via the Zoom application through the UIHC eHealth and eNovation Center to evaluate their progress with managing their symptoms, assess for barriers to implementing strategies, and offering coaching on how to improve symptom management. Questionnaires and blood samples will be collected at baseline (week 0) and follow-up (weeks 4, 8, and 12).

Part 1: OASIS web-application. The web-application is a secure web-site developed by The University of Iowa ITS that contains a number of features participants can use to improve their ability to monitor and manage their physical and emotional symptoms. The daily check-in allows participants to keep track of their symptoms and strategies on a day-to-day basis. A data visualization tool provides visual summary of their symptom distress and strategy use over time. A symptom library describes the pathophysiology (in lay language) of 16 common cancer symptoms. A strategy library contains written descriptions and videos of how to implement 47 common symptom management strategies. The contact nurse-coach feature lists the next scheduled coaching visit as well as provides a way to request an extra e-visit sooner if needed. And finally, other resources will provide phone numbers and web links to resources such as the American Cancer Society, the National Cancer Institute, and Patients Like Me. The personal data participants enter into the OASIS web-application is considered level 3 data and will be handled according to The University of Iowa policies and procedure (See X.4 Electronic Records). After baseline data collection, the web-application will guide participants through the web-application to set up their tailored symptom management plan.

Step 1: On the initial login participants will complete an orientation to the intervention that consists of a video and values exercise. The video will briefly describe how physical and emotional symptoms develop during cancer and why symptom management is critically important for patients with advanced cancer. They will then complete a brief values exercise asking them to think about what is important in their lives. The purpose of the values exercise is to help participants make the cognitive connection about how cancer symptoms may be interfering with aspects of their lives they value most.

Step 2: Next the patient will complete a brief profile (first name, age, gender, type of cancer, current cancer treatment) and select an image or avatar for their profile. Going forward computer algorithms that are driven by information provided by the participant will tailor the experience. For example, the cancer ribbon in the OASIS logo will then change to the color associated with their cancer.