self-management and activation to reduce treatment-related toxicities (smartcare)

Conditions: Lymphoma; Lung Cancer; Colo-rectal Cancer

Summary: the investigators will undertake a multi-centre, randomized controlled trial to implement and evaluate a proactive model of care (smartcare) during active cancer treatment that incorporates self-management support (sms). patients allocated to the control arm will receive care from ambulatory clinic nurses trained in sms. patients allocated to the intervention arm will will receive care from ambulatory clinic nurses trained in sms, in addition to being given access to a web-based, self-management education program and nurse-led health coaching during the first four months following the first systemic therapy administration.

self-management describes patient's behaviours and skills to manage the physical and psychosocial impact of their illness. empirical evidence shows that patient activation in self-management results in improved disease control and quality of life (qol), and lower emergency department visits and hospitalizations (ed+h) and costs in other chronic conditions. previous research conducted by the investigators of this study has shown that the quality of sms in ambulatory care was poor and patients felt unprepared to manage treatment-related toxicities. building on previous work, this study will evaluate a multi-faceted proactive model of care that includes: (1) training in self-management support (sms) strategies for ambulatory nursing staff; (2) a web-based self-management education program for patients; and (3) provision of proactive, nurse-led health coaching during the first four months following the first systemic therapy administration. using a computer-generated permuted blocks randomization scheme (permuted blocks of random size) stratified by cancer type and centre, 160 evaluable patients will be enrolled across the three participating regional cancer centres. 80 patients will be randomized to the intervention arm and 80 to the control arm. the primary objective of this study is to compare the feasibility and acceptability of the smartcare intervention to the active comparator (control arm). the secondary objectives are to: (1) assess the effect of the intervention on symptom control, health-related quality of life, psychological distress, patient activation and self-efficacy; (2) evaluate the effect of the intervention on service outcomes: ed+h and resource utilization; and (3) evaluate implementation outcomes: fidelity, adherence and adoption. in addition, patients randomized to the intervention arm will be asked to participate in a sub-study interview at the end of the study to gain further knowledge about the smartcare intervention components from the patient's perspective.

Eligibility criteria:
inclusion criteria: * diagnosis of lymphoma (hodgkin's or non-hodgkin's), colorectal, or lung cancer. * initiating adjuvant or first-line metastatic treatment with oral or systemic therapy within the accrual period at a participating centre. patients receiving treatment with immunotherapy are eligible to participate. * eastern cooperative oncology group (ecog) \</=2. * ability to understand and provide written informed consent. * access to an electronic device and internet connection to allow the participant to access the web-based i-can-manage cancer education modules. * language and literacy skills consistent with completing validated questionnaires, and willingness to complete questionnaires as required. exclusion criteria: * currently participating in a clinical trial involving receipt of an investigational agent.

Keywords: self-management support health coaching patient education treatment-related toxicities