Monitoring quality-of-life needs of cancer patients

The advent of prepayment systems in hospitals has greatly shortened the length of stay of patients who are therefore increasingly treated and cared for in outpatient settings while living at home with family or other caretakers. This shift in the locus of treatment has created a critical need for the development of organized systems of follow-up that monitor a patient's needs while he or she is undergoing active treatment but living at home. Over time, failure to develop such systems of care is likely to result in major gaps in the continuity of care, a decrease in the quality of patients' lives while on treatment, tremendous stress on caretakers, and a general decrease in the quality of services provided to patients. This article reports on a study of one such system of monitoring i.e., a computer-automated telephone outreach system that would routinely assess the concrete needs of chemotherapy outpatients (e.g., transportation to the hospital and need for assistance with activities of daily living). This automated intervention was designed in response to previous findings that 62% of chemotherapy outpatients had at least one unmet need within the month before assessment and 39% had two or more; clinical knowledge that cancer patients' needs vary considerably over time as a consequence of both the disease and its treatment; and that, because of limited professional staff, patients' needs cannot be routinely assessed without the aid of automation, particularly as the proportion of cancer patients treated as outpatients continues to increase. These conditions suggested the need to develop a cost-efficient strategy for the universal assessment of patients' need on a periodic basis, so that emerging needs could be identified in a timely way. For the feasibility study, 97 chemotherapy outpatients were surveyed at least once over the telephone by a computer in a high quality digitally-stored voice asking 12 questions regarding the patients' concrete needs. The data suggested that our computer-automated telephone outreach system is reliable and valid and has the potential for relatively broad-based acceptance. In addition, the intervention frequently allows for timely social work assistance for identified needs. It further serves as a form of outreach that can compensate for patients' reluctance to identify themselves as needing help and for passivity that may be associated with depression or physical illness. This intervention appears to have the potential to be a time- and labor-efficient strategy for ongoing assessment of the changing needs of large numbers of cancer or other chronic diseased outpatients, insuring timely professional intervention as needs arise.