Original Research

Addressing the Symptom Management Gap in Patients With Cancer and Heart Failure Using the Interactive Voice Response System: A Pilot Study

Anecita P. Fadol,(1) PhD, FNP-BC, FAANP, Tito R. Mendoza,(2) PhD, Daniel J. Lenihan,(3) MD, and Donna L. Berry,(4) PhD, RN, AOCN®, FAAN

1)Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, Texas; 2)Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas; 3)Department of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; 4)Phyllis F. Cantor Center for Research in Nursing & Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts

Authors’ disclosures of conflicts of interest are found at the end of this article.

Anecita P. Fadol, PhD, FNP-BC, FAANP, 1400 Holcombe Blvd, FC 2.2018, Unit 456, Houston, TX 77030-4000. E-mail: afadol@mdanderson.org

ABSTRACT

Abstract

Patients with cancer and concurrent heart failure (HF) have severe symptoms that may adversely affect patients’ quality of life in addition to limiting effective anticancer therapy. A system of frequent monitoring could alert clinicians, providing the opportunity for timely intervention before patients become severely ill and require hospitalization. The purpose of this pilot study was to evaluate if the MD Anderson Symptom Inventory–Heart Failure (MDASI-HF) instrument preprogrammed via the interactive voice response system (IVRS) can be used to collect symptom data that will generate symptom alerts to providers based on preset severity levels. Twenty-six patients were enrolled in the study. Symptoms were monitored using the MDASI-HF delivered via IVRS on a weekly basis for 3 months. When a participant’s reported symptom(s) reached critical predetermined threshold levels, an alert prompted the nurse to triage the patient’s response and initiate interventions per protocol. Descriptive statistics were used to describe the ratings of symptom severity and symptom interference with daily function. Demographic and disease characteristics were summarized using means, standard deviations, ranges, count, and proportions. Paired t-tests were used to examine symptom reduction from baseline to the end of 3 months. Fourteen (54%) participants completed the study with average IVRS usage rates of 84% at 1 month and 82% at 3 months. Over the course of the IVRS monitoring, 152 IVRS calls were completed and 107 critical threshold alerts were generated, prompting physician notification, medication titration, and non-routine clinic visits. Most of these alerts were managed by telephone, particularly those related to diuretic titration, and prevented hospital readmission. Symptom monitoring via the IVRS can potentially bridge the gap in symptom management to improve clinical outcomes in patients with cancer and HF. The IVRS can be of benefit in the symptom management of patients, especially those constrained by geographic location. This can potentially improve the quality of care, patient satisfaction, and quality of life of these patients.

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