Application of personalized follow-up program interventions based on patient-reported outcomes in postoperative patients with lung cancer: a single-center prospective randomized controlled study (Preprint)

Abstract

Postoperative lung cancer patients often experience frequent symptoms, multisystem dysfunction, reduced physical strength and activity levels, significantly impacting their quality of life. Continuity of care is crucial for these patients. Information technology based on patient-reported outcomes can efficiently assess symptoms and improve health.

This study aims to determine the impact of a personalized follow-up program based on patient-reported outcomes on the quality of life and self-management efficacy of postoperative lung cancer patients, and to explore their compliance and perspectives on its use.

A parallel-arm randomized controlled trial with an assessor-blinded design and repeated measures.Participants were recruited from the inpatient oncology department of a university-affiliated hospital in Shanghai, China. A total of 240 lung cancer patients who had undergone radical lung cancer surgery and were discharged participated in the postoperative follow-up study.Participants were randomly assigned to either the experimental or the control groups. Patients in the experimental group received a personalized follow-up program based on patient-reported outcomes. This program incorporated the MD Anderson Symptom Inventory with set alarm thresholds, enabling nurses, supported by a multidisciplinary team, to accurately assess and identify individual needs and provide tailored interventions. The control group received only the usual telephone follow-up. Baseline data (T0) were collected before the intervention (on the day of discharge), and quality of life, self-efficacy, and compliance were measured at 2 weeks (T1), 4 weeks (T2), and 12 weeks (T3) post-discharge. Additionally, patients in the experimental group were asked to share their experiences and perspectives on the intervention through open-ended questions.

The difference in quality of life between the experimental and control groups was significant (Wald X²=5.204, P=.023), with the experimental group showing significantly better quality of life at T2 compared to the control group (t=2.515, P=.013). No significant differences were observed at T0, T1, and T3. Both groups showed improvements in quality of life at all post-test time points (Wald X²=574.167, P < .001), and the interaction between group and time was not statistically significant (Wald X²=2.354, P=.308). Regarding self-management efficacy, Generalized Estimating Equations results indicated a significant difference between the experimental and control groups (Wald X²=6.573, P=.010), with the experimental group showing significantly higher self-management efficacy at T2 and T3 compared to the control group (t=3.024, P=.003; t=2.214, P=.028). No significant differences were observed at T0 and T1. Both groups showed improvements in self-management efficacy at all post-test time points (Wald X²=301.390, P < .001), and the interaction between group and time was not statistically significant (Wald X²=3.971, P=.137). A thematic analysis of the experimental group's feedback on device usage revealed six major categories.

This study shows that for patients after lung cancer surgery, it is appropriate, acceptable, feasible and attractive to rely on WeChat mini-programs to carry out follow-up projects based on patient-reported outcomes. This program has improved the postoperative quality of life and self-management efficacy of lung cancer patients. Evidence transformation, staff training, patient-reported outcome tool setting, and multidisciplinary cooperation are effective strategies to ensure implementation.

Registered in ClinicalTrial.gov on 13 March 2024(NCT06483295), began recruiting participants subjects on 14 March, 2024.