Feasibility of Implementing Innovative Supportive Care Plans for Symptom Management in Multiple Myeloma

Introduction: Treatment of Multiple Myeloma (MM) is undergoing transformation. With the rapid emergence of new agents and regimens has also come new toxicities that limit their tolerability and impact patient adherence. Innovative strategies are needed to proactively screen for, assess, and manage disease- and treatment-related symptoms, and engage patients (pts) and families in their identification and self-management. To be sustainable, processes must efficiently integrated within clinical workflows. Growing attention is thus being placed on the potential of novel health information technology (IT) solutions to transform cancer care delivery. Yet, most IT solutions to date have focused little attention to supportive care and facilitating self-management of symptoms. The Carevive (formally On Q) Care Planning System™ (CPS) was developed to address this gap, by providing efficient and clinically integrated IT solutions that facilitate evidence-based supportive care, while concurrently promoting supported self-management. The primary objective of this study is to assess the feasibility of the Carevive CPS electronic symptom screening and care management system in pts receiving active treatment for MM.

Methods: Ninety pts with MM and their healthcare providers (physicians and nurse practitioners) are planned for enrollment to this in-progress multi-center pilot intervention study (30 pts each at 3 sites). All participants must be 18 years or older with a pathologically confirmed diagnosis of MM and currently receiving treatment for at least 4 weeks prior to enrollment. At baseline and a 4-8 week follow-up, each patient completes an electronic patient-reported outcome (ePRO) questionnaire in the Carevive CPS about their symptoms. These, plus clinical data, are processed by the Carevive CPS proprietary rules engine to generate personalized, guideline-driven care plans with peer-reviewed and evidence-based recommendations for symptom management. Providers review, finalize, and deliver these care plans containing individually tailored education, resources, and referrals at the 2 clinical visits. Care plans can be delivered to the pts electronically (via secure email or thumb drive) or paper. Feasibility of delivery of the Carevive CPS intervention was assessed by: a) patient enrollment and attrition, b) completion rates of key intervention components (e.g., completion of the questionnaire by pts, percent of pts who receive a care plan), and c) process variables (e.g. format of care plan delivery, time spent discussing the care plan). A tracking log was used to capture percentage of pts enrolled and rates of completion of ePRO questionnaires. Process variables were captured using a study designed worksheet, completed by research staff following each intervention visit. Achievement of feasibility of the intervention was defined as a questionnaire and care plan completion rate of 75% or higher.

Data Analysis: To date 20 pts have enrolled at 2 participating sites, with a third site planned to open for enrollment in August 2015. Nine providers are participating to date. Updated data on both pts and providers will be presented at time of the symposium. Of the 25 pts approached to participate, 20 participated for a consent rate of 80%. 20/20 (100%) of pts completed the questionnaire in full. The average time the patient spent independently completing the questionnaire was 7.36 minutes and 100% of these pts received care plans. Healthcare providers spent an average of 5.55 minutes discussing the care plan with the patient. Care plan delivery has been predominately electronic, with 70% having been delivered via secure email or thumb drive and 30% being delivered via paper format.

Conclusions: The Carevive CPS is a novel electronic platform designed to deliver evidence-based and personalized supportive care plans to pts at the point of care. Preliminary data, which will be updated at time of presentation, are supportive of its feasibility in MM. The 75% threshold for feasibility has been met for enrollment, ePRO questionnaire completion, and care plan delivery. Time spent in questionnaire completion and care plan review was low compared to other studies. These feasibility data provide initial evidence to support the Carevive CPS intervention. Future studies are planned to evaluate the impact on patient outcomes including symptom burden and adherence to therapy.