Mooney Lab Research

Our current projects include the following:

• SymptomCare@Home:Deconstructing an effective, technology-assisted symptom management intervention
• Huntsman at Home: Evaluation of a new cancer supportive care delivery model
• Automated Symptom Care during Cancer Treatment
• Automated Monitoring and Coaching of Cancer Family Caregivers during Home Hospice Care
• Provider-Patient Communication about Symptoms during Oncology Office Visits

SymptomCare@Home:Deconstructing an effective, technology-assisted, symptom management intervention (R01CA206522)
Role: PI with Co-investigator Susan Beck

• This is the third of three NCI-funded R01 projects which determine the most important and cost effective components of the SymptomCare@Home system, a new approach to cancer chemotherapy symptom care that has been shown to reduce problematic symptoms through automated daily monitoring, automated self-management coaching, and oncology team follow-up care using decisional support for patients at home when their symptoms are most likely at their worst. Once the key parts of the intervention and its cost effectiveness are known, it can be moved into everyday cancer care.

Huntsman at Home: Evaluation of a new cancer supportive care delivery model
Role: PI

Huntsman at Home is an innovative approach to address supportive and palliative care needs of cancer patients throughout the continuum of care. While home care services and palliative care home visits are not new, Huntsman at Home provides a comprehensive model of home care with services and support beyond what is currently reimbursable in a fee-for-service reimbursement payment model. In addition, the demonstration project will extend the model to 1 or 2 distant communities that include underserved rural areas and utilizes on-ground staff, telehealth, and remote monitoring.

The focus of this project is evaluation. We carefully track both process and outcome metrics. We are collecting and describing process metrics such as the following:

• Referral rates
• Days of service
• Number of RN, APRN, and other provider visits
• Services provided
• Program cost
• Patient, family, and provider satisfaction scores

We examine outcomes at 12, 18, 24, and 36 months and comparing them in several ways:

• With HCI retrospective data
• With a matched cohort (age, gender, diagnosis and stage) of HCI patients not living within the Huntsman at Home service area
• With regional and national data derived from the Utah All Payers Claim Database and CMS Medicare data.

We also separately describe and compare outcomes for the distance Huntsman at Home model after 12 months of service. The comprehensive evaluation project includes comparison to regional and national data utilizing the novel resources of the Utah Population Database, which includes access to the Utah All Payer Claims Database and CMS Medicare data.

Automated Symptom Care during Cancer Treatment (R01 CA120558)
Role: PI

• This is the second of three NCI funded R01 projects to develop and test, in a randomized controlled trial, an IT enabled telephone-based automated symptom monitoring and coaching system, SymptomCare@Home. Patients receiving a course of chemotherapy called into the automated system daily and reported presence and severity of 11 common symptoms. The intervention group received automated coaching about symptom self-care based on the reported symptom pattern. In addition, symptoms at moderate or higher levels generated an automated symptom alert to a nurse practitioner who, utilizing a case management system based on national symptom guidelines, called the patient and intensified symptom care. The study found significant symptom reduction for those in the intervention group, reducing symptoms by 40-67% over usual care. This is the first reported use of a remote telemonitoring and care delivery system for cancer patients receiving chemotherapy that measured symptom outcomes and their significant reduction. The study is in the dissemination phase.

Automated Monitoring and Coaching of Cancer Family Caregivers during Home Hospice Care (Project 1 in PO1CA138317)
Role: PI with Lee Ellington and Michael Caserta, project leaders of the other two projects

• This is one of three projects in a NCI-funded program project grant (PPG). The PPG is focused on supporting cancer family caregivers in the home hospice setting, extending into bereavement. In a randomized controlled trial, an IT-enabled telephone-based automated symptom monitoring and coaching system, SymptomCare@Home, was adapted for family caregivers. Cancer family caregivers call into the automated system daily and report presence and severity of common end-of-life symptoms for their family member and also report their own well-being (such as fatigue, sleep, anxiety, and their confidence in caregiving). The intervention group receives automated coaching about how to care for their family member’s symptoms based on the reported pattern and also suggests ways to improve the caregiver’s well-being. In addition patient symptoms and caregiver concerns at moderate or higher levels generates an automated symptom alert to their hospice nurse who views the alert through a secure website. The study is in the dissemination phase. Findings demonstrated that the intervention significantly reduces patient symptoms and improves caregiver well-being.

Provider-Patient Communication about Symptoms during Oncology Office Visits
Role: PI

• This is a descriptive pilot study to determine patterns of communication about treatment-related symptoms at oncology clinic visits during a course of chemotherapy. Visits are audio recorded and later coded for the content, communication style, and length of symptom talk. Visit symptom content is correlated with patient-reported patterns of symptoms reported daily during the weeks prior to the visit utilizing the SymptomCare@Home monitoring system. We are interested in exploring how to improve communication about bothersome symptoms at clinic visits.