kathi mooney
ONS member Kathleen Mooney, PhD, RN, FAAN, is the Louis S. Peery and Janet B. Peery Presidential Endowed Chair in Nursing and Distinguished Professor of Nursing at the University of Utah and co-leader of cancer control and population sciences at Huntsman

Patients often experience symptoms at home, between clinic visits, when healthcare professionals can’t directly observe, assess, or advise the best interventions to address them. Nursing practice is at the core of symptom management, and the profession can extend itself into the home with telehealth programs. With an intimate knowledge of patient symptoms and struggles, nurses can help guide the development of new systems to connect with patients at home. 

SymptomCare@Home was a phone call-based program I developed with ONS member Susan Beck, APRN, PhD, FAAN, to monitor patients’ chemotherapy-related symptoms at home between office visits. To prevent overworking the healthcare team, we automated the telehealth program to call patients every day and asked them to respond to questions about 12 common symptoms associated with chemotherapy. After connecting with the SymptomCare system, patients would indicate if they had experienced any side effects in the past 24 hours. If a patient noted she had nausea and vomiting, for example, the system would ask her to rate its severity on a scale of 1–10. Based on her response, she would receive automated self-care management coaching tailored to the reported symptoms.  

The SymptomCare system also had predetermined thresholds for each symptom based on severity. If patients reported low- to moderate-grade symptoms, they would receive severity-appropriate coaching. If they reported moderate to severe symptoms, it would immediately alert a healthcare provider who could then contact patients for more information, assessment, and potential adjustment in symptom care.  

For the intervention, rather than expecting patients to call their providers if they experience symptoms, telehealth technology took that burden out of their hands, allowing for efficient, ongoing, systematic daily monitoring because providers are alerted only for patients with poorly controlled symptoms. Our study uncovered that when patients in the control group—who received daily phone calls but no automated coaching—were told to call their providers if symptoms were moderate to severe, they did so only 5% of the time. However, the experimental group received assessment and consultation with an advanced practice RN later in the day to address all symptoms rated moderate to severe. Overall, the study showed that telehealth monitoring and coaching greatly reduced patients’ overall symptom burden by approximately 40%–50%, measured by fewer symptom days reported at a moderate to severe level. 

Technology will not depersonalize care. Quite the opposite: it allows nurses to reach farther into the patient cancer experience to provide individualized symptom management—no matter the location.