Over the past 25 years, the field of oncology has seen dramatic changes in cancer care delivery, including the development of new therapies, the shift of care from inpatient and clinic to home care, and the widespread use of electronic medical records. I was.
problem
One area of innovation is the development of oral anticancer agents, including cytotoxic chemotherapy, that patients can self-administer at home. According to estimates, about 25% of new anticancer drugs in development are intended for oral administration. NCCN Task Force Report: Oral Chemotherapy.
“Penny,” an assistant professor of clinical medicine at the University of Pennsylvania Health System and the organization, says the use of these drugs allows patients to be more autonomous in their care and spend more time at home. Member Dr. Parul Agarwal said. The team is demonstrating leadership, particularly in its role in gastrointestinal cancers.
“But there are some issues to consider when giving oral chemotherapy at home,” she noted. “Dosing schedules can be complicated, and there is concern that efficacy may be compromised if patients take less than prescribed doses, and if patients are given more than prescribed doses, There is concern about an increased risk of potentially life-threatening toxicity.
“Recognizing these challenges, several mitigation strategies have been evaluated, including intensive outpatient monitoring programs led by health care providers and pharmacists,” she continued. “Additionally, it is difficult to measure medication adherence and adequately identify and manage toxicity in patients receiving oral chemotherapy.”
Capecitabine is a particularly complex oral chemotherapy that serves as a cornerstone of treatment for many gastrointestinal malignancies. Manufactured in two tablet sizes, it is formulated twice daily and dosed according to body surface area. The treatment plan is cyclical, followed by days of treatment on and off.
“Our PennyPilot, an augmented intelligence chatbot, is a novel strategy for improving medication adherence and managing toxicity associated with oral chemotherapeutic agents, with the primary goal of improving patient outcomes, A second goal is to improve healthcare utilization indicators.”
Dr. Parul Agarwal, University of Pennsylvania Health System
“Furthermore, capecitabine is often given concurrently with other intravenous chemotherapy, other oral chemotherapy, or radiation, which can lead to additional complications associated with administration,” Agarwal explained. “The monitoring of these agents to ensure safe management is typically provider and resource intensive, and the literature notes that errors are frequent, resulting in avoidable complications.” It has been.
“Our PennyPilot, an augmented intelligence chatbot, is a novel strategy for improving medication adherence and managing toxicity associated with oral chemotherapeutic agents, with the primary goal of improving patient outcomes, The second goal is to improve healthcare utilization indicators,” she added.
suggestion
An algorithm-driven augmented intelligence chatbot, Penny, was proposed to improve medication adherence, monitor and manage toxicity, with the ultimate goal of providing high-quality patient care.
Penny uses text-based, two-way, conversational interactions to guide patients through potentially complex regimens, reducing potential mistakes patients can make during the course of chemotherapy. .
deal with challenges
Gastrointestinal cancer patients receiving oral chemotherapy capecitabine alone or capecitabine in combination with other anticancer agents or radiation therapy were also eligible to participate. The Penny chatbot was two-way and messages could be initiated by the chatbot or the patient.
To address issues related to medication adherence and medication, the chatbot sent patients twice-daily medication reminders about capecitabine dosage and timing. In Phase 1 of the pilot, participants received a message asking them to respond “TAKEN” after each dose of capecitabine. This was later changed to a weekly survey to assess adherence.
To address toxicities associated with oral anticancer drugs, the chatbot also launched weekly surveys to elicit patient-reported symptoms. These symptoms were prioritized using a combination of algorithmic research and natural language processing, a type of AI.
Participants can also initiate a message on the chatbot at any time during the process to report their symptoms. All interactions between participants and the chatbot were monitored in real time by the research team.
result
“The main outcome of this study was to assess the feasibility of using augmented intelligence chatbots from a patient safety perspective,” Agarwal explained. “Approximately 4,000 pharmaceutical-related texts of his were exchanged, and approximately 93% were correctly interpreted by Penny.
“We measured compliance at about 70% for participants who said they did, but the actual compliance rate is probably higher,” she continued. “More than 500 of her texts related to her symptoms were exchanged and approximately 98% were correctly interpreted by Penny.”
Through an iterative process, patient involvement in symptom assessment increased from 25% to about 70%, and most of the misinterpreted messages were addressed in real time by the research team, she added.
Over 50% of participants completed a qualitative exit interview.these interviews Clear feedback that Penny provided additional support demonstrated overwhelming levels of patient engagement and increased patient confidence in taking medication and interacting with the care team, she said.
advice to others
“Repeated implementation of this intervention improved some of Penny’s natural language processing capabilities and increased patient engagement levels as the trial progressed, which is crucial for medical innovation in this area.” he said. Agarwal.
“This process required a high degree of involvement from everyone involved, including the medical team, the research team, and the Memora team we partnered with for our technology platform,” she continued. “Dr. Penney identified care delivery discrepancies in capecitabine scheduling, dosing, and monitoring among gastrointestinal cancer healthcare professionals, leading to efforts to reduce unnecessary variability in care.”
A Patient Journey Dashboard was created to provide a clear overview of schedules and dosages with the aim of facilitating the delivery of quality care.
“Going forward, this dashboard will be integrated into the EHR and will become the standard tool clinical teams use to monitor patients and adjust doses as needed,” he said. Agarwal.
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