Principal Investigator: Andrea Cheville, MD

The Enhanced EHR-facilitated Cancer Symptom Control (E2C2) pragmatic clinical trial, conducted at Mayo Clinic (Rochester), is testing a bundled intervention that leverages EHR interface and clinical decision support functionalities to implement an approach that automatically triages symptomatic patients to low-touch automated self-management (Level 1) or high-touch nurse care management (Level 2), depending on PRO scores, as well as patient and clinical factors. The E2C2 intervention will target sleep disturbance, pain, anxiety, depression, and energy deficit/fatigue, the SPADE pentad, which represents the most prevalent and potentially treatable group of overlapping cancer symptoms. To assess the effectiveness of discrete E2C2 intervention components, a Stage 1 Symptom Control Bundle will be tested for 12 months, after which a Stage 2 Implementation Bundle will be added. The trial's stepped wedge design will randomize the order of E2C2 implementation among 21 clusters defined at the level of the cancer care team. Outcomes will include SPADE symptom scores (primary), physical function, social participation, quality of life, distress, healthcare utilization, adherence to cancer treatment, and vital status which will be collected during each trial phase; pre-E2C2, Stage 1 and Stage 2. A multi-stakeholder, mixed methods approach will be used to comprehensively assess the impact of the Stage 2 Implementation Bundle, as well as both Stages' impact on rurally-based and elderly patients, groups prone to disparities in symptom control.