{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T23:54:37Z","timestamp":1783036477808,"version":"3.54.6"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Patients with advanced cancer experience substantial symptom burden that impairs health-related quality of life (HRQOL) and contributes to emergency department (ED) visits and hospitalizations. Evidence for application (app)-facilitated palliative care interventions remains limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate whether an app-facilitated palliative care intervention integrating digital symptom monitoring with nurse-led clinical follow-up can improve outcomes among patients with advanced cancer.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This multicenter randomized clinical trial was conducted at 6 palliative care clinics in Hong Kong from January 25, 2023, to February 5, 2025. Community-dwelling adults with advanced solid cancer who were no longer receiving systemic anticancer treatment were randomized 1:1 to digital symptom monitoring plus usual care or usual care alone and followed up for 18 weeks.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Digital symptom monitoring combined weekly symptom reporting using the Integrated Palliative Care Outcome Scale, automated self-management guidance, and nurse-led follow-up for severe symptom alerts.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was change in HRQOL as measured by EuroQol 5-dimension 5-level (EQ-5D-5L) assessment. Secondary outcomes included self-efficacy (6-item Self-Efficacy for Managing Chronic Disease Scale), Eastern Cooperative Oncology Group performance status (ECOG PS), ED visits, and hospitalizations.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 1214 randomized participants (590 to digital symptom monitoring and 624 to usual care; median age, 78 [range, 31-103] years; 617 [50.8%] male), including 821 caregivers (67.6%) as application users, HRQOL was better maintained with digital symptom monitoring at week 18. Mean changes from baseline favored the intervention compared with usual care for EQ-5D-5L utility (0.49 to 0.52 vs 0.50 to 0.38; mean difference in change, \u22120.15 [95% CI, \u22120.21 to \u22120.10];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and EQ-5D visual analogue scale (63.16 to 65.72 vs 63.87 to 59.69; mean difference, \u22126.09 [95% CI, \u22128.67 to \u22123.51] points;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Self-efficacy was better maintained with the digital symptom monitoring intervention (5.29 to 5.34 vs 5.43 to 4.87; mean difference, \u22120.53 [95% CI, \u22120.78 to \u22120.27];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Deterioration in ECOG PS (44 of 367 [12.0%] vs 66 of 379 [17.4%]; odds ratio [OR], 1.22 [95% CI, 0.83-1.79];\n P<\/jats:italic>\n \u2009=\u2009.31) and ED utilization (74 of 367 [20.2%] vs 97 of 379 [25.6%]; OR, 1.27 [95% CI, 0.97-1.67];\n P<\/jats:italic>\n \u2009=\u2009.09) were similar between groups. Hospitalization outcomes favored digital symptom monitoring, including fewer participants with worsening unplanned hospitalization episodes (63 of 367 [17.2%] vs 108 of 379 [28.5%]; OR, 1.59 [95% CI, 1.21-2.10];\n P<\/jats:italic>\n \u2009=\u2009.001) and fewer inpatient days during follow-up (mean [SD], 3.4 [8.9] vs 7.3 [15.5]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial of patients with advanced cancer, an app-facilitated palliative care intervention helped maintain HRQOL and self-efficacy and reduced acute care use compared with usual care.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT07475312<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.15509","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T17:30:11Z","timestamp":1780335011000},"page":"e2615509","source":"Crossref","is-referenced-by-count":1,"title":["Digital Self-Management of Symptoms and Quality of Life for Patients With Advanced Cancer"],"prefix":"10.1001","volume":"9","author":[{"given":"Wing-Lok","family":"Chan","sequence":"first","affiliation":[{"name":"Department of Clinical Oncology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region (SAR)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inda Sung","family":"Soong","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong 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