Trial design A cluster-randomized 2-arm design is used to test the E-MOSAIC intervention with the LoMoS given to physicians. At enrolment each participating physician will be randomly allocated to one of the 2 arms (standard care, E-MOSAIC+LoMoS) at 1:1 ratio stratified according to the institution. All eligible patients
to be treated by the physician will be under the same intervention (Figure3). Figure 3 Randomization with intervention. After the registration, the palm will recognize the oncologist (scroll bar) and automatically provide the software Inhibitors,research,lifescience,medical for the control or Inhibitors,research,lifescience,medical the E-MOSAIC arm, respectively. After synchronization the unique patient number (UPN) will be updated immediately, with maximal 12 patients per oncologist only 12 patient-UPNs will be possible. This trial design was chosen in
order to minimise contamination. Several patients allocated to the same physicians can hardly be considered independent. Inhibitors,research,lifescience,medical In particular, a physician familiar to the LoMoS intervention would probably treat his patients in a similar way, even if they were randomized to different interventions. To prevent this contamination, physicians are chosen as clusters . Cluster randomisation is a standard approach to evaluate both process outcomes and patient outcomes, and is considered especially
relevant if the intervention is on physician level and outcomes are patient reported . Randomization procedure and patient registration Inhibitors,research,lifescience,medical Participating physicians are randomly allocated to the intervention or control arm. Hence, all eligible patients Inhibitors,research,lifescience,medical allocated to a physician will be under the same intervention. Before randomization, the center needs to be activated and the initiation visit has taken place. Each physician has to be informed about the study procedures and has to sign informed buy 2-Methoxyestradiol consent prior to his randomization. There will be no specific training on symptom management, because the E-MOSAIC intervention in this study includes simply Adenosine the monitoring sheet. Patient registration is only possible for randomized physicians. Patients give informed consent prior to any protocol-specific procedure. Data collection procedures Patients are seen in all clinics first by oncology nurses who perform the baseline visit, educate patients about the use of the palm, ask patients about oncologist’ interventions in the previous week, and perform at weeks 3 and 6 the outcome assessments. At baseline, weeks 3 and 6, the cognitive status of patients is assessed.