Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
Dana Farber/Harvard Cancer Center, Boston, MA.
JCO Clin Cancer Inform. 2020 Oct;4:947-957. doi: 10.1200/CCI.20.00081.
There is increasing interest in implementing digital systems for remote monitoring of patients' symptoms during routine oncology practice. Information is limited about the clinical utility and user perceptions of these systems.
PRO-TECT is a multicenter trial evaluating implementation of electronic patient-reported outcomes (ePROs) among adults with advanced and metastatic cancers receiving treatment at US community oncology practices (ClinicalTrials.gov identifier: NCT03249090). Questions derived from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) are administered weekly by web or automated telephone system, with alerts to nurses for severe or worsening symptoms. To elicit user feedback, surveys were administered to participating patients and clinicians.
Among 496 patients across 26 practices, the majority found the system and questions easy to understand (95%), easy to use (93%), and relevant to their care (91%). Most patients reported that PRO information was used by their clinicians for care (70%), improved discussions with clinicians (73%), made them feel more in control of their own care (77%), and would recommend the system to other patients (89%). Scores for most patient feedback questions were significantly positively correlated with weekly PRO completion rates in both univariate and multivariable analyses. Among 57 nurses, most reported that PRO information was helpful for clinical documentation (79%), increased efficiency of patient discussions (84%), and was useful for patient care (75%). Among 39 oncologists, most found PRO information useful (91%), with 65% using PROs to guide patient discussions sometimes or often and 65% using PROs to make treatment decisions sometimes or often.
These findings support the clinical utility and value of implementing digital systems for monitoring PROs, including the PRO-CTCAE, in routine cancer care.
在常规肿瘤学实践中，人们对实施用于远程监测患者症状的数字系统越来越感兴趣。关于这些系统的临床实用性和用户认知，信息有限。
PRO-TECT 是一项多中心试验，评估了在美国社区肿瘤学实践中接受治疗的晚期和转移性癌症成人患者实施电子患者报告结局（ePROs）的情况（ClinicalTrials.gov 标识符：NCT03249090）。从患者报告结局版常见不良事件术语标准（PRO-CTCAE）中得出的问题通过网络或自动电话系统每周进行管理，如果症状严重或恶化，则向护士发出警报。为了征求用户反馈，向参与的患者和临床医生进行了调查。
在 26 家诊所的 496 名患者中，大多数患者认为系统和问题易于理解（95%）、易于使用（93%）且与他们的护理相关（91%）。大多数患者报告说，临床医生会使用 PRO 信息进行护理（70%），改善与临床医生的讨论（73%），让他们更能控制自己的护理（77%），并会向其他患者推荐该系统（89%）。在单变量和多变量分析中，大多数患者反馈问题的评分与每周 PRO 完成率呈显著正相关。在 57 名护士中，大多数人报告说 PRO 信息有助于临床文档记录（79%），提高了患者讨论的效率（84%），对患者护理有用（75%）。在 39 名肿瘤学家中，大多数人发现 PRO 信息有用（91%），其中 65%有时或经常使用 PRO 来指导患者讨论，65%有时或经常使用 PRO 来做出治疗决策。
这些发现支持在常规癌症护理中实施用于监测 PRO 的数字系统的临床实用性和价值，包括 PRO-CTCAE。
