Texas Oncology, Dallas, TX.
Dell Medical School, The University of Texas at Austin, Austin, TX.
JCO Clin Cancer Inform. 2021 May;5:615-621. doi: 10.1200/CCI.21.00063.
Among patients receiving chemotherapy, symptom monitoring with electronic patient-reported outcomes (ePROs) is associated with improved clinical outcomes, satisfaction, and compliance with therapy. Standard approaches for ePRO implementation are not established, warranting evaluation in community cancer practices. We present implementation findings of ePRO symptom monitoring across a large multisite community oncology practice network.
Patients initiating a new systemic therapy at one of the 210 practice sites at Texas Oncology were invited to use the Navigating Cancer ePRO platform, with stepped-wedge implementation from July to December 2020. Participating patients received a weekly prompt by text message or e-mail to self-report common symptoms and well-being. Severe self-reported symptoms triggered a real-time notification to nursing triage to address the symptom. Enrollment and compliance were systematically tracked weekly with evaluation of barriers and facilitators to adoption and sustainability.
Four thousand three hundred seventy-five patients planning systemic treatment were enrolled and participated. Seventy-three percent (1,841 of 2,522) of enrolled patients completed at least one ePRO assessment. Among these individuals, 64% (16,299 of 25,061) of available weekly ePRO assessments were completed. Over a 10-week period, compliance declined from 72% to 52%. Barriers currently being addressed include lack of a second reminder text or e-mail prompt, inconsistent discussion of reported ePROs by clinicians at visits, and COVID-related changes in workflow. Facilitators included ease of use and patient and staff engagement on the importance of PROs for symptom management.
ePROs can be effectively implemented in community oncology practice. Utilization of ePROs is high but diminishes over time without attention to barriers. Ongoing work to address barriers and optimize compliance are underway.
在接受化疗的患者中，使用电子患者报告结局（ePROs）进行症状监测与改善临床结局、提高治疗满意度和提高治疗依从性有关。尚未建立 ePRO 实施的标准方法，因此需要在社区癌症实践中进行评估。我们介绍了在一个大型多站点社区肿瘤学实践网络中实施 ePRO 症状监测的结果。
德克萨斯肿瘤学的 210 个实践站点之一的新系统治疗开始的患者被邀请使用“Navigating Cancer ePRO”平台，从 2020 年 7 月到 12 月逐步实施。参与的患者每周通过短信或电子邮件收到自我报告常见症状和健康状况的提示。严重的自我报告症状会触发实时通知，以便护理人员进行分诊以解决症状问题。每周系统地跟踪登记和遵守情况，并评估采用和可持续性的障碍和促进因素。
有 4375 名计划接受系统性治疗的患者被登记并参与了研究。在登记的患者中，73%（1841/2522）完成了至少一次 ePRO 评估。在这些患者中，64%（16299/25061）完成了可用的每周 ePRO 评估。在 10 周的时间里，遵守率从 72%下降到 52%。目前正在解决的障碍包括缺乏第二个提醒短信或电子邮件提示、临床医生在就诊时对报告的 ePROs 讨论不一致，以及与 COVID 相关的工作流程变化。促进因素包括易于使用以及患者和工作人员对 PRO 用于症状管理的重要性的参与。
ePROs 可以在社区肿瘤学实践中有效实施。ePROs 的使用率很高，但如果不注意障碍，随着时间的推移会逐渐降低。正在进行解决障碍和优化遵守率的工作。
