Generalova Olga, Roy Mohana, Hall Evan, Shah Sumit A, Cunanan Kristen, Fardeen Touran, Velazquez Brianna, Chu Gilbert, Bruzzone Bianca, Cabot Anna, Fisher George A, Srinivas Sandy, Fan Alice C, Haraldsdottir Sigurdis, Wakelee Heather A, Neal Joel W, Padda Sukhmani K, Johnson Tyler, Heestand Gregory M, Hsieh Robert W, Ramchandran Kavitha
Stanford Cancer Institute, Stanford, USA.
Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA.
J Patient Rep Outcomes. 2021 Sep 15;5(1):91. doi: 10.1186/s41687-021-00358-2.
Patient reported outcomes (PROs) have been associated with improved symptom management and quality of life in patients with cancer. However, the implementation of PROs in an academic clinical practice has not been thoroughly described. Here we report on the execution, feasibility and healthcare utilization outcomes of an electronic PRO (ePRO) application for cancer patients at an academic medical center.
We conducted a randomized trial comparing an experimental ePRO arm to standard of care in patients with advanced cancer in the thoracic, gastrointestinal, and genitourinary oncology groups at Stanford Cancer Center from March 2018 to November 2019. We describe the pre-implementation, implementation, and post-implementation phases of the ePRO arm, technological barriers, electronic health record (EHR) integration, clinician burden, and patient data privacy and security. Feasibility was pre-specified to be at least 70% completion of all questionnaires. Acceptability was based on patient and clinician feedback. Ambulatory healthcare utilization was assessed by reviewing numbers of phone messages, electronic portal messages, and referrals for supportive care.
Of 617 ePRO questionnaires sent to 72 patients, 445 (72%) were completed. Most clinicians (87.5%) and patients (93%) felt neutral or positive about the ePRO tool's ease of use. Exposure to ePRO did not cause a measurable change in ambulatory healthcare utilization, with a median of less than two phone messages and supportive care referrals, and 5-6 portal messages.
Web-based ePRO tools for patients with advanced cancer are feasible and acceptable without increasing clinical burden. Key lessons include the importance of pilot testing, engagement of stakeholders at all levels, and the need for customization by disease group. Future directions for this work include completion of EHR integration, expansion to other centers, and development of integrated workflows for routine clinical practice.
患者报告结局（PROs）与癌症患者症状管理的改善及生活质量的提高相关。然而，在学术临床实践中PROs的实施情况尚未得到充分描述。在此，我们报告了在一所学术医疗中心为癌症患者应用电子PRO（ePRO）的执行情况、可行性及医疗保健利用结局。
2018年3月至2019年11月，我们在斯坦福癌症中心对胸部、胃肠道和泌尿生殖系统肿瘤学组的晚期癌症患者进行了一项随机试验，比较了实验性ePRO组与标准治疗。我们描述了ePRO组的实施前、实施和实施后阶段、技术障碍、电子健康记录（EHR）整合、临床医生负担以及患者数据隐私和安全。可行性预先设定为所有问卷至少完成70%。可接受性基于患者和临床医生的反馈。通过审查电话留言、电子门户留言数量以及支持性护理转诊情况来评估门诊医疗保健利用情况。
在发送给72名患者的617份ePRO问卷中，445份（72%）已完成。大多数临床医生（87.5%）和患者（93%）对ePRO工具的易用性持中立或积极态度。接触ePRO并未导致门诊医疗保健利用情况发生可测量的变化，电话留言和支持性护理转诊的中位数均少于两条，门户留言为5 - 6条。
用于晚期癌症患者的基于网络的ePRO工具是可行且可接受的，不会增加临床负担。关键经验教训包括试点测试的重要性、各级利益相关者的参与以及按疾病组进行定制的必要性。这项工作的未来方向包括完成EHR整合、扩展到其他中心以及开发常规临床实践的综合工作流程。
