Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada.
Division of General Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Canada.
Support Care Cancer. 2022 Sep;30(9):7535-7544. doi: 10.1007/s00520-022-07191-3. Epub 2022 Jun 7.
Prior to the COVID-19 pandemic, patients attending ambulatory clinics at cancer centers in Ontario completed the Edmonton Symptom Assessment Scale (ESAS) at each visit. At our center, completion was via touchpad, with assistance from clinic volunteers. As of March 2020, clinic appointments were conducted virtually when possible and touch pads removed. We anticipated a negative impact on the collection of patient-reported outcomes (PROs) and the recognition of severe symptoms.
We performed a prospective cross-sectional cohort study to investigate remote ESAS completion by patients with appointments at a weekly surgical oncology clinic. Patients in the initial study cohort were asked to complete and return the ESAS virtually (V). Given low completion rates, the ensuing cohort was asked to complete a hard-copy (HC) ESAS. For the final cohort, we provided remote, personal mentorship by a member of the care team to support virtual electronic ESAS completion (virtual-mentored (VM) cohort).
Between May and July 2020, a total of 174 patient encounters were included in the study. For the V cohort, 20/46 patients (44%) successfully completed and returned the electronic ESAS, compared to 49/50 (98%) for the HC cohort. For the VM cohort, the overall completion rate was 74% (58/78); however, 12 of these 58 patients did not independently complete a virtual ESAS. Virtual questionnaire completion was not predicted by age, sex, or tumor site, although patients who completed the ESAS were more likely to be in active management rather than surveillance (p = 0.04). Of all completed forms, 42% revealed a depression score of ≥2, and 27% an anxiety score of ≥4.
We identified significant barriers to the virtual completion of ESAS forms, with a lack of predictive variables. The severe degree of psychological distress reported by ~50% of respondents demonstrates the need for ongoing regular collection/review of these data. Innovative solutions are required to overcome barriers to the virtual collection of PROs.
在 COVID-19 大流行之前，安大略省癌症中心的门诊患者每次就诊时都会使用埃德蒙顿症状评估量表（ESAS）进行评估。在我们中心，通过触摸板完成评估，由诊所志愿者提供帮助。自 2020 年 3 月以来，只要可能，就通过虚拟方式进行门诊预约，并移除触摸板。我们预计这将对患者报告的结果（PRO）的收集和严重症状的识别产生负面影响。
我们进行了一项前瞻性的横断面队列研究，以调查每周进行一次外科肿瘤学门诊预约的患者的远程 ESAS 完成情况。最初的研究队列中的患者被要求远程填写并返回 ESAS（V 组）。由于完成率较低，随后的队列被要求填写纸质版 ESAS（HC 组）。对于最后一个队列，我们由护理团队的一名成员提供远程个人指导，以支持虚拟电子 ESAS 完成（虚拟指导（VM）组）。
2020 年 5 月至 7 月期间，共有 174 例患者的就诊情况纳入研究。V 组中，有 20/46 名患者（44%）成功完成并返回了电子 ESAS，而 HC 组中这一比例为 49/50 名患者（98%）。VM 组的总体完成率为 74%（58/78）；然而，在这 58 名患者中，有 12 名并非独立完成虚拟 ESAS。尽管完成 ESAS 的患者更可能处于积极管理而非监测状态（p=0.04），但年龄、性别或肿瘤部位并不能预测虚拟问卷的完成情况。所有完成的表格中，有 42%的患者抑郁评分≥2，27%的患者焦虑评分≥4。
我们发现虚拟完成 ESAS 表格存在显著障碍，且无预测变量。约 50%的受访者报告存在严重程度的心理困扰，这表明需要持续定期收集/审查这些数据。需要创新解决方案来克服虚拟收集 PRO 的障碍。
