Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL.
JCO Oncol Pract. 2024 Mar;20(3):409-418. doi: 10.1200/OP.23.00493. Epub 2024 Jan 11.
Telemedicine provides numerous benefits to patients, yet effective communication and symptom assessment remain a concern. The recent uptake of telemedicine provided an opportunity to use a newly developed dashboard with patient-reported outcome (PRO) information to enhance communication and shared decision making (SDM) during telemedicine appointments. The objective of this study was to identify barriers to using the dashboard during telemedicine, develop implementation strategies to address barriers, and pilot test use of this dashboard during telemedicine appointments in two practice settings to evaluate acceptability, adoption, fidelity, and effectiveness.
Patients and clinicians were interviewed to identify determinants to dashboard use in telemedicine. Implementation strategies were designed and refined through iterative feedback from stakeholders. A pilot study of dashboard use was conducted from March to September 2022. Acceptability, adoption, and fidelity were evaluated using mixed methods. SDM was evaluated using the collaboRATE measure.
One hundred two patient encounters were evaluated. Most patients (62; 60%) had completed some PRO data at the time of their telemedicine encounter. Most (82; 80%) encounters had clinician confirmation that PRO data had been reviewed; however, collaborative review of the dashboard was documented in only 27%. Degree of SDM was high (mean collaboRATE score 3.40; SD, 0.11 [95% CI, 3.17 to 3.63] out of a maximum score of 4). Implementation strategies focused on patient engagement, education, and remote PRO completion. Clinician-facing strategies included education, practice facilitation, and small tests of change.
This study demonstrated that implementation of a PRO-based dashboard into telemedicine appointments was feasible and had acceptable adoption and acceptability by patients and clinicians when several strategies were used to engage end users. Strategies targeting both patients and clinicians are needed to support routine and effective PRO integration in telemedicine.
远程医疗为患者带来了诸多益处，但医患间的有效沟通和症状评估仍是关注重点。远程医疗的普及为使用新开发的患者报告结局（PRO）信息仪表盘提供了机会，以增强远程医疗预约期间的医患沟通和共享决策（SDM）。本研究旨在确定在远程医疗中使用仪表盘的障碍，制定实施策略以解决这些障碍，并在两个实践环境中试点测试在远程医疗预约中使用该仪表盘，以评估其可接受性、采用率、忠实度和有效性。
对患者和临床医生进行访谈，以确定在远程医疗中使用仪表盘的决定因素。通过利益相关者的迭代反馈来设计和完善实施策略。2022 年 3 月至 9 月进行了仪表盘使用的试点研究。使用混合方法评估可接受性、采用率和忠实度。使用 collaboRATE 量表评估 SDM。
评估了 102 次患者就诊。大多数患者（62 例，60%）在远程医疗就诊时已经完成了部分 PRO 数据。大多数（82 例，80%）就诊时临床医生确认已查看 PRO 数据，但仅记录了 27%的情况下对仪表盘进行了协作审查。SDM 的程度较高（平均 collaboRATE 评分为 3.40；SD，0.11 [95%置信区间，3.17 至 3.63]，满分 4 分）。实施策略侧重于患者参与、教育和远程 PRO 完成。面向临床医生的策略包括教育、实践促进和小范围的改变测试。
本研究表明，当采用多种策略来吸引最终用户时，将基于 PRO 的仪表盘纳入远程医疗预约是可行的，且患者和临床医生对其接受度和可接受性较高。需要针对患者和临床医生制定策略，以支持远程医疗中常规且有效的 PRO 整合。
