Oldenburger Eva, Isebaert Sofie, Coolbrandt Annemarie, Van Audenhove Chantal, Haustermans Karin
Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Palliative Care, University Hospitals Leuven, Leuven, Belgium.
Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
Ann Palliat Med. 2024 Nov;13(6):1317-1331. doi: 10.21037/apm-24-74.
Radiotherapy is a frequently utilized palliative treatment for cancer patients. Electronic Patient-Reported Outcome Measures (ePROMs) offer a method for patients to communicate their symptoms and concerns to healthcare providers (HCPs) remotely. While ePROMs have demonstrated significant benefits for oncology patient care, their integration into routine clinical practice of palliative radiotherapy (PRT) poses challenges. The current study aimed to evaluate the implementation of an ePROM-intervention after PRT.
We conducted a two-phase study to evaluate the implementation of a self-developed ePROM intervention, known as the ePRomT diary, for symptom monitoring post-PRT. This diary offered automated self-management advice for mild symptoms and also guided patients to contact an HCP for severe symptoms. We assessed various implementation aspects using the RE-AIM framework and collected data through surveys, interviews, electronic health records, and field notes. Quantitative data analysis employed descriptive statistics, while qualitative data underwent thematic analysis using NVivo. Recruitment periods for both phases spanned 10 weeks.
In Phase I, 37 out of 87 eligible patients (43%) participated, a number that rose to 40 out of 49 eligible patients (82%) in Phase II. Among participating patients, 93% in Phase I and 98% in Phase II reported the ePRomT diary as a valuable addition to their care. Additionally, 75% and 84% expressed willingness to reuse it, while 70% and 80% would recommend it to others in Phases I and II, respectively. In Phase I, 17 out of 39 patients (44%) completed at least one ePROM assessment, increasing to 26 out of 40 patients (65%) in Phase II. While patients found the self-management advice generally correct and relevant, they noted its somewhat generic nature. Moreover, while the advice to contact an HCP was deemed appropriate, adherence to it varied. HCPs expressed satisfaction with the intervention, deeming it valuable in patient care, and believed that integrating it into routine clinical practice would enhance patient acceptability with minimal workflow disruptions.
Despite certain limitations, including participant bias, our study offers valuable insights into the implementation and potential implications of an ePROM intervention for symptom follow-up post-PRT, framed within the RE-AIM framework. ePROM interventions like the ePRomT diary show promise and are well-received by both patients and HCPs. However, optimizing such interventions to better align with patient needs and seamlessly integrating them into clinical workflows within the context of PRT warrants further investigation.
放射治疗是癌症患者常用的姑息治疗方法。电子患者报告结局测量（ePROMs）为患者提供了一种远程向医疗服务提供者（HCPs）传达其症状和担忧的方法。虽然ePROMs已证明对肿瘤患者护理有显著益处，但将其纳入姑息性放射治疗（PRT）的常规临床实践存在挑战。本研究旨在评估PRT后ePROM干预措施的实施情况。
我们进行了一项两阶段研究，以评估一种自行开发的ePROM干预措施（称为ePRomT日记）在PRT后症状监测中的实施情况。该日记为轻度症状提供自动自我管理建议，并指导患者在出现严重症状时联系HCP。我们使用RE-AIM框架评估了各个实施方面，并通过调查、访谈、电子健康记录和现场记录收集数据。两阶段的招募期均为10周。
在第一阶段，87名符合条件的患者中有37名（43%）参与，在第二阶段，49名符合条件的患者中有40名（82%）参与。在参与的患者中，第一阶段93%、第二阶段98%的患者报告ePRomT日记是其护理中的一项有价值的补充。此外，75%和84%的患者表示愿意再次使用，而在第一阶段和第二阶段，分别有70%和80%的患者会向他人推荐。在第一阶段，39名患者中有17名（44%）完成了至少一次ePROM评估，在第二阶段，这一比例增至40名患者中的26名（65%）。虽然患者认为自我管理建议总体正确且相关，但他们指出其性质有些通用。此外，虽然联系HCP的建议被认为是合适的，但遵守情况各不相同。HCP对该干预措施表示满意，认为其在患者护理中有价值，并认为将其纳入常规临床实践将提高患者接受度，同时对工作流程的干扰最小。
尽管存在包括参与者偏差在内的某些局限性，但我们的研究在RE-AIM框架内，为PRT后症状随访的ePROM干预措施的实施及其潜在影响提供了有价值的见解。像ePRomT日记这样的ePROM干预措施显示出前景，并且受到患者和HCP的好评。然而，优化此类干预措施以更好地符合患者需求，并在PRT背景下无缝融入临床工作流程，值得进一步研究。
