Acceptability of an Electronic Self-report Assessment Program for Patients With Cancer (original) (raw)
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BMC cancer, 2014
The electronic self report assessment - cancer (ESRA-C), has been shown to reduce symptom distress during cancer therapy The purpose of this analysis was to evaluate aspects of how the ESRA-C intervention may have resulted in lower symptom distress (SD). Patients at two cancer centers were randomized to ESRA-C assessment only (control) or the Web-based ESRA-C intervention delivered to patients' homes or to a tablet in clinic. The intervention allowed patients to self-monitor symptom and quality of life (SxQOL) between visits, receive self-care education and coaching to report SxQOL to clinicians. Summaries of assessments were delivered to clinicians in both groups. Audio-recordings of clinic visits made 6 weeks after treatment initiation were coded for discussions of 26 SxQOL issues, focusing on patients'/caregivers' coached verbal reports of SxQOL severity, pattern, alleviating/aggravating factors and requests for help. Among issues identified as problematic, two measur...
Oncology Nursing Forum, 2004
➤ Although cancer symptoms and quality-of-life issues are of the highest priority to oncology nurse clinicians, little time is available in most clinical settings for comprehensive screening and assessment of problematic areas. ➤ Advances in computer and Internet technologies have made electronic assessment a feasible and attractive method of gathering patient-reported information in busy clinical settings. ➤ Patient-generated symptom and quality-of-life assessment is feasible in an ambulatory setting with patients with various levels of education and prior computer use. pain specialist, social worker, nutritionist) for further evaluation. Such system enhancement could greatly facilitate oncology nurses' coordination role in caring for complex patients with cancer. Purpose/Objectives: To develop and test an innovative computerized symptom and quality-of-life (QOL) assessment for patients with cancer who are evaluated for and treated with radiation therapy. Design: Descriptive, longitudinal prototype development and crosssectional clinical data. Setting: Department of radiation oncology in an urban, academic medical center. Sample: 101 outpatients who were evaluated for radiation therapy, able to communicate in English (or through one of many interpreters available at the University of Washington), and competent to understand the study information and give informed consent. Six clinicians caring for the patients in the sample were enrolled. Methods: Iterative prototype development was conducted using a standing focus group of clinicians. The software was developed based on survey markup language and implemented in a wireless, Web-based format. Patient participants completed the computerized assessment prior to consultation with the radiation physician. Graphical output pages with flagged areas of symptom distress or troublesome QOL issues were made available to consulting physicians and nurses. Main Research Variables: Pain intensity, symptoms, QOL, and demographics. Instruments: Computerized versions of a 0-10 Pain Intensity Numerical Scale (PINS), Symptom Distress Scale, and Short Form-8. Findings: Focus group recommendations included clinician priorities of brevity, flexibility, and simplicity for both input interface and output and that the assessment output contain color graphic display. Patient participants included 45 women and 56 men with a mean age of 52.7 years (SD = 13.8). Fewer than half of the participants (40%) reported using a computer on a regular basis (weekly or daily). Completion time averaged 7.8 minutes (SD = 3.7). Moderate to high levels of distress were reported more often for fatigue, pain, and emotional issues than for other symptoms or concerns. Conclusions: Computerized assessment of cancer symptoms and QOL is technically possible and feasible in an ambulatory cancer clinic. A wireless, Web-based system facilitates access to results and data entry and retrieval. The symptom and QOL profiles of these patients new to radiation therapy were comparable to other samples of outpatients with cancer. Implications for Nursing: The ability to capture an easily interpreted illustration of a patient's symptom and QOL experience in less than 10 minutes is a potentially useful adjunct to traditional face-to-face interviewing. Ultimately, electronic patient-generated data could produce automated "red flags" directed to the most appropriate clinicians (e.g., nurse,
JAMA
IMPORTANCE Electronic systems that facilitate patient-reported outcome (PRO) surveys for patients with cancer may detect symptoms early and prompt clinicians to intervene. OBJECTIVE To evaluate whether electronic symptom monitoring during cancer treatment confers benefits on quality-of-life outcomes. DESIGN, SETTING, AND PARTICIPANTS Report of secondary outcomes from the PROTECT (Alliance AFT-39) cluster randomized trial in 52 US community oncology practices randomized to electronic symptom monitoring with PRO surveys or usual care. Between October 2017 and March 2020, 1191 adults being treated for metastatic cancer were enrolled, with last follow-up on May 17, 2021. INTERVENTIONS In the PRO group, participants (n = 593) were asked to complete weekly surveys via an internet-based or automated telephone system for up to 1 year. Severe or worsening symptoms triggered care team alerts. The control group (n = 598) received usual care. MAIN OUTCOMES AND MEASURES The 3 prespecified secondary outcomes were physical function, symptom control, and health-related quality of life (HRQOL) at 3 months, measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30; range, 0-100 points; minimum clinically important difference [MCID], 2-7 for physical function; no MCID defined for symptom control or HRQOL). Results on the primary outcome, overall survival, are not yet available. RESULTS Among 52 practices, 1191 patients were included (mean age, 62.2 years; 694 [58.3%] women); 1066 (89.5%) completed 3-month follow-up. Compared with usual care, mean changes on the QLQ-C30 from baseline to 3 months were significantly improved in the PRO group for physical function
Journal of Hospital Management and Health Policy
Background: A web-based patient-reported outcomes capture system (WPROCS) can potentially improve efficacy of symptom monitoring and management and overcome barriers to long-term monitoring and care among adult cancer patients. The patients' needs, acceptance and readiness for such a system need to be explored and understood to support and guide its development. We developed an instrument to survey needs, acceptance and readiness for WPROCS among adult cancer patients. Methods: Literature was searched for applicable instruments in English and for relevant studies to guide modification of such existing instruments according to our objectives. Filipino versions were developed. The modified questionnaires were subjected to content validation by experts and pilot-tested to adult cancer patients. Results: Three questionnaires were developed, one for each dimension-needs, acceptance and readiness. The Needs Assessment Questionnaire explored overall and emotional health; healthcare needs; distressing symptoms and medications; feeding and nutrition; social support and access to healthcare; and ambulatory capacity and functional disability. The Acceptance Assessment Questionnaire explored socio-demographic variables; attitude towards WPROCS, perceived logistic capacity and competency to use it, and willingness to acquire materials, equipment, knowledge and/or access to it when lacking. The Readiness Assessment Questionnaire explored computer and Internet access and use; and computer and Internet skills training and perceived competence. The final instrument, Web-Based Patient-Reported Outcomes Capture System-Needs, Acceptance and Readiness Assessment (WPROCS-NARA), was shown to be practicable, valid and reliable. Conclusions: The WPROCS-NARA is a useful tool in understanding the needs, acceptance and readiness among adult cancer patients for a web-based PROs capture system. We have undertaken a survey using this instrument to guide and support future development of a web-and/or short message service (SMS)-based application to facilitate symptom screening and evaluation of symptom management outcomes through remote symptom-reporting. The findings of this survey are reported elsewhere.
Journal of Hospital Management and Health Policy
Background: Telehealth applications may improve health outcomes by engaging patients as active participants, focusing clinic visits on important problems and intensifying symptom management in response to patient reports. Our group developed an internet-based computerized system for patient self-report of symptoms (iComPAsS), and our aim is to evaluate the usability of this mobile application for reporting cancer symptoms among patient and physician end-users. Methods: The literature was surveyed for validated symptom tools available in both English and Filipino. A focused-group discussion (two oncologists, two pain specialists and an international symptom researcher) was conducted to assess face validity and elect an instrument. Application interface and system design was developed collaboratively with information technology consultants over several iterations until beta testing revealed a satisfactory design. Twenty end-users (10 physicians, 10 patients) were invited to assess the app's functionality after a training workshop. App assessment was done using the Mobile Application Rating Scale (MARS). Results: The Edmonton Symptom Assessment System (ESAS) was elected due to its validity, ease of administration and prevalent use in local research and clinical settings. The iComPAsS was shown to be satisfactorily functional on beta testing. It allows patients to report symptom severity, indicate pain location on a body diagram, view prescriptions, and receive notifications from their physicians. On usability testing, engagement, functionality, aesthetics and information scores revealed high and moderate acceptability among physician and patient users, respectively. A clinical trial will be conducted to determine its impact and define maintenance and scale-up issues. Conclusions: The iComPAsS mobile application for patient self-reporting of cancer symptoms is useable and acceptable by both physician and patient end-users.
2010
Objective To examine the effects of a computerassisted, interactive tailored patient assessment (ITPA) tool in oncology practice on: documented patient care, symptom distress, and patients' need for symptom management support during treatment and rehabilitation. Design and methods For this repeated measures clinical trial at a university hospital in Norway, 145 patients starting treatment for leukemia or lymphoma were randomly assigned to either an intervention (n¼75) or control group (n¼70). Both groups used the ITPA for symptom assessments prior to inpatient and outpatient visits for up to one year. The assessment summary, which displayed patients' self-reported symptoms, problems, and distress in rank-order of the patient's need for support, was provided to physicians and nurses in the intervention group only but not in the control group. Results Significantly more symptoms were addressed in the intervention group patient charts versus those of the control group. Symptom distress in the intervention group decreased significantly over time in 11 (58%) of 19 symptom/problem categories versus 2 (10%) for the control group. Need for symptom management support over time also decreased significantly more for the intervention group than the control group in 13 (68%) symptom categories. Conclusion This is the first study to show that an ITPA used in an interdisciplinary oncology practice can significantly improve patient-centered care and patient outcomes, including reduced symptom distress and reduced need for symptom management support. < An additional appendix is published online only. To view this file please visit the journal online