Use of Technology to Support Patient Reported Outcomes in Palliative Oncology

About

Patients with cancer may experience high levels of symptoms and distress that negatively impact their care and quality of life. As such, clinicians regularly discuss and monitor patients’ symptoms and distress at each visit in order to provide treatment options and resources, using a qualitative approach. Efforts to quantify and streamline this process have involved validated questionnaires and utilization of technology (patient portals) to capture patient reported outcomes (“ePRO”), however some clinicians have concerns regarding the uptake of this approach.

Methods

In 2020, our palliative oncology (PO) team transitioned from a qualitative to quantitative approach, implementing four research-validated tools to assess mental distress (PHQ-9, GAD-7), symptoms (ESAS), and spirituality (FICA). In 2021, the PO team initiated an electronic patient reported outcome (ePRO) workflow in which patients were prompted to complete all tools via the EHR patient portal before each visit, defaulting to PD workflow when not utilized. To understand the utilization of ePRO at our PO clinic and providers’ perceptions of this approach, we gathered data from the electronic health record that showed when patients completed the questionnaires through the patient portal and conducted interviews with seven providers in the PO clinic. This project was reviewed and approved as a quality improvement project by Parkview Institutional Review Board.

Results

We found that the ePRO workflow was utilized in about one-third of visits and included all four questionnaires for the majority of those visits. When the ePRO workflow was not used, providers often employed the PD workflow at visits and completed only the ESAS questionnaire. The providers expressed that using the questionnaires provided greater standardization and improved the ability to track data. They also expressed that the ePRO workflow helped improve visit preparation and overall efficiency. However, the system prompted patients to fill out all four questionnaires, which wasn’t always useful or relevant and created more work for patients.

Conclusions

Although the ePRO workflow has advantages, in order to fully realize the potential benefits of the technology, further changes need to be addressed. This project assessed the ePRO workflow from the providers’ perspective. To better understand the full range of challenges and benefits to the ePRO workflow, future work should examine the use of ePRO from the patients’ perspective.

Partners

• Parkview Mirro Center for Research and Innovation
• Joseph McCollum, MD, Parkview Packnett Family Cancer Institute

Funding

Publications and presentations

• McCollom, J. W., Coupe, A., Cornet, V., Tan, YR., Lin, HY., Flanagan, M., & Daley, C. (2023). PRO-SHOUT: Patient reported outcome supportive health in oncology utilizing technology. JCO Oncology Practice,19(supp 11, abstr 578. [link]

Press

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