Bringing PROMIS to practice: Brief and precise symptom screening in ambulatory cancer care

Abstract

Background Supportive oncology practice can be enhanced by integrating brief and validated electronic patient-reported outcome (ePRO) assessment into the electronic health record (EHR) and clinical workflow. Methods 636 women receiving gynecologic oncology outpatient care received instructions to complete clinical assessments through Epic MyChart, the EHR patient communication portal. PROMIS computer adaptive tests (CATs) were administered to assess fatigue, pain interference, physical function, depression, and anxiety. Checklists identified psychosocial concerns, informational and nutritional needs, and risk factors for inadequate nutrition. Assessment results, including PROMIS T-scores with documented severity thresholds, were immediately populated in the EHR. Clinicians were notified of clinically elevated symptoms through EHR messages. EHR integration was designed to provide automated triage to social work providers for psychosocial concerns, health educators for information, and dietitians for nutrition-related concerns. Results Of 4,042 MyChart messages sent, 3,203 (79%) were reviewed by patients. The assessment was started by 1,493 (37%) patients, and once started 93% completed (1,386 patients). Using first assessments only, 49.8% of patients who reviewed the MyChart message completed the assessment. Mean PROMIS CAT T-scores indicated a lower level of physical function and elevated anxiety compared to the general population. Fatigue, pain, and depression scores were comparable to the general population. Impaired physical functioning was the most common basis for clinical alerts, occurring in 4% of patients. Conclusions We used PROMIS CATs to measure common cancer symptoms in routine oncology outpatient care. Immediate EHR integration facilitated the use of symptom reporting as the basis for referral to psychosocial and supportive care.

Linking Physical and Mental Health Summary Scores from the Veterans RAND 12-Item Health Survey (VR-12) to the PROMIS® Global Health Scale

“…Likewise, individual clinicians or departments may wish to integrate PROMIS Global Health into their practice, given its brevity and simplicity. 4,31 Our results allow users to leverage the accumulated evidence in support of a Blegacy^instrument (such as the VR-12) to provide benchmark data and reference points, 10 though further validation of such points would be required.…”

Establishing a Common Metric for Physical Function: Linking the HAQ-DI and SF-36 PF Subscale to PROMIS® Physical Function

“…Given the advantages of PROMIS instruments, 33 clinicians in medical centers who are already administering the HAQ or SF-36 PF may choose to switch to PROMIS PF. By using Tables 2, 3 and 4, they can compare historical patient data to newly obtained scores on PROMIS.…”

“…By using Tables 2, 3 and 4, they can compare historical patient data to newly obtained scores on PROMIS. Clinicians already using PROMIS may now connect their patient scores to recommended norms and clinical cutoffs established for the HAQ or SF-36 [33][34][35] and can provisionally apply these linked PROMIS cut-offs to inform treatment decisions.…”

Feasibility and diagnostic accuracy of the Patient‐Reported Outcomes Measurement Information System (PROMIS) item banks for routine surveillance of sleep and fatigue problems in ambulatory cancer care

“…To date, we were only able to identify three studies that have examined the feasibility of the application of PROMIS ® for use in routine oncology clinical care [37][38][39] . These studies did not assess the diagnostic accuracy of PROMIS ® CAT in comparison to legacy measures using a Receiver Operator Characteristic (ROC) methodology.…”