Enhancing Patient-Provider Communication With the Electronic Self-Report Assessment for Cancer: A Randomized Trial

Abstract

Purpose Although patient-reported cancer symptoms and quality-of-life issues (SQLIs) have been promoted as essential to a comprehensive assessment, efficient and efficacious methods have not been widely tested in clinical settings. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment–Cancer (ESRA-C) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits. Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians. Patients and Methods This randomized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center. Patient-reported SQLIs were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit (n = 327); in the control group, no summary was provided (n = 333). SQLIs were scored for level of severity or distress. One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI. We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians. Results The likelihood of SQLIs being discussed differed by randomized group and depended on whether an SQLI was first reported as problematic (P = .032). Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful. Conclusion The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US randomized clinical trial.

Patient-reported outcomes in clinical practice

“…9,[18][19][20][21] Multiple studies confirm that clinical integration of PROs does not increase the duration of clinic visits, that provider and patient satisfaction is high, and that all parties feel their use improves communication. 12,19,20,[22][23][24] The successful use of PROs in outpatient orthopedic surgery clinics highlights the feasibility of use in busy outpatient settings and the benefit in clinical decision making. Orthopedic clinics have integrated PRO collection into clinical practice to monitor patient pain, mobility, and function.…”

“…Salient issues related to PROs, such as psychosocial issues and symptoms were more likely to be discussed for visits where the clinical team received the summary. 12,19,20 Some patients experienced better functioning as a result of the intervention. 12 Similar work in children with advanced cancer and pediatric cancer survivors has demonstrated that providing PRO data to clinicians increased discussion of psychosocial issues and improved the patient's health status in certain subpopulations (see Example 1).…”

Nurses’ experiences of using an interactive tailored patient assessment tool one year past implementation

“…In the study most of the nurses and allied health professions found the ESAS to enhance patient care, help patients to articulate their symptom issues, and facilitate follow-up with patients with past symptom issues. Similarly, in a study of an electronic version of ESAS, clinicians reported it as useful [35]. Some of the nurses noted, however, that even though they knew the advantages and possibilities that Choice could bring, they still did not have "good experiences" using it.…”

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

“…In terms of the theories under test, Berry et al 354 suggest that, in these instances, the Electronic Self-Report Assessment of Cancer report may have acted as an 'ice-breaker', giving patients or clinicians 'permission' to discuss sensitive issues. However, relative to the number of times it was reported at threshold, the number of times sexual function was actually discussed in the consultation, even in the intervention group, was relatively very small.…”