Impact of assessment frequency of patient-reported outcomes: an observational study using an eHealth platform in cancer patients

Innominato, Pasquale F.; Komarzynski, Sandra; Dallmann, Robert; Wreglesworth, Nicholas I; Bouchahda, Mohamed; Karaboué, Abdoulaye; Ulusakarya, Ayhan; Spiegel, David; Lévi, Françis

doi:10.1007/s00520-021-06262-1

Cited by 6 publications

(9 citation statements)

References 18 publications

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“…The importance of self-reporting frequency is also supported less directly by 3% (2/61) of studies that evaluated the effect of the cadence of ePROM self-reporting on symptom monitoring [ 73 , 74 ]. Daly et al [ 74 ] evaluated daily ePROM reporting in patients initiating anticancer treatment and observed that 45.1% of red alerts generated by completing ePROM reports were not preceded by yellow alerts in the previous 7 days.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, less-frequent reporting might not only miss red alerts because they are not preceded by yellow alerts but also miss the opportunity to prevent adverse events. Another study by Innominato et al [ 73 ], with a small sample size, used exploratory analysis of longitudinal data and showed that 55.6% of severe symptoms might be missed when symptoms were sampled only weekly. Presuming that the immediacy of self-reporting when symptoms occur is important to accurately report symptoms without being affected by recall issues, it can be inferred from the abovementioned studies that frequent reporting may offer a better opportunity to identify symptoms and potentially prevent downstream adverse events.…”

Section: Resultsmentioning

confidence: 99%

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Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes

Govindaraj,

Agar,

Currow

et al. 2023

J Med Internet Res

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Background The routine measurement of patient-reported outcomes in cancer clinical care using electronic patient-reported outcome measures (ePROMs) is gaining momentum worldwide. However, a deep understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed. Objective This study aims to identify the implicit mechanisms that underpin the effectiveness of ePROM interventions and develop program theories about how and when ePROM interventions improve health outcomes. Methods A realist synthesis of the literature about ePROM interventions in cancer clinical care was performed. A conceptual framework of ePROM interventions was constructed to define the scope of the review and frame the initial program theories. Literature searches of Ovid MEDLINE, Ovid Embase, Scopus, and CINAHL, supplemented by citation tracking, were performed to identify relevant literature to develop, refine, and test program theories. Quality appraisal of relevant studies was performed using the Mixed Methods Appraisal Tool. Results Overall, 61 studies were included in the realist synthesis: 15 (25%) mixed methods studies, 9 (15%) qualitative studies, 13 (21%) descriptive studies, 21 (34%) randomized controlled trials, and 3 (5%) quasi-experimental studies. In total, 3 initial program theories were developed regarding the salient components of ePROM interventions—remote self-reporting, real-time feedback to clinicians, and clinician-patient telecommunication. The refined theories posit that remote self-reporting enables patients to recognize and report symptoms accurately and empowers them to communicate these to clinicians, real-time feedback prompts clinicians to manage symptoms proactively, and clinician-patient telephone interactions and e-interactions between clinic encounters improve symptom management by reshaping how clinicians and patients communicate. However, the intervention may not achieve the intended benefit if ePROMs become a reminder to patients of their illness and are not meaningful to them and when real-time feedback to clinicians lacks relevance and increases the workload. Conclusions The key to improving health outcomes through ePROM interventions is enabling better symptom reporting and communication through remote symptom self-reporting, promoting proactive management of symptoms through real-time clinician feedback, and facilitating clinician-patient interactions. Patient engagement with self-reporting and clinician engagement in responding to feedback are vital and may reinforce each other in improving outcomes. Effective ePROM interventions might fundamentally alter how clinicians and patients interact between clinic encounters.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes

Govindaraj,

Agar,

Currow

et al. 2023

J Med Internet Res

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“… 23 , 24 Finally, the optimal frequency, in terms of insight generated and compliance over time, is yet to be defined. 25 …”

Section: Electronic Patient-reported Outcomes (Epros)mentioning

confidence: 99%

“…The choice and integration of appropriate wearables and PRO measures, and the definition of their frequency of sampling will require abiding by clinical needs, feasibility, acceptability, usability and attrition, patients' preferences, and technical constraints. 25,31,[81][82][83] The analytical algorithms that provide the most relevant insight to the clinical team and the patient need to be developed, tested and improved, and ideally coupled with predictive and interpolative algorithms to maximize the potential benefit to the patients. [84][85][86] The caring team at large, both hospital-and community-based, should integrate not only the nursing and physician actors, but also the allied healthcare staff who could promote effective and safe behavioral interventions on patient's physical and psychological domains.…”

Section: Circadian Phenotypingmentioning

confidence: 99%

“…23,24 Finally, the optimal frequency, in terms of insight generated and compliance over time, is yet to be defined. 25 Wearable technology is another facet of mHealth where recent improvement potentially creates a path for significant benefits to patients. Such devices, often worn on the wrist like a watch but sometimes worn elsewhere, for example as a chest strap or a ring, are readily available for members of the public to purchase.…”

Section: Electronic Patient-reported Outcomes (Epros)mentioning

confidence: 99%

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Holistic Needs Assessment of Cancer Survivors—Supporting the Process Through Digital Monitoring of Circadian Physiology

Gibb

Winter

Komarzynski³

et al. 2022

Integr Cancer Ther

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The year 2022 could represent a significant juncture in the incorporation of mHealth solutions in routine cancer care. With the recent global COVID-19 pandemic leading a surge in both observation- and intervention-based studies predominantly aimed at remote monitoring there has been huge intellectual investment in developing platforms able to provide real time analytics that are readily usable. Another fallout from the pandemic has seen record waiting times and delayed access to cancer therapies leading to exhausting pressures on global healthcare providers. It seems an opportune time to utilize this boom in platforms to offer more efficient “at home” clinical assessments and less “in department” time for patients. Here, we will focus specifically on the role of digital tools around cancer survivorship, a relevant aspect of the cancer journey, particularly benefiting from integrative approaches. Within that context a further concept will be introduced and that is of the likely upsurge in circadian-based interpretation of continuous monitoring and the engendered therapeutic modifications. Chronobiology across the 24-hour span has long been understood to control key bodily aspects and circadian dysregulation plays a significant role in the risk of cancer and also the response to therapy and therefore progressive outcome. The rapid improvement in minimally invasive monitoring devices is, in the opinion of the authors, likely to advance introducing chronobiological amendments to routine clinical practices with positive impact on cancer survivors.

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Essential Components of an Electronic Patient-Reported Symptom Monitoring and Management System

Mooney,

Gullatte,

Iacob

et al. 2024

JAMA Netw Open

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ImportanceMulticomponent electronic patient-reported outcome cancer symptom management systems reduce symptom burden. Whether all components contribute to symptom reduction is unknown.ObjectiveTo deconstruct intervention components of the Symptom Care at Home (SCH) system, a digital symptom monitoring and management intervention that has demonstrated efficacy, to determine which component or combination of components results in the lowest symptom burden.Design, Setting, and ParticipantsThis randomized clinical trial included participants who were older than 18 years, had been diagnosed with cancer, had a life expectancy of 3 months or greater, were beginning a chemotherapy course planned for at least 3 cycles, spoke English, and had daily access and ability to use a telephone. Eligible participants were identified from the Huntsman Cancer Institute, University of Utah (Salt Lake City), and from Emory University Winship Cancer Institute, including Grady Memorial Hospital (Atlanta, Georgia), from August 7, 2017, to January 17, 2020. Patients receiving concurrent radiation therapy were excluded. Dates of analysis were from February 1, 2020, to December 22, 2023.InterventionsParticipants reported symptoms daily during a course of chemotherapy and received automated self-management coaching with an activity tracker without (group 1) and with (group 2) visualization, nurse practitioner (NP) follow-up for moderate-to-severe symptoms without (group 3) and with (group 4) decision support, or the complete SCH intervention (group 5).Main Outcomes and MeasuresThe primary outcome, symptom burden, was assessed as the summed severity of 11 chemotherapy-related symptoms rated on a scale of 1 to 10 (with higher scores indicating greater severity), if present.ResultsThe 757 participants (mean [SD] age, 59.2 [12.9] years) from 2 cancer centers were primarily female (61.2%). The most common cancer diagnoses were breast (132 [17.4%]), lung (107 [14.1%]), and colorectal (99 [13.1%]) cancers; 369 patients (48.7%) had metastatic disease. The complete SCH intervention including automated self-management coaching and NP follow-up with decision support (group 5) was superior in reducing symptom burden to either of the self-management coaching groups, as shown by the mean group differences in area under the curve (group 1, 1.86 [95% CI, 1.30-2.41] and group 2, 2.38 [95% CI, 1.84-2.92]; both P &lt; .001), and to either of the NP follow-up groups (group 3, 0.57 [95% CI, 0.03-1.11]; P =.04; and group 4, 0.66 [95% CI, 0.14-1.19]; P = .014). Additionally, NP follow-up was superior to self-management coaching (group 1 vs group 3, 1.29 [95% CI, 0.72-1.86]; group 1 vs group 4, 1.20 [95% 12 CI, 0.64-1.76]; group 2 vs group 3, 1.81 [95% CI, 1.25-2.37]; and group 2 vs group 4, 1.72 [95% CI, 1.17-2.26]; all P &lt; .001), but there was no difference between the 2 self-management coaching groups (−0.52 [95% CI, −1.09 to 0.05]; P = .07) or between the 2 NP groups (−0.10 [95% CI, −0.65 to 0.46]; P = .74).Conclusions and RelevanceIn this randomized clinical trial of adult participants undergoing chemotherapy treatment for cancer, the complete intervention, rather than any individual component of the SCH system, achieved the greatest symptom burden reduction. These findings suggest that a multicomponent digital approach to cancer symptom management may offer optimal symptom burden reduction.Trial RegistrationClinicalTrials.gov Identifier: NCT02779725

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Impact of assessment frequency of patient-reported outcomes: an observational study using an eHealth platform in cancer patients

Cited by 6 publications

References 18 publications

Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes

Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes

Holistic Needs Assessment of Cancer Survivors—Supporting the Process Through Digital Monitoring of Circadian Physiology

Essential Components of an Electronic Patient-Reported Symptom Monitoring and Management System

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