The electronic self report assessment and intervention for cancer: promoting patient verbal reporting of symptom and quality of life issues in a randomized controlled trial

Abstract

BackgroundThe 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).MethodsPatients 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 measures were defined for each patient: the percent SxQOL reported that included a coached statement, and an index of verbalized coached statements per SxQOL. The Wilcoxon rank test was used to compare measures between groups. Clinician responses to problematic SxQOL were compared. A mediation analysis was conducted, exploring the effect of verbal reports on SD outcomes.Results517 (256 intervention) clinic visits were audio-recorded. General discussion of problematic SxQOL was similar in both groups. Control group patients reported a median 75% of problematic SxQOL using any specific coached statement compared to a median 85% in the intervention group (p = .0009). The median report index of coached statements was 0.25 for the control group and 0.31 for the intervention group (p = 0.008). Fatigue, pain and physical function issues were reported significantly more often in the intervention group (all p < .05). Clinicians' verbalized responses did not differ between groups. Patients' verbal reports did not mediate final SD outcomes (p = .41).ConclusionsAdding electronically-delivered, self-care instructions and communication coaching to ESRA-C promoted specific patient descriptions of problematic SxQOL issues compared with ESRA-C assessment alone. However, clinician verbal responses were no different and subsequent symptom distress group differences were not mediated by the patients' reports.Trial registrationNCT00852852; 26 Feb 2009

Can patient-reported measurements of pain be used to improve cancer pain management? A systematic review and meta-analysis

“…Full details of the results of these outcome measures are included as an online supplementary table in appendix 2. Six studies (detailed in 10 reports) considered the effect of the PROMs on the clinical consultation 20 22 29–32 37 42–43 45. Interventions were associated with more symptoms being reported and/or more discussions specifically about pain.…”

Symptom-related emergency department visits and hospital admissions during ambulatory cancer treatment

“…Randomized trial outcomes resulted in significantly lower symptom distress over the course of treatment and significantly more frequent detailed patient communication of sx-QoL. 12,13 …”

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

“…293 PROMs completion is often embedded in broader self-management support interventions, and a number of studies have examined the feasibility and acceptability of web-based PROMs completion 313,314 and its impact on patient outcomes. [315][316][317][318] The process of self-monitoring and its role in supporting self-management for people with long-term conditions has been considered in a number of existing systematic reviews. 319,320 We have not focused on exploring whether or not and how patients use PROMs to self-manage long-term conditions.…”