Utilizing Patient Reported Outcome Measures (PROMs) in ambulatory oncology in Alberta: Digital reporting at the micro, meso and macro level

Abstract

Cancer patients experience numerous distressing symptoms and concerns across the course of their illness, which negatively influence their quality of life. Regardless of cancer type, unmanaged symptoms can lead to adverse downstream consequences. Patient Reported Outcome Measures (PROMs) can be used to inform patient care and lead to targeted symptom management but simply gathering this information does not improve outcomes for the patient. Patient generated information must be easy for the clinicians to access and interpret if it is to be used to inform care delivery in ambulatory oncology facilities. This pragmatic work responded to this need. One Canadian provincial ambulatory oncology jurisdiction implemented digital tracking of PROMs over time in the provincial Electronic Medical Record (EMR) to support full integration of PROMs into standard care workflows and processes. Due to an inability within the EMR for direct patient entry, a hybrid data-entry was designed where the patient completes a paper-based PROM in the waiting room, and after clinical review, a clinician documents this along with their clinical assessment in the EMR. Several digital dashboards were developed which report PROMs data at the micro (individual), meso (clinic) and macro (program) levels. Using PROMs routinely in these provincial practice settings has numerous benefits including enhanced patient-clinician communication, assisting with problem detection, management of symptoms, and improving outcomes for patients. There are over 60,000 unique patients represented in our PROMs database, and over 300,000 unique screening events captured. The PROMs data is now used at all levels of the provincial cancer jurisdiction to provide targeted person centred care (micro), to staff appropriately at a clinic or program level (meso), and for capacity planning for provincial programs (macro). A new provincial EMR is currently being implemented which has an associated patient portal. Based on the success of this work, integration of direct entry of PROMs by the patient prior to the appointment and an associated workflow for symptom management is underway in this jurisdiction.

Feasibility and Implementation of an Oncology Rehabilitation Triage Clinic: Assessing Rehabilitation, Exercise Need, and Triage Pathways within the Alberta Cancer Exercise–Neuro-Oncology Study

“…Screening for distress programs, including the revised Edmonton System Assessment System (ESAS) and the Canadian Problem Checklist, have been implemented in most Canadian Cancer Centers [19,20]. The purpose of these pre-existing tools is to help healthcare providers identify, assess, and manage distressing symptoms and concerns experienced by patients, and enhance the person centeredness of care delivered by providing appropriate and tailored referrals [31]. The purpose is also to have automated thresholds that trigger referrals to appropriate resources, avoiding missed opportunities for patient care.…”

“…The proposed CREST tool screens for physical inactivity and allows participants to report pre-identified functional concerns and difficulties with activities of daily living using a 1-10 Likert scale. Similar to the ESAS, which has now been widely implemented at most cancer appointments [31], CREST may improve the efficient and effective identification of those with functional impairment. To the best of our knowledge, no other functional screening tool designed for implementation in a clinical setting has been successfully integrated into cancer care.…”

“…Eligible neuro-oncology patients were approached by the study team after obtaining consent to contact. If interested, a clinical team member (nurse or oncologist) sent a referral to the Rehabilitation Oncology department via the electronic medical system [31]. Patients were also able to self-refer to the study via a study brochure or poster located within relevant clinic areas.…”

Facilitators and barriers to implementing electronic patient-reported outcome and experience measures in a health care setting: a systematic review

“…ePROMs/ePREMs allow for patient monitoring across all levels of the healthcare landscape, from individual clinician-patient ‘point-of-care’ interactions (micro level) to population surveillance and informing policy (macro level) [ 5 ]. Integration of patient-reported data with clinical and service delivery data can enable a holistic view of patients’ overall care journey, while concurrently enabling the monitoring of service performance to identify gaps and opportunities for enhancement, creating a positive feedback loop for improvement [ 5 , 6 ]. Despite the apparent opportunities provided by digital technology, in practice the implementation and uptake of ePROMs, and especially ePREMs, remains sparse and inconsistent.…”

Symptom severity and complexity trends in patients undergoing radiation therapy

“…The Canadian Problems Checklist (CPC) is an evidence-based, 54-item self-report checklist designed to identify common concerns that patients with cancer experience. It is used in conjunction with the ESAS-r and tracks emotional, informational, social, practical, spiritual and physical concerns [14].…”