Abstract
Background: Oncology practice can be enhanced by the integration of the assessment of patient-reported symptoms and concerns into the electronic health record (EHR) and clinical workflows. Methods: Adult oncology outpatients (n = 6825) received 38,422 invitations to complete assessments through the EHR patient portal. Patient-Reported Outcomes Measurement Information System computer adaptive tests were administered to assess fatigue, pain interference, physical function, depression, and anxiety. Checklists identified psychosocial, nutritional, and informational needs. In real time, assessment results were populated in the EHR, and clinicians were notified of elevated symptoms and needs. Results: In all, 3521 patients (51.6%) completed 8162 assessments; approximately 55% of the responding patients completed 2 or more within 32 months. Fatigue, pain, anxiety, and depression scores were comparable to those of the general population (approximately 5% of assessments triggered clinical alerts across those domains); mean scores indicated a lower level of physical function (with severe scores prompting alerts in nearly 5% of assessments). More than half of assessments triggered an alert based on patient endorsement of supportive care needs, with the majority of those being nutritional (41.82% of assessments). Patient endorsement of supportive care needs was associated with significantly higher anxiety, depression, fatigue, and pain interference scores and lower physical function scores. Patients who triggered clinical alerts tended to be younger and more recently diagnosed, to have greater comorbidities, and to be a racial/ethnic minority. Patients who triggered clinical alerts had more health care service encounters in the ensuing month. Conclusions: EHR integration facilitated the assessment and reporting of patient-reported symptoms and needs within routine oncology outpatient care.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 4059-4068 |
| Number of pages | 10 |
| Journal | cancer |
| Volume | 125 |
| Issue number | 22 |
| DOIs | |
| State | Published - Nov 15 2019 |
Funding
This study was supported by the Robert H. Lurie Comprehensive Cancer Center, the Coleman Foundation, and the Northwestern University Clinical and Translational Sciences Institute (grant UL1TR001422). David Cella reports funding from the National Institutes of Health (grant U54AR057951). Patients with cancer commonly experience symptoms and psychosocial concerns that are best evaluated through self-report and can otherwise go unrecognized by clinicians. Leading organizations have emphasized 1) the integration of patient-reported outcomes (PROs) within cancer care, 2) the utilization of health information technology to facilitate patient-reported data informing oncology practice, and 3) the importance of responding to the psychosocial needs of patients with cancer. To help meet Commission on Cancer emotional distress screening standards at the Robert H. Lurie Comprehensive Cancer Center (RHLCCC), we implemented an electronic patient-reported outcome (ePRO) screening assessment that is integrated into the electronic health record (EHR). Including PROs in oncology care can foster a focus on priority symptoms, and improved symptom monitoring promotes favorable patient outcomes, including increased survival and better health-related quality of life as well as fewer adverse events. However, the majority of existing ePROs in clinical interventions use measures that lack clear clinical action thresholds, are too lengthy for repeat administration in busy oncology settings, or are not integrated into EHRs or clinical workflows. Building upon a pilot in gynecological oncology, we implemented our ePRO screening assessment within care practices across RHLCCC medical oncology clinics. Our primary aim was to implement an ePRO screener, which uses Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) that allow for simultaneously brief and precise measurement as well as easily interpretable results, into standard clinical care. The EHR integration provides a means of overcoming common patient-clinician communication barriers by delivering and triaging screening results so that clinicians can address significant symptoms and concerns in a timely manner. Here we present the primary metrics from this systemwide implementation. This study was supported by the Robert H. Lurie Comprehensive Cancer Center, the Coleman Foundation, and the Northwestern University Clinical and Translational Sciences Institute (grant UL1TR001422). David Cella reports funding from the National Institutes of Health (grant U54AR057951).
Keywords
- ehealth
- electronic health records
- outcomes measurement
- patient-reported outcomes
- psychosocial care
- symptom management
ASJC Scopus subject areas
- Oncology
- Cancer Research
