Collection of electronic patient-reported symptoms in patients with advanced cancer using Epic MyChart surveys

Background Use of electronic patient-reported outcomes (ePROs) in routine cancer care can help identify troublesome symptoms and facilitate discussions between patients and clinicians and has been shown to improve patient satisfaction, quality of life, and survival. Methods Eighty patients with stage IV non-hematologic malignancies on chemotherapy participated. Patient-Reported Symptom Monitoring (PRSM) surveys were sent every 14 days via the Epic MyChart system over a 12-week period. Surveys were offered via phone or paper if patients failed to complete the automated MyChart survey by day 16. Severe symptoms or concerning symptom trends were automatically highlighted in reports for clinic staff. Patients reporting severe symptoms were routed to oncology nursing triage for standard symptom care management. Results Two hundred seventy-one surveys were sent during the 12-week study period. One hundred eighty-three surveys (66%) were completed, with 68% completed electronically via MyChart, 25% by paper, and 7% by phone call from a research coordinator. At least one severe symptom was reported on 36% of all surveys. However, most severe symptoms did not result in urgent triage follow-up because they were already being addressed and/or patients felt they were manageable. Patients and clinicians generally said the ePRO was efficient and helpful for addressing distressing symptoms and would use it in routine oncology care. Conclusion ePROs can be integrated into the electronic health record using the Epic MyChart system. Patients and clinicians gave positive feedback on the system. Monitoring symptoms in real time may soon become part of standard oncology practice and requires seamless methods for collection.

[1]  M. Schlup Cancer survivorship. , 1991, Oncology nursing forum.

[2]  Susan Halabi,et al.  Pain predicts overall survival in men with metastatic castration-refractory prostate cancer. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[3]  Murielle Mauer,et al.  Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials. , 2009, The Lancet. Oncology.

[4]  Alexia Iasonos,et al.  Adverse symptom event reporting by patients vs clinicians: relationships with clinical outcomes. , 2009, Journal of the National Cancer Institute.

[5]  S. Kaasa,et al.  Health care providers underestimate symptom intensities of cancer patients: A multicenter European study , 2010, Health and quality of life outcomes.

[6]  J. V. Von Roenn,et al.  The integration of palliative care and oncology: the evidence. , 2011, Oncology.

[7]  Amy P Abernethy,et al.  Supporting clinical practice decisions with real-time patient-reported outcomes. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[8]  Bryant T Karras,et al.  Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[9]  Paul E. Johnson,et al.  Impact of Electronic Health Record Clinical Decision Support on Diabetes Care: A Randomized Trial , 2011, The Annals of Family Medicine.

[10]  Qiuling Shi,et al.  Automated symptom alerts reduce postoperative symptom severity after cancer surgery: a randomized controlled clinical trial. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  Amy P Abernethy,et al.  Recommendations for incorporating patient-reported outcomes into clinical comparative effectiveness research in adult oncology. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  Paul E. Johnson,et al.  Cost-effectiveness of an electronic medical record based clinical decision support system. , 2012, Health services research.

[13]  Ethan Basch,et al.  Electronic patient‐reported outcome systems in oncology clinical practice , 2012, CA: a cancer journal for clinicians.

[14]  Hsin-Chieh Yeh,et al.  Effect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial. , 2013, JAMA internal medicine.

[15]  Roma Maguire,et al.  What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  E. Basch The rationale for collecting patient-reported symptoms during routine chemotherapy. , 2014, American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting.

[17]  Amy P Abernethy,et al.  Review of electronic patient-reported outcomes systems used in cancer clinical care. , 2014, Journal of oncology practice.

[18]  David Cella,et al.  Bringing PROMIS to practice: Brief and precise symptom screening in ambulatory cancer care , 2015, Cancer.

[19]  Ronald C. Chen,et al.  Integrating Patient-Reported Outcome Measures into Routine Cancer Care: Cancer Patients’ and Clinicians’ Perceptions of Acceptability and Value , 2015, EGEMS.

[20]  Deborah Schrag,et al.  Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  M. Kris,et al.  Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment , 2017, JAMA.

[22]  E. Basch,et al.  Implementation of Patient-Reported Outcomes in Routine Medical Care. , 2018, American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting.

[23]  C. Shapiro Cancer Survivorship , 2018, The New England journal of medicine.

[24]  J. Webber Center , 2011 .