Enhancing Patient-Provider Communication With the Electronic Self-Report Assessment for Cancer: A Randomized Trial

Harvard University, Cambridge, Massachusetts, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 03/2011; 29(8):1029-35. DOI: 10.1200/JCO.2010.30.3909
Source: PubMed


Although patient-reported cancer symptoms and quality-of-life issues (SQLIs) have been promoted as essential to a comprehensive assessment, efficient and efficacious methods have not been widely tested in clinical settings. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment-Cancer (ESRA-C) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits. Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians.
This randomized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center. Patient-reported SQLIs were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit (n = 327); in the control group, no summary was provided (n = 333). SQLIs were scored for level of severity or distress. One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI. We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians.
The likelihood of SQLIs being discussed differed by randomized group and depended on whether an SQLI was first reported as problematic (P = .032). Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful.
The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US randomized clinical trial.

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Available from: William B Lober, Oct 04, 2015
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    • "When used effectively the data may be used as an ice-breaker to open up conversations on challenging topics such as sexual functioning [24]. Clinicians may focus on areas where interventions may change the outcome rather than on problems, such as a decline in cognitive functioning or fatigue, for which there is inadequate evidence for how to avoid the problem or a lack of treatment interventions and may avoid problems they consider they are not personally able to help with [24] [80] [81]. However, within a multidisciplinary team setting it may be possible to collaborate with other members using each other's different areas of expertise to enable patients to receive support for all issues raised [82]. "
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    ABSTRACT: There is increasing interest in the use of patient-reported outcomes (PROs) in routine practice in cancer care to measure symptoms and health related quality of life (HRQOL). PROs are designed to capture the patient's perspective of their care and treatment, and complement the traditional clinical outcomes of survival and toxicity assessment. Integrating routine collection and feedback of PROs has been found to improve care for patients on both an individual level, through improved communication and management of symptoms, and at an organizational level, by enabling aggregation of data to compare performance. This article reviews the benefits and challenges of introducing patient-reported assessments into routine clinical practice. Methods for choosing a questionnaire; collection and presentation of results; timing and frequency of administration as well as clinician training methods to aid the ability of clinicians to integrate the use of PROs into their own practice are described. Electronic PRO capture and integration with electronic health records seems to provide the most effective method for seamless integration into existing patient care pathways. Case studies from our own practice illustrate the issues raised. Electronic methods enabling immediate collection, scoring and interpretation of the data, as well as real-time data capture, email alert systems and individualized, online self-management advice may enable severe symptoms to be managed in a more timely manner. Evaluation methods are described to establish the effectiveness of the PRO intervention. Engaging stakeholders throughout the process of initial consultation and development, during delivery and evaluation is key to success. Future work needs to focus on the effectiveness of PROs in longer-term follow-up of patients in routine care and the relationship between the PRO severity grading and clinician severity grading using the Common Terminology Criteria of Adverse Events (CTCAE).
    Gynecologic Oncology 11/2014; 136(3). DOI:10.1016/j.ygyno.2014.11.071 · 3.77 Impact Factor
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    • "European Journal of Oncology Nursing experience (Couriel et al., 2006; Syrjala et al., 2012). Systematic use of patient-reported outcomes (PROs) in clinical practice can strengthen care planning (Beavers and Lester, 2010), facilitate communication between patients and health care workers (Berry et al., 2011), and optimize symptom management (Velikova et al., 2010). The National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) is the internationally accepted system for grading transplant-related adverse effects in trials (Martin et al., 2002), and may also be used in clinical settings (Trotti et al., 2007). "
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    ABSTRACT: Purpose The aim of this sequential mixed methods study was to develop a PRO-CTCAE (Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events)-based measure of the symptom experience of late effects in German speaking long-term survivors of allogeneic stem cell transplantation (SCT), and to examine its content validity. Methods The US National Cancer Institute's PRO-CTAE item library was translated into German and linguistically validated. PRO-CTCAE symptoms prevalent in ≥50% of survivors (n = 15) and recognized in its importance by SCT experts (n = 9) were identified. Additional concepts relevant to the symptom experience and its consequences were elicited. Content validity of the PROVIVO (Patient-Reported Outcomes of long-term survivors after allogeneic SCT) instrument was assessed through an additional round of cognitive debriefing in 15 patients, and item and scale content validity indices by 9 experts. Results PROVIVO is comprised of a total of 49 items capturing the experience of physical, emotional and cognitive symptoms. To improve the instrument's utility for clinical decision-making, questions soliciting limitations in activities of daily living, frequent infections, and overall well-being were added. Cognitive debriefings demonstrated that items were well understood and relevant to the SCT survivor experience. Scale Content Validity Index (CVI) (0.94) and item CVI (median = 1; range 0.75–1) were very high. Conclusions Qualitative and quantitative data provide preliminary evidence supporting the content validity of PROVIVO and identify a PRO-CTCAE item bundle for use in SCT survivors. A study to evaluate the measurement properties of PROVIVO and to examine its capacity to improve survivorship care planning is underway.
    European Journal of Oncology Nursing 09/2014; 19(1). DOI:10.1016/j.ejon.2014.07.007 · 1.43 Impact Factor
    • "Accessibility has been previously assessed not only in patients — suffering from diabetes, general disease, multiple sclerosis, oncological process or psychiatric disorder, but also in physicians. The success rate ranges from 40% in the oldest papers to 90% in the latest ones.[232425262728] "
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    ABSTRACT: Background:Information technology can play a vital role in meeting patient needs and reinforcing the relationship among patients and their pain physicians. However, strong resistance remains on the medical side to this type of non-frontal care.Objectives:The primary objective of this study was to assess the effectiveness of an E-mail intervention on customers’ satisfaction. The secondary goals were to analyze the messages from patients to their clinician (not only the volume but also the content) and the impact on client, professional and health services outcomes.Study Design:A prospective, non-randomized evaluation of patients undergoing treatment for chronic pain from September 2011 to May 2012.Setting:A private, specialty referral center in Spain.Materials and Methods:Participants were users visiting the Pain Management Unit evaluated by one physician. The E-mail address of the facility was written in every medical report provided. Patient satisfaction at the end of the 8-month trial period was assessed and outcomes recorded.Results:Patients reported better communication with their therapist and greater satisfaction with overall care. 780 E-mails were read. Specialists received an average of 5 messages per day (standard deviation 0,3). None of them was unsuitable.Limitations:This is a prospective, single center evaluation performed by one doctor. There was no control group due to ethical considerations.Conclusions:Electronic communication is a cheap, easy and feasible way to address a wide range of concerns, thus enhancing patients’ satisfaction. More efforts are needed to implement routinely usage of this tool. If used appropriately, E-mail can facilitate physician-dependent interactions, promote access to care, save time and reduce costs. Concerns about billing, improper utilization, privacy and confidentiality might complicate its introduction and acceptance. Internet access remains a significant barrier to online patient-provider transference.
    07/2014; 8(3):364-7. DOI:10.4103/1658-354X.136434
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